Episode 186: Chris sits down with Dr Jeffrey Hunger to discuss the erroneous assumptions around weight and health, social identity threat and how it's connected to weight stigma, and healthism.
Dr. Hunger is an assistant professor of psychology at Miami University in Oxford, Ohio, where he is the director of the Stigma and Health Lab.
He completed his PhD in social psychology at UC Santa Barbara, followed by postdoctoral training in health psychology at UCLA. His current research focuses primarily on the mental and physical health effects of weight stigma.
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Chris Sandel: Welcome to Episode 186 of Real Health Radio. You can find the links talked about as part of this episode at the show notes, which is www.seven-health.com/186.
Seven Health is currently taking on new clients. There are a handful of reasons that clients commonly come and see us. Hypothalamic amenorrhea, the fancy name for not getting your period, is one of them. This is often the result of undereating and over-exercising for what your body needs, irrespective of your actual weight. It’s almost always coupled with body dissatisfaction and a fear of gaining weight.
Disordered eating and eating disorders would be another, and we work with clients along the disordered eating and eating disorder spectrum. Some clients wouldn’t think to use the term disordered eating to describe themselves, but they see that they’re overly restrictive with their eating, with fears around certain foods, whether that be bread or fat or processed food or carbs. They feel compelled to exercise excessively, and/or they find themselves binging and feeling out of control around food.
Clients who want to move on from dieting, clients who’ve had years or decades of dieting and realizing that it’s just not working, but they’re struggling to figure out how to do food without dieting. So what should they eat? How do they listen to their body? What will become of their weight? They’re confused and overwhelmed. They just don’t know what to do.
And then body dissatisfaction and negative body image would be the final one. Many of our clients experience feelings of body shame and hatred, and they find themselves fixated on weight and determined to be a particular size and frustrated by what they see in the mirror. They may even avoid social events or opt out of photographs or put off appointments as a result of negative body thoughts.
In all these areas, we’re able to help and do so through a mix of understanding physiology and psychology, so understanding how to support the physical body and how it works, but also being compassionate and uncovering the whys behind clients’ behavior and figuring out how to change this.
If any of these are areas you want help with, then please get in contact. You can head over to www.seven-health.com/help, and there you can read about how we work with clients and apply for a free initial chat. The address, again, is www.seven-health.com/help, and I’ll also include that in the show notes.
Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. There’s three things I want to mention before getting started with today’s show. The first is that we now have a Resources page on the website. This is actually something I’ve been wanting to create for a long time, but it just never materialized until now. This is going to be a constant work in progress. As we continue to find more resources, we will continue to add to it. As we read more books and find more books that we like, we’ll continue to add to it.
This is going to be a place that you can find books or blogs to help you on your journey, so I recommend checking it out. You can go to www.seven-health.com/resources, or if you go to the menu navigation in the top left-hand corner, Resources will be one of the options there.
The second thing is we are going to start doing giveaways each week on the show. Real Health Radio has been running for 4-½ years, and over this time we’ve had some ratings and reviews on iTunes, but not that many in the whole scheme of things. This is largely because I’ve never actually asked for it – or I think on two or three occasions out of those last 4-½ years have I actually asked for it. On many podcasts I listen to, with every episode there is a request for a rating and a review.
I’ve always been fairly against this. This podcast is pretty stripped back as much as possible. I try to just get on with the show. I hate listening to podcasts and having to start a podcast, skipping through 5 or 10 or 15 minutes of adverts and the host talking about their life. I mean, there are a few exceptions to this, but the majority of the time I find it incredibly annoying.
But I’ve also been made painfully aware of just how important ratings and reviews are and that by missing out on them, we’re missing out on lots of people discovering the podcast. For me, that really sucks. So I wanted to try and find a compromise with this, a way to increase ratings and reviews but to take up as little time as possible and to give people a genuine incentive to do so on top of the fact that they really like the show.
What we’re going to do is a giveaway each show. When you leave a rating and review, please email it over to info@seven-health.com. Each week with every show, we will pick one person who has left a review, and we will send them a free book. They get to pick anything from the resources list, and we will send it to them.
That is what is going to be going on moving forward, and I will promise to keep it as quick as possible so we can then get on with the show. But it’s a way that I can say thank you for leaving a rating and review, to give people a chance to get books that they might not otherwise buy for themselves. But yeah, that’s what’s going to be going on.
The final thing is at the end of each episode, I’m going to start to give out some recommendations of things that I’ve read or watched or listened to that I think people may be interested in. This is something I do during my end-of-year roundup, but there’s only so much you can cover in one show.
A lot of this is actually going to be completely unrelated to the topics covered on this podcast. It’s interesting when I’m working with clients – I actually end up making lots of recommendations of non-health and non-recovery type stuff that they can be checking out. Clients are so entrenched in that stuff, and for good reason – they find it very valuable and supportive. But they’re often wanting to just read or watch something totally unrelated, whether it be for pleasure, for laughter, to widen their understanding of the world.
That’s actually what I spend so much of my own time consuming. It’s funny; I was having a conversation with my dad when we were home at Christmas. My dad is a lawyer and he deals mostly in contract law, so a lot of wills and dealing with estates. It all sounds very tedious to me, but he enjoys it and he’s very thorough and has the right kind of mind and temperament for that sort of work. But because he spends all his day reading contracts and very dense material, when he’s not at work, he often reads the complete opposite. He loves crime thrillers and gets through them in record time. After a day of heavy reading, he wants something different.
In some ways, I’m the same. I spend so much of my day living and breathing everything to do with health and nutrition and eating disorders and recovery that when it’s time for me to put on a podcast or watch something or read a book, I typically want something that is unrelated, or relatively unrelated, that I then try and shoehorn into how it becomes relevant to what I do.
All this is to say from now on, in the outro, I will be giving recommendations. If you don’t care for that stuff, you can simply stop listening. At least that way it’s at the end and you don’t have to skip through anything or sit through anything.
That is it for the housekeeping. Let’s get on with the focus of the actual show. Today is a guest interview, and my guest is Dr. Jeffrey Hunger. Dr. Hunger is an assistant professor of psychology at Miami University in Oxford, Ohio, where he is the director of the Stigma and Health Lab. He completed his PhD in social psychology at UC Santa Barbara, followed by postdoctoral training in health psychology at UCLA. His current research focus is primarily on mental and physical health effects of weight stigma.
I first became aware of Jeff probably a couple years ago, I think when doing my own research on weight stigma and finding one of his papers, or it might’ve been hearing him on someone’s podcast and then I went to find papers after that. But once I found his work, I really went through everything I could find. He just presents such compelling data of why weight stigma is a problem and what these problems are and how they occur.
I actually did a solo episode on weight stigma. You can check it out; it’s Episode 140. The plan when I did that episode was actually to do a Part 2 and a Part 3 and go through different papers as part of each of those different episodes, which up until this point hasn’t materialized. But I’m hoping that this episode with Jeff is a good substitute for that as we cover the topic in a fair amount of depth.
I cover in the intro how I’m going to structure the show, so I won’t repeat it here, but as part of the conversation we look at some of the erroneous assumptions around wealth and health. We cover how weight stigma affects physiology and psychology and behavior. We talk about social identity threat and how this connects to weight stigma. We cover healthism, what it is, why it’s important to understand, and if we’re moving to a more weight-neutral place, why we don’t want the new discrimination to be around health or the lack thereof.
We talk about making research in journals more accessible to the lay public and making it easier for people to read and understand, and it was really me complimenting Jeff on the excellent work that he’s done with these papers in really being able to do that.
I should say that I feel like I sound a little dull in this interview. I actually really enjoyed this conversation, but when I went to re-listen to it again, my voice doesn’t sound so upbeat. This was recorded shortly after I got back from traveling, and I was fairly jet-lagged. This was also mixed with Ramsay being really unwell, so I’d had some poor nights’ sleep because of him, too. So if I sound like I’ve taken a tranquilizer, you know why.
That is it for this super-long intro. The irony of mentioning I like to keep my intros and shows stripped back and get straight into it, and then I do the complete opposite here. But here is my conversation with Dr. Jeffrey Hunger.
Hey, Dr. Hunger. Thanks for joining me on the show today. I’m really excited to be chatting with you.
Dr. Jeffrey Hunger: Thank you so much for having me. I’m excited to be here.
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Chris Sandel: I’ve invited you on the show because I want to chat about weight stigma. This is an area of specialty as a researcher for you, and you’ve been involved in a number of studies looking at weight stigma and been the author or co-author on numerous papers. I’m going to use a handful of these papers to guide our conversation, but I’m also just happy to touch whatever other topics or ideas come up, so don’t feel you need to stay on this narrow path.
But before we start with the papers, let’s start with you and your background. Are you able to give a brief bio of sorts, like who you are, what you’ve done study-wise, that kind of thing?
Dr. Jeffrey Hunger: Yeah, absolutely. My training and background is in social psychology, which is the area of psychology that studies how our social worlds impact our thoughts, feelings, and behaviors. Obviously – and I’m completely unbiased here – social psychologists tackle some of the most interesting questions. [laughs]
After I completed my PhD in social psychology, I spent a few years at UCLA doing postdoctoral training in health psychology because in my lab in particular, we’re really interested in the mental and physical health effects of being in a stigmatized group. For the better part of the last decade, kind of like you alluded to earlier, I focused a lot of this work on weight stigma in particular. For folks out there that aren’t fully versed in the weight stigma literature, weight stigma encompasses broadly the very pervasive stereotypes, prejudice, and discrimination that’s directed at higher body weight individuals.
Chris Sandel: When you were first starting – obviously you started with a Bachelor of Psychology – did you always know you were going to go in that way in terms of doing social psychology, or what was your intent? Was it always to be a researcher?
Dr. Jeffrey Hunger: Yeah, from a very early on part in my undergraduate career, I realized that I wanted to be a researcher in psychology. I actually transferred schools to pursue that. This was my second year in undergraduate; I realized that social psychology, even though I didn’t have the language for it at the time, was what I was interested in. I was really interested in how our social interactions and our social worlds influence us psychologically.
It wasn’t actually until late in my second year in undergraduate that I realized that was actually an entire sub-discipline of psychology. So I knew from a pretty early on stage that I wanted to be a social psychology researcher, but it wasn’t until the end of my undergraduate career that I realized that being a researcher in the stigma field, and particularly stigma in health, was of interest to me.
Before that I was interested in things like impression management, which is how people convey certain aspects of their identities to different groups, or I was interested in personality and how people differ on personality characteristics. But it was I think my sophomore or my senior year I read a paper on the stigma associated with higher body weight written by Rebecca Puhl, and it changed my research direction for the past 10 or 11 years now.
I read that paper on weight stigma, could see how it fit with the ways that we think about identity in social psychology, and that just launched a brand new trajectory for me from that point onward.
Chris Sandel: Had you had an interest – obviously weight stigma is quite a niche thing, but just in terms of the health side of things? Had that been something you’d always been interested in?
Dr. Jeffrey Hunger: Yeah. I had a background in biology. My first major before psychology, like many people who started out pre-med, was biology. But it was fortuitous that when I came across the weight stigma paper by Rebecca Puhl, at the same time I was actually managing a health psychology lab. I was Traci Mann’s lab manager because she had just recently moved to the university where I was doing my undergraduate degree.
So here I am running this lab dedicated to health psychology broadly, but really the psychology of eating and dieting, and I come across this fantastic paper about weight stigma. It was just this confluence of things at this moment that made me realize that this was the direction I wanted to go and that these areas of research really needed to be melded, needed to be synthesized together.
Chris Sandel: For you growing up, was dieting or the things that were then touching weight stigma something that had impacted upon you?
Dr. Jeffrey Hunger: Not particularly. I think like many at least young Americans, we can point to parents who engaged in dieting behavior. I could see that to some extent in my mom or older female family members.
It wasn’t something that impacted me in particular, but it was something that I was always interested in. I was always interested in the psychology of eating, the psychology of exercise, and had never really considered how social experiences like stigma and discrimination might actually shape those behaviors. I saw them operating in these two separate worlds. So it was certainly that “aha” moment to see them come together that last year of undergraduate.
Chris Sandel: Just so I can have a sense of this, what year did you say that was that you came across that paper?
Dr. Jeffrey Hunger: It would’ve been – we’re talking a decade ago at this point, so I believe it’s about 2009. It was towards the end of my undergraduate career, and it’s a paper by Rebecca Puhl. I’m neglecting the co-author’s name at this point. I feel terrible. But yeah, it was a 2009 publication that really shifted my views on what I wanted to pursue in graduate school.
Chris Sandel: That’s, as you said, going back a decade. It feels like the concept of weight stigma is making it much more into the public consciousness probably in the last couple of years in a way it hadn’t before. Maybe I’m just biased around that, and undoubtedly you’ve had a hand in this happening, but when you first started into this area, did it feel like it was this tiny niche? Or was there already this growing awareness around it?
Dr. Jeffrey Hunger: Honestly, I agree with you. I think it felt like a novel and sort of niche area of research. There was certainly no one in mainstream social psychology conducting that research at the time, so when my graduate advisor and I started to brainstorm ideas and come up with grant proposals and things like that, there wasn’t a ton of research in social psychology to draw on.
But I do think that we have that 2009 paper by Rebecca Puhl to thank for launching this growing, burgeoning, and very broad field of weight stigma, because it cuts across disciplines, which is really fascinating. It’s one of the few areas of research that are really effectively de-siloed. There’s not just psychologists talking about it. There’s anthropologists like Alex Brewis at I believe Arizona State, who’s approaching it from an anthropological perspective. There are folks in public health, social work. It really resonated with people.
I haven’t looked recently, but I think the last time I checked, that paper’s been cited upwards of like 3,000 times since 2009, which is incredibly impressive.
00:19:45
Chris Sandel: I know in one of the papers that we’re going to go through, you talk about the attacks on Katherine Flegal that she’s received. For people who don’t know who she is, she’s a scientist with the CDC that’s published a number of papers or articles challenging some of the embedded beliefs around weight and health. So I just want to find, how have you personally fared? Are you someone who receives criticism or pushback based on your research and publications?
Dr. Jeffrey Hunger: One thing that I learned very early is to never read the comments on any sort of public news article about my work and to absolutely never search myself on Reddit. [laughs] Those are the two things that I’ve come to realize early on in my career that will help my mental wellbeing.
The criticism that I’ve faced has not nearly been as prominent and widespread as Kathy Flegal has faced, because that was in the large media and the comments were coming from very prominent figures in nutrition and public health, but yeah, we certainly get a lot of pushback.
Even very early on in pursuing this research, we got pushback from funding agencies who thought that weight stigma should be an effective tool for health promotion, so why would we be pursuing research that is counter to that? Why would we be framing our research as something that possibly suggests that weight stigma is not an effective tool for changing behavior, because it should work?
Thankfully over the past decade, we’ve seen a shift in how at least funding agencies think about stigma as a health promotion tool, but the challenge is we still face a lot of public pushback in terms of our findings. I think oftentimes as a social psychologist or a psychologist in general, trying to push into the public health sphere or the medical sphere and raise these questions or push back against the dogma there, we still are up against a wall to some extent.
Chris Sandel: Is there research coming out that counters what you’re saying? It’s one thing that it’s just dogma or hearsay or bias that people have, but are there people who are publishing papers that run counter to some of the things you’re saying?
Dr. Jeffrey Hunger: Yeah, and this is how we structured the assumptions in one of the papers you’re interested in on evidence-based rationale for weight-inclusive health policies. You can find these relationships say between weight and poor health. There are papers out there that exist that show that that relationship can be found, but it often overlooks a lot of third variables that aren’t weight causing poor mental and physical health.
This is one of the arguments that we make. Yes, you can find this correlation between body weight and poor mental and physical health – and it is just a correlation. This leaves us open to alternative explanations that for the most part aren’t pursued by researchers who are coming at this relationship from the perspective that weight is and always will be a predictor of poor health.
I would just love to see a lot of these studies that come out control for things like the weight stigma that folks have experienced. But if that’s not in the dataset, because it’s likely not – this is one of the challenges of operating with secondary data – why don’t you just control for stress? That’s a good proxy. Stress and depression would be good proxies for weight stigma because we know that weight stigma is a large and significant predictor of both stress and depression.
So I would just love to see these researchers adopt a perspective on the relationship between weight and health that is more agnostic to the outcome.
Chris Sandel: I guess with my original question, it was more around there’s people publishing papers that show “in this scenario, weight stigma is beneficial.”
Dr. Jeffrey Hunger: Oh. No. [laughs] I apologize about misperceiving that question. No, for the most part – I can only think of one paper that has shown salubrious effects of weight stigma, and it’s in a very small, very self-selected sample. There are about seven or eight other papers that directly contradict its findings on specific outcomes related to weight changes or health behaviors.
The literature, at least from the weight stigma side, is pretty consistent that weight stigma is going to be a negative predictor of mental and physical health, of anxiety and depression, stress, various health behaviors. As far as I know – and after that latest paper, I feel like I have a fairly strong grasp on the extant literature, which is growing and growing – I can’t seem to see much research that suggests that there’s any positive benefits of weight stigma.
Chris Sandel: So at least there, it’s a fairly solid consensus on that; it’s just all of the other moving parts that then connect into that where there seems to be more disagreement and blind spots.
Dr. Jeffrey Hunger: Yes, absolutely. But I think on the weight stigma side of things, it is a fairly consistent and fairly robust literature showing that those that experience weight stigma are at risk for poor mental and physical health. And even mortality. There’s a really compelling paper by Angelina Sutin in Psych Science longitudinally linking weight stigma to mortality risk.
Chris Sandel: What I want to do is just go through, as I said, some of the papers you’ve been involved in – and there are two main papers that I want to use as a jumping-off point. One’s called “An Evidence-Based Rationale for Adopting Weight-Inclusive Health Policy,” and then the other is called “Weighed Down by Stigma: How Weight-Based Social Identity Threat Contributes to Weight Gain and Poor Health.” I will link to both of these in the show notes as well as any other papers we make reference to today, and you can access it all as well on Jeff’s site, which is www.jeffreyhunger.com.
00:26:35
Let’s start with the paper “An evidence-based rationale for adopting weight-inclusive health policy.” As part of this, you go through a number of misguided assumptions. I want to just walk through each of these and then you can comment on why they’re misguided and what you found as part of putting together this paper. Assumption #1 is “higher body weight equals poor health.”
Dr. Jeffrey Hunger: Yeah, and I think we kind of just touched on that a little bit. There is this existing correlation between body weight and health that occasionally manifests, but that relationship is complicated. We don’t consistently see that it is a linear relationship between body weight and health.
And as I mentioned before, it overlooks the consequences, at least the social consequences, that come along with being in a higher body weight in a fatphobic society. This is encountering weight stigma, which itself is associated with a whole host of psychological and physiological stress consequences, changes in eating behaviors, changes in physical activity, elevated risk for anxiety and depression and other mood disorders – a whole host of things that we know are strong predictors of poor health over time.
So if we don’t account for those, we can’t be certain that the relationship between weight and health is just this direct one, like a lot of researchers would like to assert.
Relatedly, it overlooks really compelling work showing that things like poor body image, which are wrapped up in weight stigma more broadly, but poor body image itself is associated with outcomes like greater inflammation and Type II diabetes risk. There’s some really newer and compelling research in this area.
So yeah, to me, that relationship is tenuous at best, and we need more direct research that is looking at these very plausible factors that could confound that relationship or explain it.
Chris Sandel: I’m trying to think of places around the world that don’t have the same thoughts around weight and weight stigma in the same way. I know a lot of times people make reference to Mauritania, where women are fed more food and their beauty ideals are for a bigger body. I’m just wondering, are there locations around the world that could have different beliefs around what weight means and what ideals are where you could test some of this stuff?
Dr. Jeffrey Hunger: To me that’s the million dollar question, of how we could get access to this data, because it’s a really fascinating question. But one of the challenges is that in today’s modern technological world, we’ve done a very fantastic job, unfortunately, exporting this Western ideal of thinness and this Western ideal of glorifying thin bodies over fatter bodies. But I do think there are places, like you bring up, where we might be able to find folks with less strong links between weight and cultural worth where we could test these questions.
Again, this is maybe a paper I can send you, but I believe there’s a paper by Peter Muennig from a while ago, maybe 2009-2010, showing that in a culture that had less strong cultural assumptions related to the body hierarchy and actually I think was more of a culture that saw higher body weight individuals as more valued, the relationship between weight and blood pressure or weight and self-reported health was attenuated. So that would be some very suggestive early evidence to what you’re suggesting.
But I think it is kind of wide open. This is an area of research that would be fascinating to team up with folks like the cultural anthropologists at ASU that I mentioned earlier to see if we can find existing cultures or subcultures that don’t show the same relationship between weight and health or don’t show the same relationship between weight stigma and health.
Chris Sandel: With Mauritania, if you’re force-feeding people, I think there’s probably some added problems coming along that would confound things there. I’ve made reference on this podcast before to the Fiji study where you had apprising of bigger bodies that was very quickly eradicated as soon as television came in, so I agree; I think you’re going to struggle a lot more to find places that have been untarnished by the exporting of Western ideals.
Dr. Jeffrey Hunger: Absolutely. The Muennig paper that I was referring to was in 2009, it looks like. A small region in Dominican Republic is where they had surveyed folks. There was a small community in the Dominican Republic that had these similar body ideals that you’re talking about. I can send you that link as well so that we can link to it in the show notes.
00:32:05
Chris Sandel: Perfect. Assumption #2 that you talk about in the paper is “long-term weight loss is widely achievable.”
Dr. Jeffrey Hunger: We see this very frequently, perhaps more for those that are embedded in diet culture, that weight is something that’s under individual control, we can lose significant amounts of weight, and that we can keep that weight off in the long term.
I think that most all of those are challenged by exciting science, particularly that long-term weight loss is achievable. We see this from meta analyses looking at dieting. One of the meta analyses in particular is my co-author Janet’s from 2007 with Traci Mann and colleagues. They find that, for the most part, short-term weight loss is achievable. We can have an entire conversation here about what constitutes clinically significant short-term weight loss, but we’ll save that for a different day. [laughs]
But in the long term, most everybody that loses weight in the short term gains it back, and a significant portion actually gain back more than they lost. There’s this really compelling paper by Alison Fildes in American Journal of Public Health that talks about the probability of higher body weight individuals returning to a “normal” body weight range. They look at the probability of people that have a higher BMI returning to a lower BMI that the government considers “healthy” – which we know is a little bit incorrect, or a lot incorrect depending on which day you catch me on.
But the probability for folks that are in the “overweight” range is 1 in 200, and it jumps to something like 1 in 1200 for folks that are in the – still using quotes because I hate the BMI – “obese” BMI range. For those listening, I only use those terms when we’re talking very specifically about those categories. You can look to a lot of my work, where I have a large bone to pick with the BMI in general and those categories and their labels.
But for the most part, the data suggests that long-term weight loss, at least a significant amount, just is not achievable for the overwhelming majority of people. There will, of course, be outliers. I’m not saying that there’s no one that has ever done it. But then that leads to a second question: how has that changed their quality of life? Are these folks that are restricting day in and day out to maintain that weight loss engaging in unhealthy weight control behaviors or disordered eating behaviors to maintain that weight loss? What are the other consequences for their mental and physical health other than just weight suppression?
Chris Sandel: And I think also the long-term piece. It feels like it’s more doable because you catch someone a month afterwards or 6 months afterwards or whatever, so you’re like “Oh, everyone’s able to do this.” But it’s much rarer that you’re catching someone who’s 10 years on who has been able to do that.
Dr. Jeffrey Hunger: I think that’s one of the insidious aspects of diet culture. That’s when we capture people’s awful before and afters, and that really reinforces this idea to others who are viewing it that weight is controllable. They see it as something like “that person over there just lost 40 pounds in 6 weeks because they haven’t so much as walked past a carb.” But it doesn’t really look toward the long term – even a year out, let alone true long-term follow-ups of 2, 3, 4, 5 years.
Chris Sandel: Yeah. You were alluding to this; I imagine in terms of what constitutes weight loss or significant weight loss is now something like 5% or 10% is enough to consider weight has been lost as part of a study. Is that correct?
Dr. Jeffrey Hunger: Yeah, I believe the most recent “success stories” for weight loss studies is 5%. Over the past 20 or 30 years in that literature, you see that number slowly creeping down as it becomes more and more evident that larger weight losses are just not sustainable. In the ’80s and ’90s, we’re talking about people that are saying 20% is clinically significant or 20% is that success story. Then it was 15%, then it was 10%, now it’s 5%.
And now you’ll even see weight loss trials keep the weight loss frame, but basically make the argument that we’re trying to make: they didn’t lose weight, but their health improved. Well, that was because their health behaviors changed, probably, on your diet. Not only are they eating healthier, perhaps, but they’re probably exercising or maybe finding a more mindful relationship with their body and what they’re putting in it. It’s just really interesting to see the goalposts consistently change from folks that are still embedded in the weight loss model.
00:37:55
Chris Sandel: Definitely. Assumption #3 is “weight loss results in consistent improvement in physical health.”
Dr. Jeffrey Hunger: I think one of the easiest articles to point to here is, again, to my esteemed co-author Janet Tomiyama.
She has a meta analysis in 2013 that basically approaches this question and says, okay, let’s assume that you argue weight loss is possible. What if we go out and we look at all the literature and see how much the weight that you lost is associated with improved physical health. If it truly is something about the weight that you lost, that should be a predictor of improvements in physical health. We’re talking about things like blood pressure, cholesterol, triglycerides, risk for all sorts of physical ailments.
So they sought out to do this and reviewed the literature, and basically found no relationship between the amount of weight lost and improvements in health. To me, that says that it’s not about the weight that was lost on whatever regimen you were a part of or whatever study you were into; it’s really about the health behavior changes that come along with it.
Chris Sandel: How was that paper taken by researchers at large? Was there pushback on that?
Dr. Jeffrey Hunger: I don’t know how it’s been received since, but I do know from having been a collaborator with Janet for the better part of the past 12 years that before it ended up at its current journal that it’s published in, it was severely – very harshly reviewed by other journals that were more medically-oriented journals, I think in part because it pushed back against existing beliefs about weight loss and health improvements. I know that it was a challenge to actually get that paper published.
As a researcher who comes at these relationships from a not-traditional perspective, that’s a little scary that important papers like this – this is not data that Janet and her team generated; this was just a review of existing published data. If that can get suppressed or can get tanked because certain reviewers are invested in a certain way that science should go, that should be alarming. That should be concerning for all of us.
00:40:45
Chris Sandel: The next one was “stigmatizing weight will promote weight loss and improved health.”
Dr. Jeffrey Hunger: This touches back onto what we talked about earlier and the approach that a lot of people have taken to weight stigma as a public health promotion tool. I think about 9 or 10 years ago, that was still the predominant view, that higher body weight individuals just need to be stigmatized and shamed, and it’s “for their own good” because it’s going to spur behavior change or it’s going to spur weight loss that’s going to result in improvements in health.
Over the past 10 years now, we’ve shown it from our lab and maybe five or six other labs have shown that individuals who experience weight stigma are actually more likely to gain weight over time and are more likely to show decrements in mental and physical health over time. Just completely flies in the face of this assumption.
And it’s this assumption that you would have seen implicitly in health promotion campaigns years ago. There are some very harsh health promotion campaigns that – for example, the CR UK health campaigns I know received a lot of pushback in the UK. This is the Cancer Research UK – are you familiar with these ads, Chris?
Chris Sandel: Yeah, where they put obesity on a cigarette packet? That one?
Dr. Jeffrey Hunger: Yeah. These are great examples of public health campaigns that are implicitly trying to leverage stigma and leverage those negative feelings associated with shame and thinking that that’s going to motivate health behavior change. We’ve seen it here in the U.S. as well. Less so as the conversation on this side of the pond has gotten very loud about them. Folks have been criticized widely.
I know that from my perspective, the CR UK advertisements were criticized at least in online forums. I’m curious to hear – were they discussed at all a lot in the lay community in the UK?
Chris Sandel: They entered into all the papers and it was discussed that way. It’s hard because I’m biased, so my Facebook feed is made up by people who work in this industry. I know Laura Thomas – I’ve had her on my podcast before, and she was really trying to spearhead a lot of that and wrote an open letter. She then sat down with Cancer UK. So it felt like lots of people were talking about it, but I don’t know if that’s just because I was living in a bubble where it felt like people were talking about it.
Dr. Jeffrey Hunger: I suppose that actually could be my own experience too. I may just have a Twitter echo chamber that is full of folks that are involved in the body image and weight stigma spheres, so we’ve had those conversations.
But we’ve seen this over the past 10 years, this assumption play out in either policies or public health campaigns. But over the past 10 years, we’ve shown fairly consistently that it’s just not true. Weight stigma is not going to promote weight loss.
If it does spur the motivation to lose weight, it’s because people are motivated to avoid being stigmatized. If it makes people more likely to engage or motivates weight loss, it’s because it’s going to lead them to engaging in these drastic forms of unhealthy weight control behaviors and disordered eating as a way to escape the stigma that they know is associated with being a higher body weight individual.
So even if it does “increase motivation,” it’s not increasing a healthy form of health motivation. It’s increasing this “I need to get out of this fat body because I am constantly a source of denigration and a source of stigma.”
Chris Sandel: Yeah. I would say for the majority of people who have that feeling, in terms of impacting on health behaviors, either, as you talked about it, it leads to really disordered behaviors, or it’s pretty fleeting in terms of creating healthy behaviors, and then someone gets right back to what was going on before – or leads to worse choices because of being stigmatized and the stress response that that causes.
Dr. Jeffrey Hunger: Yeah, or leading you to do things to avoid stigma. You can imagine a higher body weight person who’s physically active, always at the gym, but the gym for the most part is a negative space for fat individuals. That stigma might actually lead them to engage in less physical activity than they were before.
So whether it’s undermining their motivation or their desire to engage in health-promoting behaviors or leading to a whole host of health-compromising behaviors, its net effect is terrible for mental and physical health.
Chris Sandel: Yeah. I think I saw that play out last year in terms of the Nike campaign, when Nike had bigger mannequins and people were talking about how terrible this is, and it’s promoting obesity. I’m like, you can’t win. You’re either in a bigger body and it’s your own fault and that’s why you need to exercise, but then at the same time, you’re told “don’t exercise in anything that we can see you in or that has Nike on the leggings” or whatever. I couldn’t get my head around it.
Dr. Jeffrey Hunger: To me, it’s a really fantastic example of concern trolling. This is not about “wanting to do what’s good for their own health.” It pulled the curtains back on weight stigma of, no, you just want to generally shit on fat people. So that’s why they can’t have it both ways. You just want to express your bias in a way that seems socially acceptable because you can couch it in “I’m really concerned for their health. That why I’m kind of being an asshole.” [laughs] Sorry, I don’t know if I can swear on here.
Chris Sandel: You can swear as much as you like. [laughs]
Dr. Jeffrey Hunger: Okay. I feel like I have a tendency to swear a little bit and I’m trying to dial it back. But yeah, I think that instance in particular, the Nike case with the higher body weight mannequins really revealed people’s biases. This was clearly not anything ever related to promoting the health of those that reside in a fat body. It was really just you want to denigrate them and you want to put them down.
Chris Sandel: Yeah, it was just showing the moralizing that we have around bodies and weight and what people should look like.
Dr. Jeffrey Hunger: Yeah, absolutely.
00:48:00
Chris Sandel: In the paper you also made reference to legislation in Reykjavík in Iceland which I hadn’t heard about. Do you want to just talk a little about this in terms of stigmatizing weight and what they’ve done there?
Dr. Jeffrey Hunger: I will say that Joslyn Smith was our policy expert not that paper, so she would probably have a stronger sense of the Reykjavík policies and might actually be a fantastic guest on the podcast. She’s one of the policy directors at the National Eating Disorders Association here in the U.S. and was a fantastic addition to that paper because she brought into focus all the really important policy-related things that this research was relevant to.
But effectively, it banned discrimination on the basis of body weight and shape. What I found really fascinating was they did it really from a social justice perspective. Other places that have tried to get legal protections for higher body weight individuals – at least here in the U.S., there have been a few attempts – have couched it within what we have as the Americans with Disabilities Act. They really used the disease and disability model, which I know that a lot of fat activists push back against.
What was really novel and interesting about the Reykjavík perspective was that it was rooted not in needing to protect higher body weight individuals because they are a disabled class; it was rooted in social justice and equality. I think that it really gives a nice roadmap or a nice template for how other countries and other municipalities can go about leveraging those respective laws in their countries to make weight a protected class.
Chris Sandel: Maybe you’re not going to know the answer to this, but do you know how it’s then impacted upon their public health policies and the way that they then talk about those things? Because it sounds like if that’s what they’ve got as their foundation, it would then be great to see how they’re tackling or talking about different issues that are affecting the health of their population.
Dr. Jeffrey Hunger: Yeah, I wish I had data on that, or I wish I had more information on that. We haven’t really seen how it’s played out because it’s also – adopting that ordinance was recent. I want to say it was late 2016 or 2017. Once that law was in place, it would be a really interesting test case to see how health promotion policies have changed, have shifted in a way that’s more health-inclusive or weight-inclusive.
It would also be really interesting to think about how attitudes related to body weight have shifted in the country after that was adopted. We know that one of the ways that stigma is perpetuated is through laws and institutions, so if your government is saying, “body weight diversity is important; discrimination faced by folks that don’t fit your typical mold of what a person should look like is outlawed,” what does that convey to the citizens of Iceland, and what are the consequences of that for their attitudes over time?
You can imagine that this could have this upward positive spiral for the health of higher body weight individuals in Iceland, and that is fascinating. I’m writing that down now because I never thought about that. You can think about in many ways, this could’ve had a positive impact on higher body weight individuals at least in Reykjavík, because what it’s doing is signaling from the government to the higher body weight individuals that they’re protected, that they are worthy, and that their bodies are respected and deserve equal treatment. Which is going to convey a whole host of things related to their sense of belongingness in the city, their lack of loneliness, things like that.
At the same time, if these changes in these laws shift how they’re interacting with others at the interpersonal level, it’s going to have an even more positive effect. So perhaps these laws translate not only into heavier individuals feeling more accepted and like they belong in the society, they actually come to be treated less negatively and feel that at the interpersonal level as well.
Going back to your original question, I have no clue, but it leaves open this really interesting dataset for the next few years for someone to hop onto and really track.
Chris Sandel: Also, just from what you said there, I think over the long term that then has an impact. I’m trying to think of other changes in legislation in terms of gay rights, that kind of thing, of when laws are changed, over the longer term that then becomes more normalized and then there’s less stigma attached to all of that.
Dr. Jeffrey Hunger: Yeah. Mark Hatzenbeuhler, who’s a stigma researcher at Columbia, actually has a lot of very fascinating research on that specific topic related to changes in LGBT protections and how changes in what he calls structural stigma – so laws or policies that either affirm LGBT rights or that actively take them away – can translate into mental and physical health for the LGBT individuals in those states or in those provinces. It’s really incredibly compelling work that suggests that a lot of the ways in which stigma gets under the skin to affect health at the top is from these policies, from these broader institutional things.
That was partially why I was motivated to write this paper on weight-inclusive health policy, because I’m used to just talking about these things at the personal and interpersonal level, but as years go by, you start to see that how they unfold outside of interpersonal at more community and national levels is so important because as much as we can do to eradicate weight stigma at the individual level, it’s going to be really hard if people are still operating in a fatphobic society when it comes to our cultural norms, our cultural laws, and how we’re socialized as a culture.
So I’ve really been pushing myself to broaden what I think about when it comes to my research and broaden the ways that I think we can use what we know at the interpersonal level about stigma to shape these bigger conversations.
00:55:20
Chris Sandel: I think one of the things that we talked about off-mic before we started was I really liked this paper because it was really readable. There’s another paper we’re going to go through in a little while as well that I also found really readable. I think there is a real problem with academia in terms of writing academia for academics, when actually there is so much value in the lay public being able to read a paper like this and being able to understand it and see the importance of it. You just did a really good job of making that accessible.
Dr. Jeffrey Hunger: I love to hear that, and I agree wholeheartedly that – we have an issue of even getting siloed in our language within one discipline. Sometimes we get stuck in our theories and our framing and our language that psychologists can’t even talk to public health people and sociologists or anthropologists, let alone communicate effectively to non-experts, to lay individuals that are just really interested in the research that we have and thinking about how it impacts their day-to-day life.
So we were very, very conscious about that when we wrote this paper. That was partially because of the editorial guidance of the journal. They really wanted this to be an accessible piece. A comprehensive, well-researched, well-cited piece, but make it accessible. And that was the same with the paper that you alluded to that we’ll cover next. Equally at that journal, they were interested in making sure that the way we were writing was comprehensive, it was well-sourced, but it wasn’t designed to only be read by the five or six other people that are in your tiny research niche.
Chris Sandel: From a writing perspective, is that easier to do with papers like this because it wasn’t talking about a specific study and you didn’t have to go through methodology and all of that? Or do you think it’s still achievable regardless of what the paper is?
Dr. Jeffrey Hunger: I think it should be the goal regardless of what the paper is. When it comes to things like the methods and the results, you can’t do much to sexy up a methodological approach. [laughs] And you really don’t want to. That’s the part of the paper that is specifically for the other researchers, or should be. It should be telling the other researchers how exactly you went about doing this if we want to say try to replicate it, or if we want to follow up. That’s going to be a chunk of an original empirical paper that might not resonate as much with non-experts or folks not in psychology.
But I think we can still write the introductions and we can still write the discussions to our papers in an accessible way that conveys the gist of the paper, even if the audience doesn’t have training in the statistical or methodological approaches that we’ve taken.
It does make them have to fully trust that we’ve done the methods and statistics correctly, but if the scientific endeavor is working as it should, any peer-reviewed publication should be rigorously vetted by experts in the field. So lay readers, even if they don’t understand the statistics, should feel confident in the conclusions that are drawn. I know that differs by discipline, but I’d like to think that at least our papers have been rigorously vetted and are trying to be written in a much more open and accessible way.
Chris Sandel: You said for both of these that this was almost requested by the journal. Are you seeing this as a shift more generally, that this is what’s wanting to happen, or at least within your space? Or you just got lucky with those journals?
Dr. Jeffrey Hunger: I think I honestly got a little bit lucky. I think there are certain journals that – for example, this journal, Social Issues and Policy Review, is an interdisciplinary international journal that wants to make sure that it is accessible to policymakers and folks that might vote on policy that aren’t experts. So it’s sort of baked in. Especially with the recent editorial change, this was something that was really important to the editors to make sure that we were able to do this in a way that everyone could get access to intellectually.
With the next article that we’re going to talk about, those review papers are geared toward non-experts specifically. That’s the outlet. It’s read a lot within psychology and within higher education, but their goal was to make it so that somebody could plop that paper into a first year course or a second year course, before people are experts in psychology, and they would fully get it. They would know what’s happening, it’s not too jargon-y.
That’s why I was drawn to both of these journals. At its core, that is part of why I’m interested in doing things like what we’re doing right now, having these conversations. Like I mentioned off-mic, it doesn’t help me if I’m only talking to 10 or 12 people. I want to make sure that the findings that come out of my lab or that are in these big review papers that I do get disseminated more widely, because I have confidence in their importance.
Chris Sandel: Maybe you can’t speak for everyone, but is there a fear that if you’re making it easier for the layperson to read, you’re not showing your scientific chops, you’re not showing that you can use the phrases that should be used? I don’t know. I also know that there is the whole “publish and perish” thing – or “publish or perish.”
Dr. Jeffrey Hunger: Maybe both. [laughs]
Chris Sandel: [laughs] And you’re trying to get funding. There are so many things that people are trying to balance up when they’re trying to publish.
Dr. Jeffrey Hunger: Yeah, I think there are a lot of competing demands when it comes to how we want to structure our papers that are going to peer-reviewed publications. I do see perhaps there’s a little bit of a generational divide in it, but I think that more early career scientists are really keen on turning to venues like Twitter or social media to have conversations about their research in ways that are accessible to non-experts.
I’ll admit I don’t read all of the other early career researchers’ research at all times because it’s different areas, but I would like to think that they’re also trying their best to make sure that they adopt a similar, broader scientific communication approach to their articles. I think it is something that only time will tell, but I’d like to think that there’s a growing push towards making everything we do, whether it be if you can actually access the journal article or if you can intellectually comprehend what’s going on, at the forefront of a lot of young scientists’ minds.
Chris Sandel: Yeah, I think that’s the way that I would like it to be. There’s this real push towards people should do their own research and people should be more scientifically minded, but you’re then really severely hamstrung if it’s written in a way that, unless you’ve done a postdoc, you’re just not going to understand it.
Dr. Jeffrey Hunger: Exactly. I am all for people being more scientifically literate and engaging with original research and engaging with scientific communication, but yeah, like you say, sometimes these papers are written where even someone who’s in a faculty position, I’m like, what is actually happening? [laughs]
Chris Sandel: [laughs] Yeah, that was a little bit of a detour, but I just wanted to definitely make you aware and others who are listening to this aware that these papers that we’re going through are very accessible. Even if you have really no background in any of this, you’ll be able to read and understand what is being discussed in them.
Dr. Jeffrey Hunger: Absolutely.
01:04:05
Chris Sandel: One of the other parts that you touch on with this one in terms of “stigmatizing weight will promote weight loss and improved health” and that incorrect assumption was talking about healthism. Do you want to just mention what healthism is and how it’s defined?
Dr. Jeffrey Hunger: When we think about healthism – it’s always a concern when we talk about health promotion because we want to be talking about health not being a marker of your sense of self-worth or your sense of societal worth. It’s often a concern when people make this transition from a weight-focused framework to a health-focused framework that then there becomes a new class of stigmatized, marginalized, or othered folks, and those are the “unhealthy.”
From our perspective, you owe no one health. Health is not a moral imperative. Everybody deserves respect. Everybody deserves full access to society. So when we talk about making this shift from a weight-focused perspective to a more weight-inclusive approach that emphasizes health behaviors, we want to make sure that we’re doing so in a way that respects that not everybody wants to do that, not everybody has access to that, and not everybody is capable of that.
Healthism is this perspective that now at the top of the hierarchy, instead of thinner bodies, are healthier people. We want to make sure that when we shift this, we are dismantling that body hierarchy, we are leveling the playing field when it comes to access to health, but we are in no way yoking health to your worth.
Chris Sandel: I think that’s a really important thing because there are so many social determinants of health that are completely out of someone’s control. Just as socioeconomics and status within society can make it easier for someone to be in a thinner body, that’s also true of being healthy.
Dr. Jeffrey Hunger: Exactly. Access to resources, access to time. Not everyone has the time or the energy at the end of the day, after they’ve worked two jobs, to go to the gym. Even if they can afford access to the gym. So by no means should health be considered a moral imperative.
It’s just something that we want to break down. At least from my perspective, we want to break down as many barriers that people have to it as possible. If weight stigma is one of those barriers, like I see it is, I want to make sure that we can dismantle that. If a weight-centered approach to health promotion is a barrier, let’s dismantle that. But know that, like you just mentioned, there are so many other social determinants of access to or engagement in health-promoting behaviors that we need to be thinking ways to dismantle those as opposed to blaming someone for not going to the gym after their third shift.
01:07:20
Chris Sandel: The next assumption as part of the paper you mentioned was “recognizing that one is overweight is necessary for health promotion.”
Dr. Jeffrey Hunger: Yeah, there’s this idea that things like screening people’s weight or screening people’s BMI, or even worse, sending kids home with BMI report cards – which some schools in the United States do, which I think is atrocious, and we can talk about that at length a different time – but they think that the issue is that higher body weight people just don’t know it, and the second that they know they’re fat, they’re going to be able to leap to action and engage in health behaviors and make these changes that are really going to spur health promotion and weight loss. And it’s bullshit.
The literature on this is gigantic and incredibly comprehensive and incredibly compelling how bullshit it is.
Chris Sandel: You had a paper that connects well with this, the “Perceived weight status and risk of weight gain across life in US and UK adults.”
Dr. Jeffrey Hunger: Yeah. Back in I want to say 2015, UK scientists Eric Robinson and Mike Daly and I published this paper that looked at how perceiving yourself as overweight versus not might impact weight gain over time. We find pretty consistently across three datasets, I believe, in the UK and the US, in these large, nationally representative datasets, merely perceiving yourself as overweight, regardless of your BMI, regardless of your actual weight, was associated with weight gain over time.
We find, at least in I believe the third study of that paper, that this is in part because perceiving yourself as overweight is associated with stress eating. To me, that really meshes very well with the weight stigma research that I’ve been doing for quite some time. It makes sense that for folks that see themselves as overweight – and we might be getting into this a little early – but for folks who see themselves as overweight, they see themselves as susceptible to being marginalized and stigmatized and discriminated against on the basis of that identity.
This is the whole weight-based social identity threat model that we’ll get to in a moment, but that literature is so compelling that just simply perceiving yourself as overweight has all sorts of long-term negative mental and physical health consequences, from physiological dysregulation to increases in depression, anxiety, and suicidality over time. A lot of robust and very consequential effects, particularly among adolescents. It seems to be slightly stronger among adolescents, although I don’t know if anybody has formally tested that.
Chris Sandel: As part of this assumption is the idea that if people don’t know that they’re overweight, they’re going to just keep up with poor behaviors and that’s going to lead to more and more weight gain and this vicious spiral. If I’m remembering correctly with the paper that you had, if people were in a higher weight body but yet they didn’t perceive themselves as being overweight, they were either not gaining weight or the weight gain was much lower than the people who did perceive themselves as overweight. Am I remembering that correctly?
Dr. Jeffrey Hunger: Yeah, and that’s the consistent finding across – ours is one of a handful of papers that have shown a very similar finding. Exactly what you mentioned, if higher body weight folks don’t perceive themselves as overweight, their weight tends to be fairly stable across time.
I think what you touched at was how this assumption is really situated on stereotypes. This assumption is situated on stereotypes that a fat person must be inherently unhealthy, must be engaging in unhealthy behaviors. They must not be working out, they must have a terrible diet, all these other things that for the most part just aren’t true. The differences in physical activity and differences in diet quality across body weight groups is not as large as folks would like to think. But the stereotypes about it are strong and pervasive.
Chris Sandel: My sense would be, if we’re looking from a health perspective and looking at things that really push the needle in one direction or another, we’d be back in the social determinants of health. They’re going to be the things that are most likely to be determining whether someone is doing well on the health scale or not doing so well on the health scale.
Dr. Jeffrey Hunger: Yeah, absolutely. This touches back on what we were talking about a little bit earlier, this need to consider things broader than the individual interpersonal level. The social determinants of health are unfolding at a much larger, much broader level. But if we stay wedded to a weight-focused, individual-focused model, we’re going to continue to come at this from a pretty erroneous perspective.
Chris Sandel: Yeah, the whole personal responsibility piece doesn’t typically end well.
Dr. Jeffrey Hunger: Yeah, that’s the understatement of the century. [laughs]
01:13:30
Chris Sandel: I want to then look at the next paper that I made reference to. At the end, I want to go through some of the recommendations that you would make and chat about it from that perspective, but I want to touch on the other paper first. That was called “Weighed down by stigma: how weight-based social identity threat contributes to weight gain and poor health.” You may have touched on it a little bit just a little while ago, but what is social identity threat?
Dr. Jeffrey Hunger: Social identity threat is this psychological phenomenon that at its core is really all about the anticipation of stigma. What I noted a little bit earlier was that part of anticipating stigma is seeing yourself as a member of the stigmatized group. This is probably why that large literature on perceiving oneself as overweight has all these negative health consequences. A lot of that is probably mediated through stigma-related processes or stigma-related consequences. We don’t know that for sure; it’s still an open question.
So in terms of social identity threat, it’s this psychological state in which an individual anxiously anticipates or is concerned about being devalued, rejected, or discriminated against because of their weight. It’s different than just having experienced discrimination, which is a common occurrence for higher body weight individuals, but it’s this anticipatory concern that can happen even outside of situations in which they’re being discriminated against.
It can happen because of overhearing a fat joke at work or being exposed to TV shows where the whole purpose is to lose hundreds and hundreds of pounds in a very short amount of time while you’re getting shouted at by trainers. The show shall not be named here. [laughs] There are all sorts of situations other than just being directly discriminated against that can elicit social identity threat, which is why I think it’s such an important and potent driver of these health consequences.
Again, it’s linked not just to what’s happening at the interpersonal level. It’s linked to broader exposures at the cultural, societal, or community levels.
Chris Sandel: It’s also waiting for those things to happen as well, so it’s the constantly waiting for the other shoe to drop so that someone tells a joke or that TV program comes on or you read an article or whatever. Even without those other things, there’s the anticipation, as you say, and that means that it’s pretty much just there humming in the background the whole time.
Dr. Jeffrey Hunger: Exactly. It’s this constant, chronic vigilance because you know it’s going to happen; you just don’t know exactly when or where. That commercial is going to come up on your streaming platform that’s advertising for that terrible TV show that should be taken off air, or you’re walking across the office and you overhear somebody make a terrible joke. Or like you say, one of the many articles comes across your health section of your newspaper that is reinforcing these weight-centric approaches and the need to engage in weight loss behaviors.
There’s a whole host of things that can elicit this social identity threat, and that is terrible. It just puts people constantly on edge.
Chris Sandel: I know we were chatting at the beginning and you were talking about the path that you took to study or research in the area you’ve ended up researching. Had you come across social identity threat before, but outside of weight stigma?
Dr. Jeffrey Hunger: Yeah. I didn’t mention it at the beginning, but what really got me to this paper in terms of thinking was that same year that I read the weight stigma review paper, I read my first paper on race-based social identity threat. A very similar phenomenon happens with respect to race and stereotypes about academic performance, at least in the United States.
There are these negative stereotypes about black students that they are underperformers on a college campus, so they often encounter race-based social identity threat in various educational contexts. I had read this paper – it’s a very influential paper by Claude Steele, an American social psychologist who’s really pioneered research on stereotype and social identity threat. I read that at the same time as I read the weight stigma review.
Basically in 2009, the roots of this paper started. I had read this social identity threat framework related to race and I had read this paper about weight stigma, and I was like, this is the theoretical approach that needs to be the underpinning of this literature. It just struck me as the easiest way to give the weight stigma literature a little bit more of a theoretical guiding about why. Why would all the different ways we know that weight stigma manifests, why would that lead to health consequences?
In the 2009 paper, if you and your readers have a chance to go and check it out, what you’ll see is this beautiful review of what we know about the effects of weight stigma, but at that time we knew very little about why. We knew, for example, that weight stigma was correlated with lower physical activity or exercise avoidance, but we didn’t know why. So in this 2015 paper, we argue that that’s probably motivated by avoiding stigma because we know that the gym can be a terribly stigmatizing environment. We knew that weight stigma seemed to be associated with unhealthy weight control behaviors. Again, that could’ve been a motivation to escape the stigma that they were in and no longer have to contend with it.
I’m glad that you asked that question, because it really was this crazy confluence of a few papers and being in a health psychology lab that laid the foundation for what is now the career that I’m talking about right now.
01:20:25
Chris Sandel: Wow. You made reference to race there, so how does that differ in terms of how it affects physiology or self-regulation or psychological health? Are there differences between weight stigma and race? Or because it’s still under that umbrella of social identity threat, does it all work in the same way?
Dr. Jeffrey Hunger: When we wrote this paper back in 2014-2015, we pretty much made the argument that it would probably operate the same way. That was because at that time there was very little research on weight-based social identity threat, where there was data, there were studies, on race-based identity threat, gender-based identity threat, these other related identities. We could look at those literatures and see the immediate consequences to them.
I would say for the most part, most of them are going to elicit a very similar psychological and physiological stress response, and that’s going to have some similar downstream consequences. But what you’re really going to see differences on are going to be the conditions that elicit it, obviously. A situation that’s stigmatizing for racial minorities is not going to be stigmatized for higher body weight individuals.
The concern, and one of the things that I would like to do moving forward with our lab, is more often than not – and I am just as guilty of this as anybody – we become experts in one form of stigma or one form of social identity threat. I do a lot of work on weight stigma; there are other researchers that are experts in gender-based stigma or race-based stigma or sexual identity.
Very rarely – and I can’t even actually think of studies that have directly compared them like you’re thinking – would we see a study where we randomly assign people to weight versus race versus a control, just to see. I think that would be really interesting and really important information to help us as we start to develop out these models and these papers a little bit more. Do they do the same things? And if they don’t, where do they differ? But you hit on a very important and wide-open question.
Chris Sandel: I know obviously there’s weight stigma conferences; are there identity threat conferences?
Dr. Jeffrey Hunger: There is the International Weight Stigma Conference, which I believe is still accepting submissions. For those of you listening that might be of interest, it’s going to be in Auckland, New Zealand from June 22nd to June 23rd. So we do have a dedicated conference for weight stigma. I’ve been a member of the steering committee for a few years now, but it’s really the brainchild and the baby of Dr. Angela Meadows.
But with race and other forms of social identity, it tends to be integrated into our more mainstream conferences because those identities have been studied longer. They don’t face the same challenges of being seen as a legitimate research endeavor that weight stigma faced for the first few years that we were doing it, at least within the social psychology framework.
I would love to put together a social identity threat conference one day. If there’s folks out there listening that are social identity threat researchers and are a glutton for conference-organizing punishment like I am. [laughs] I would love to put something together that really tackles that question, though, Chris, because it’s so important. How do these different forms of identity threat operate similarly? Where do they break differently? And more importantly, I’d have to say, how do they unfold with people that possess multiple stigmatized identities?
I think one of the biggest issues that I see with the stigma literature right now is we tend to think about these identities like they operate in a vacuum. Again, I’ve been just as guilty of this, so commenting on my own work as much as anybody else’s. But I look at the effects of weight stigma among people that are different races, different genders, not considering how they may operate differently, or not making that an explicit consideration in how we design the study so that we actually have the resources to test it. We need to collect enough folks across different racial groups or across genders to see, does weight stigma unfold differently across these different identities? It’s such an important and understudied area.
Chris Sandel: It seemed like one of the papers that you were working on – I know we chatted about this before we hit record – that you were brought in late on was looking at how weight is perceived across different groups. If you’re a man or you’re a woman or you’re black or white or whatever, you could be at a higher weight and be perceived as being “normal weight,” and it’s not an even playing field. Not everyone at a BMI of 26 is thought about in the exact same way in terms of where the layperson sees that person’s body and how they feel about it.
Dr. Jeffrey Hunger: Exactly. I think, like you touch on, when a certain person will be perceived as “overweight” differs across these different social categories. But one of the things that we still haven’t touched on is, does that translate into how people perceive themselves? That paper was all about how others perceive you.
A really interesting question to pursue that paper next with is, how does that actually translate into your social experiences? Do we see different groups identifying themselves as overweight or not at different thresholds that map onto how everybody else sees them? It gets really – even that sentence made it sound as complex as it is. It gets really complex really quickly, and addressing makes these questions even more challenging. But I think it makes them even more worthwhile.
The closer we get to studying social identity and studying stigma in the lab as it operates in the wild, the better. Just looking at a single identity at a time constrains our ability to really conceptualize the rich ways in which who we are and the groups that we belong to shape our social experiences.
Chris Sandel: But from a scientific perspective, the more variables you add in, does it then become more difficult to work out what’s doing what?
Dr. Jeffrey Hunger: The biggest challenge is it just grows the size of the study. If we want to recruit people that differ across just their weight, we’re talking about two groups: higher body weight, lower body weight. If we add in race, then we’re talking about four groups. If we add in gender, then we’re talking about eight groups. The need for resources and for participants in those studies just gets exponentially larger – which I assume is why a lot of folks don’t pursue slightly more complex research, because it’s resource-demanding and it’s challenging recruiting across these various populations.
01:28:40
Chris Sandel: Let’s talk specifically about this paper. Just looking at how weight stigma affects different areas, starting with – and you’ve probably touched on this already, but anything else you want to add in in terms of how weight stigma affects physiology?
Dr. Jeffrey Hunger: From what we understand, at least from the research that’s happened thus far, it seems like weight stigma elicits a physiological stress response, so that has increases in cardiovascular reactivity, increases in the production of the stress hormone cortisol, and some evidence to suggest an increase in inflammation. We are seeing all of these physiological stress processes that are associated with a whole host of physical health outcomes seem to be elicited from weight stigma.
Chris Sandel: Interestingly, all the things you describe there are associated with or symptoms that occur with someone say with metabolic syndrome. So there’s often the disease that is then blamed on the weight, but it could be the stigma.
Dr. Jeffrey Hunger: 100%. This is why – I think we touched on this earlier – we need a lot more agnostic research coming out of folks doing work in metabolic syndrome and related research to consider social factors or psychological factors, even.
Chris Sandel: Then self-regulation and executive functioning. How does weight stigma impact on this? When I first read this paper, this was really interesting to me because it wasn’t something that was at the forefront of my mind.
Dr. Jeffrey Hunger: It was something that we wrote about and something that there’s not a ton of data on. There’s maybe one or two papers on it at present. But it’s the stress and the vigilance that we just talked about. These types of experiences come with a lot of heightened vigilance, and that vigilance for “is the other shoe going to drop?”, suppressing and regulating the negative emotions that come along with this shitty experience of being stigmatized, all of these things seem to undermine our working memory capacity.
Once our working memory capacity is undermined, it can lead to things like increases in high calorie snacking, which is one of our earlier papers. We found that exposure to weight stigma made individuals more likely to consume high calorie snacks. That was actually what led us to think that maybe this self-regulation or executive functioning pathway was one pathway that could lead to changes in health.
I think this is one of the areas that’s most interesting to me in terms of pursuing in the future because there are not a ton of weight-related papers on this. We drew a lot from the gender and the race-based literatures. But the work that’s out there so far seems incredibly compelling.
Chris Sandel: The paper that you then did on “The psychological and physiological effects of interacting with an anti-fat peer,” does that connect in with this as well? If I’m remembering correctly, there were comments around how that would impact on cognitive ability.
Dr. Jeffrey Hunger: Yeah, in that paper we did use a very crude measure of cognitive ability. I consider that one piece of a broader puzzle of getting us towards understanding, truly, its effects on executive functioning. We used a word-finding task, which from other research has been used as a proxy for your ability to engage working memory.
But yeah, in that paper we did find that simply interacting with someone who you thought was anti-fat or not – in all cases they were actually just a confederate working for me; the joys of deception research in social psychology.
So interacting with this anti-fat person was sufficient to make you worry about being a target of stigma, which was associated with decreases in cognitive performances. Decreases in performance on this word-finding task, but then also an increase in things like rumination, increase in stressfulness associated with the interaction, decreases in self-esteem – a whole host of things that should, combined, also predict undermined actual working memory if we were to use a more cognitive-based working memory task.
But I’m glad that you brought that up. I was a little hesitant to because our measure of cognitive performance there is admittedly a little crude. But it does lay the foundation for future research to use our paradigm, the interaction task paradigm, but to extend it to these more well-validated measures of cognitive performance.
Chris Sandel: Have you got some research in mind for that, or have you applied for a grant to do something in this area?
Dr. Jeffrey Hunger: I have applied for plenty of grants recently as a brand new faculty member. [laughs] But yeah, unpacking the cognitive consequences of weight-based social identity threat is something that I’m really going to be pursuing starting this fall, once I have a graduate student start. A graduate student will be joining my lab this fall, which is exciting and only slightly terrifying.
In collaboration with that graduate student, we really hope to dive into these different ways that we manipulate weight-based social identity threat, like reading an article about escalating discrimination, interacting with someone who you learn is anti-fat, things like this, how these different elicitors of identity threat are related to working memory capacity specifically so that we can really unpack that self-regulation or executive function pathway in this model.
Chris Sandel: It seems there are obviously a lot of misbeliefs that people are lazy or they’re not as intelligent – there’s all these things around someone being in a higher weight body, and I think some of those are just complete nonsense anyway. But if that is occurring, then this can be part of why that is occurring.
Dr. Jeffrey Hunger: You hit the nail on the head with why I’m so interested in this. There’s actually a fairly sizable literature that makes the argument based almost exclusively on correlations that BMI is a predictor – they call it a strong predictor – of different forms of executive functioning and working memory. Just like a lot of the other literatures that are trying to make this direct effects argument, it never controls for something like stress or anxiety, and it doesn’t come anywhere close to thinking about stigma as a possible reason.
To me, that’s very disheartening, because I agree with you that that research is really serving to potentially bolster stereotypes associated with higher body weight individuals. And it gives people “science” to turn to, to justify those biased beliefs or those stereotypes.
I feel like social scientists or folks that are approaching the weight literature from a slightly more nuanced, slightly more agnostic perspective are also thinking about the consequences in the ways that we frame our findings when we publish them or when we talk about them. As much as people would like to assume that science is just this objective thing that happens as scientists stand 3 feet away and watch it happen, that is not true. How you frame your findings, the places you publish your findings, the way you interpret it when you turn to the media – all of these things are shaped by your own perspective, they’re shaped by your own biases, and they’re shaped by your own interests.
That’s why we try to approach all of our research from a fairly agnostic perspective. We also want to use it as a way to – maybe agnostic isn’t the best way, but a way that’s open to multiple perspectives. It’s a way that emphasizes that the social dimensions associated with living in a higher body weight carry a lot of significance and probably mean a lot more than just the BMI or the weight on a scale.
01:38:05
Chris Sandel: Definitely. Another one was the weight stigma impact on psychological health. You’ve obviously touched a lot on it just then. Is there anything else you would add?
Dr. Jeffrey Hunger: I think just fully realizing, especially for folks that are a little bit more invested in a medical model, fully realizing the relationship between mental and physical health is really important. I’m sure that’s not something terribly new for your listeners, that mental and physical health are intimately intertwined with one another.
But when we think about examining this relationship between weight and health, or at least weight and physical health, we really need to realize and account for the fact that there’s strong relationship with mental health as well. I think that really changes, or at least it should change, people’s perspective on this “direct relationship” between weight and health.
Chris Sandel: I know you did a paper recently called “Weight-based discrimination, interpersonal needs, and suicidal ideation.” I think there were two studies as part of this paper. This touched on the psychological side of things quite well.
Dr. Jeffrey Hunger: Yeah, absolutely. This is one of the most recent papers out of my lab and was in collaboration with some of my fantastic new colleagues and graduate students, April Smith and Dorian Dodd. We were really interested in the relationship between weight stigma, or in this case weight-based discrimination, and suicidal ideation.
There’s growing research showing that other forms of discrimination – racial discrimination and sexual orientation discrimination – seem to be pretty potent predictors of suicidal ideations and thoughts and behaviors. Across two studies, we find that this is also the case with weight – again, the caveat being this was a cross-sectional survey, so we can’t be certain about the causal direction. But it at least gives us initial evidence to suggest that weight-based discrimination translates into risk for suicidal ideation in part because it escalates depression, and we know that depression is a very potent predictor of suicidal thoughts and behaviors.
It also makes people feel like they are a burden on others, and I think that’s a really important aspect to consider. When we think about wellbeing, we often think – we’re getting better about thinking “wellbeing” in a holistic sense in that we think about mental health and physical health, but what we hope to draw attention to is also thinking about social health, like our social connections, our social relationships.
If one of the consequences of weight stigma is that it’s making people feel like they are a social burden on others, or in some of the other work I’ve got going, makes them feel socially isolated, it adds just another new way in which weight stigma is going to exert all these awful, awful downstream effects.
Chris Sandel: I know the focus on the negative outcomes associated with loneliness is getting a lot more airtime. I can’t remember how many cigarettes a day it is if you’re lonely, but it’s 20 or quite a high number. But just how much of a real problem this is within our society. And if you’re talking about the things that happen when people feel stigmatized, it’s pretty much creating that.
Dr. Jeffrey Hunger: Absolutely. You can imagine weight stigma or other forms leading to a sense of loneliness for a few reasons. One, being a target of stigma and discrimination conveys something about what others think about you. It ostracizes you. It others you. At the same time, you might be motivated to go out less, to engage with people less because you want to avoid being stigmatized. One of the easiest ways to avoid encountering interpersonal stigma is to avoid interpersonal situations.
But then you have this really nasty combination of socially isolating yourself and feeling a sense of social distance and social loneliness because of what stigma conveys. Like you say, that research is just getting more and more compelling. The health risks, the mortality risks of loneliness and social isolation – they’re breathtaking.
That research is, I think, one of the most under-appreciated when it comes to how we talk about psychosocial risk factors. I think that needs to be a much more prominent aspect of our conversation. Social isolation is a huge driver of health outcomes.
01:43:25
Chris Sandel: What I want to do just to finish up with what remaining time we have is just focus on some recommendations that you would have. I know this came up in at least the first paper. What could governments and policymakers be doing? What can individuals who are dealing with other individuals and other people be doing? How do we start to leave stigma behind and how can we be better?
Dr. Jeffrey Hunger: That’s pretty much the million dollar question, so I’m glad that we’re ending on that, not opening with it. [laughs] I think, kind of like we’ve alluded to earlier, it starts from the top. It starts with thinking about stigma stemming in part from broader structural and social forces.
Some of those structural forces are things like laws and policies that leave higher body weight individuals susceptible to being fired simply because of their weight, that do not protect them from discrimination in health insurance pricing or other forms of discrimination.
From broader societal representations, if we think about the ways that we are socialized, one of the ways that we’re socialized is through media and things like television. We need to be more critical of the ways that higher body weight individuals are represented in our media. Very rarely do we see fat leading characters on TV or in movies where they’re just living their lives. Either the punchline or the focal point is their weight.
Getting better representation with respect to fat characters just living their lives like normal people, struggling with normal day-to-day life adult things without weight being the focal point, that can help to shift stereotypes about higher body weight individuals. That can help to provide more nuanced representations and get people to empathize and sympathize more readily with their heavier peers or the heavier folks around them.
At the interpersonal level, this is a struggle, but I guess don’t be so shitty to fat people. [laughs] Try to have a more nuanced view on the relationship between weight and health, and try to think about how the comments that you’re making, even if you think they might be positive or might be congratulatory, come off in a way that glorifies thinness or that engages in healthism. Congratulating someone for their weight loss basically reinforces the system that they should be seeking weight loss because that’s when their body is viewed most positively.
So quit those conversations. Quit fat talk around others, quit fat talk around our kids. At the individual level, if we’re getting down to that level of this equation, for higher body weight individuals, know that folks out there see you and realize that you are struggling with things that are embedded in all these other levels that I’ve just talked about. The issue of combating stigma associated with higher body weight individuals should not rest on the shoulders of the marginalized. It should not rest on the shoulders of the oppressed.
Know that there are folks out there that are working to make these changes and hope that we can get these changes happening at other levels, but at the same time, you need to find folks that are likeminded and can be your source of social support, your source of social connection, your source of resistance against this shitty, oppressive system, because it’s not going to change overnight. So you need to find those folks that you can get in your life and that can get you to a place of happiness and joy and appreciation of your body.
Chris Sandel: Nice. For you, when did you find Health at Every Size? When you were getting into all this research, how early on did you find them?
Dr. Jeffrey Hunger: I have known about Health at Every Size for probably 5 or 6 years and have dug into that literature a little bit more and have read really influential papers like Tracy Tylka’s 2014 paper. I’m going to pull up the paper right now because it’s everywhere. They have a paper called “The weight-inclusive versus weight-normative approach to health.” A lot of what we talk about in our 2020 paper is rooted in papers like that.
So I came to this earlier. I don’t think I came to a place of fully realizing the power of the way we talk about these things or the power of language or the power of standing up for and centering fat bodies in this conversation until about 4 years ago.
You can see that in the language that I use in the 2015 paper. I’m mortified by some of the phrasing in there, the way that I talk about higher body weight individuals or the way that even weight loss is talked about to some extent in there, or the way that it loosely phrases weight gain as being associated with poor health. You can see the ways that my language has changed over the past 5 years, and that really corresponds with my engagement with the Health at Every Size movement, my engagement with a weight-inclusive approach, and my stronger engagement with a social justice orientation.
I think when I was a younger graduate student, I was that person who wanted to act like science was unequivocally objective and I was just standing there on the outside watching it go by. That’s just not true, and I’m starting to stand in that a little bit more, starting to realize my own positions in this as a researcher and as someone invested in eradicating weight stigma and trying to be a little bit more conscious and cognizant of the ways that we go about talking about these things, if that makes sense.
01:50:10
Chris Sandel: Yeah, it does. Just from your perspective, how hopeful are you of the shifts that you talked about earlier on in terms of the changes that can be made and them actually coming to fruition? If we were to get into the DeLorean, how long do we have to travel into the future before we see that it’s reached a point that those shifts have happened?
Dr. Jeffrey Hunger: Let’s just start by saying I have seen a wild shift in the past 9 years of being really enmeshed in this literature. As someone who has been at the interface of weight stigma in public health and weight stigma in medicine, the conversations that have been able to get into mainstream medical and public health journals when in 2011 and 2012 we were being shut out gives me hope. It gives me hope that we are on the correct upswing.
I also think what happens is now that the researchers are onboard and we’re starting to talk about it more, there’s this shift in the public consciousness about this. We’re seeing body positive campaigns. We’re seeing body positive, no-fucks-given models like Tess Holiday, performers like Lizzo. We’re seeing people really lean into this in the public sphere, so that gives me hope that attitudes will change, and with changes in attitudes, hopefully we’ll see changes in policies and things at both levels.
Folks’ attitudes about these things and representation are at that middle level. Representation and interpersonal attitudes can both negatively and positively impact people downward – because that’s the people that are a target of this bullshit – but then it can negatively and positively impact people upward, who have control over structures and laws.
So I’d like to be hopeful and say that within the next 5 or 6 years, we’re starting to see more protections when it comes to higher body weight individuals in terms of discrimination and things like that. I think Washington state in the U.S. just became the second state to outlaw it at the state level, so that’s at least a little promising. We also have promising models from Reykjavík in terms of strategies to couch this in a social justice orientation.
But at the same time – I can’t be completely ominous; I can still be a little bit gloom and doom, because otherwise, why would you have me on? At the same time, we just saw a reboot in The Biggest Loser – which will finally be named – and it’s terrible. It’s a fat-shaming, weight-stigmatizing, negative attitude-driving shithole of a TV show. And that’s not just me speaking. There’s data on that.
There’s actually data on exposure to The Biggest Loser exacerbating anti-fat bias. There’s plenty of data on the fact that most folks from that show gain the weight back, and that the ways they go about losing weight has just gutted their metabolism and has harmed them in the long term.
Chris Sandel: At some point I had Kai Hibbard on the show to chat about her experience and what happened after she appeared on that show.
Dr. Jeffrey Hunger: I’m glad that that conversation is coming out, because they’re trying to rebrand in the wellness frame that a lot of other folks are. I won’t completely get a bunch of lawsuits at my doorstep and name a bunch of other folks that are doing that, but there are plenty of organizations that are adopting, and co-opting, for the most part, wellness framing in a way that if we don’t push back against it very strongly, very loudly, and very quickly, we’re going to lose a lot of the ground that we’ve made.
Chris Sandel: Okay. So you started positive and then it went a little bit downhill from there. [laughs]
Dr. Jeffrey Hunger: It got a little negative. We have to be realistic, but I do think that if anything, we’re on an upward trajectory if we compare where we are now to where we were 10 years ago when I started.
Chris Sandel: Are you also seeing at the level of researchers, more people are wanting to come into this area of study?
Dr. Jeffrey Hunger: Absolutely. There is growing interest not only in social psychology, but in nutrition and dietetics and public health and interest in weight stigma. We’ve seen Angela Meadows grow the Weight Stigma Conference over the past 5 or 6 years, and we’ve seen funders and agencies actually consider the impact of weight stigma for mental and physical health and do workshops on it, be open to funding it – things that were a very, very uphill battle when I started doing this work in 2011. Especially from funders. It was very challenging to get folks to fund this research.
Chris Sandel: Nice. Okay, that is positive to hear those changes. Is there anything that we haven’t covered? It feels like we’ve been chatting for quite a while and we’ve gone through a lot of what the research covers, but is there anything I haven’t asked you or we didn’t go through?
Dr. Jeffrey Hunger: I think we have had a very comprehensive conversation, and I hope that it didn’t end too much on doom and gloom. I hope that it was enlightening to your listeners, and I appreciate you taking the time to have me on.
Chris Sandel: Thanks. Yeah, I’m glad that I did. It’s been a wonderful conversation. Where can people go and find out more information about you?
Dr. Jeffrey Hunger: The easiest place to find more about my research is just www.jeffreyhunger.com. You can also follow me on Twitter for equal amounts of snark and research, and that is @drhunger. Those are probably the two easiest places.
Chris Sandel: Perfect. I will put that in the show notes. Thank you so much for your time. This has been awesome.
Dr. Jeffrey Hunger: Thank you so much for having me, Chris.
Chris Sandel: That was the episode. I really loved it. Jeff is an incredibly smart guy, and I’m so thankful we had a chance to have this kind of in-depth conversation.
As I said at the beginning, I want to start to mention some things that I’ve been enjoying and that I thought you might too, and there’s just one thing that I’m going to start off with.
My recommendation this week is a podcast called Hunting Warhead. This was recommended to me by a client, and I’m really glad that she did recommend it to me. I’ve subsequently recommended it to lots of other people. It is very me, meaning it is incredibly dark and disturbing, which is often how I like my podcasts and my documentaries. It’s about a child abuse website called Child’s Play that was on the Dark Web and how the police then infiltrated it and were able to make arrests connected to those who were running it.
It is by no means light listening, and the show talks about some rather alarming statistics concerning rates of pedophilia. As a parent, it makes me never want to let Ramsay go to anyone’s for sleepovers or let him ever out of my sight. I’ve had so many clients who’ve experienced sexual abuse during childhood, and these figures really put this into perspective of just how often it’s occurring. It really is frightening.
This show really grabbed me. It reminded me of when I was new to podcasts and I first listened to Serial and I finally understood A) how podcasts could be so good and B) why listening to radio in the 1950s was so pleasurable. I just couldn’t wrap my head around, having always grown up on TV, why people would be wanting to do that and how engaging it could really be. That was the series that really demonstrated to me actually how wrong I was and how gripping audio can be.
Hunting Warhead is well-produced, it’s well-edited, it’s well-paced. It wasn’t stretched out, but covers everything in six episodes, which I managed to blitz through in 2 or 3 days. If you’re into great investigative journalism and are okay with dark topic material like this, then I highly recommend it.
That’s it. As I mentioned at the top of the show, Seven Health is currently taking on clients. If you’re struggling with dieting, with disordered eating, recovery, body image issues, or any of the topics that we cover as part of the show, then please get in contact. You can go to www.seven-health.com/help, and I will catch you next time.
Thanks so much for joining this week. Have some feedback you’d like to share? Leave a note in the comment section below!
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