00:00:00

Intro

00:05:28

What food was like for Ragen growing up

00:07:37

Her relationship to sport as a child

00:10:30

How she developed an eating disorder

00:17:38

Her experience with recovery

00:22:05

How she learned to love her body + how it led to fat activism

00:31:08

Lack of evidence for long-term weight loss effectiveness

00:38:06

Healthism, hypocrisy, + fatphobia

00:47:54

How Ragen deals with online hate

00:52:59

Ragen’s speech on size acceptance + eating disorders

01:00:40

What the reception has been to her speech

01:04:50

Her training for an Ironman Triathlon

01:09:04

How she got into cooking

01:12:36

The ‘vague future health threat’ + ‘everybody knows’

01:15:35

Are people becoming more aware of weight stigma?

01:20:09

“What if I’m wrong?”

01:26:27

My recommendations for this week

00:00:00

Intro

Chris Sandel: Welcome to Episode 241 of Real Health Radio. You can find the show notes and the links talked about as part of this episode at www.seven-health.com/241.

Before we get started, I want to mention that I just reopened my practice to new clients. I specialise in helping clients overcome eating disorders and disordered eating, chronic dieting, body dissatisfaction and poor body image, exercise compulsion and overexercising, and also helping clients to regain their period. If you want help in any of these areas or simply want support improving your relationship with food and body and exercise, then please get in contact. You can head to www.seven-health.com/help, and you can read about how I work with clients and apply for a free initial chat. The address, again, is www.seven-health.com/help, and I’ll also include it in the show notes.

Hey, everyone. Welcome back to another episode of Real Health Radio. I’m your host, Chris Sandel. I’m a nutritionist that specialises in recovery from disordered eating and eating disorders, or really just helping anyone who has a messy relationship with food and body and exercise.

Today on the show, it’s a guest interview. My guest today is Ragen Chastain. Ragen is a speaker, a writer, a multi-certified health and fitness professional, and thought leader in the fields of Health at Every Size and weight stigma, including health care and fitness. Utilising her background in research methods, statistics, and intersectional social justice work, Ragen has brought her signature mix of humour and hard facts to diverse groups, from general audiences to physicians and other health and wellness professionals. She’s spoken at conferences from the Diabetes Education Specialists National Conference to the Montana Population Health Summit to the New England-New York College Health Association National Conference, and more.

She’s the co-author of the Health at Every Size Health Sheets, weight-neutral healthcare guides for practitioners, patients, and advocates, and the editor of the Praeger anthology The Politics of Size. Ragen is frequently featured as an expert in print, radio, television, and documentary film. In her free time, she is a national dance champion, a triathlete, a marathoner who holds the Guinness World Record for the heaviest woman to complete a marathon, and co-founder of the Fit Fatties Forum, which has over 10,000 members. Ragen lives in LA with her partner and her two adorable dogs.

This episode is way, way, way long overdue. I’ve known of Ragen well before I started the podcast and have been a huge fan of her work for years and years. So I’m excited that we finally got to have this chat. As part of the conversation, we talk about Ragen’s background and how she got into writing and speaking about Health at Every Size and weight stigma; we cover her life growing up and the healthy relationship she had with her body and how this then changed, and her time with an eating disorder and then the subsequent years of dieting.

She talks about a number of ‘aha’ moments which led her to then take a different path – one that was in support of her health and her happiness and truly taking care of her body. We cover weight stigma, the different unhealthy activities that we either care to get upset about or we give a pass to. Ragen talks about her experience as a fat dancer and the online trolling that she receives. We talk about weight bias in eating disorder recovery and the problems that this creates, and then also the vague future health threat.

Much of the conversation is based around Ragen’s book, Fat: The Owner’s Manual. It’s a book that I highly recommend you listeners check out, and that’s true irrespective of what size body you live in. You definitely will not be disappointed.

Towards the end of the conversation, Ragen mentions Novo Nordisk and the co-opting of weight stigma that they have been doing over the last couple of years. In the moment, I couldn’t remember the name of the guest with which I’d covered this topic in detail on the podcast before, so I will add it here. It was with Louise Adams, and it is Episode 231.

At the end, I’ll be back with a couple of recommendations of things to check out, but for now, here is my conversation with Ragen Chastain.

Hey, Ragen. Welcome to Real Health Radio. I’m so pleased to be chatting with you tonight.

Ragen Chastain: Hey, thank you so much for having me. I am thrilled to be here.

Chris Sandel: I’m such a fan of your work. Over the years you’ve been referenced on the podcast many, many times, so it’s my error that it’s taken this long to actually have you on the show. I’m super excited to be able to chat with you. I think what I would like to cover – you have a really wonderful book called Fat: The Owner’s Manual that I loved, and I thought we could use this for much of the conversation. There’s also a keynote that you’ve done called ‘Size Acceptance and Eating Disorders: A Critical, Crucial, Core Conversation’. A lot of the clients that I work with these days are suffering with eating disorders, so I’d love to be able to go through some of the information that you cover as part of this talk.

But I’d also like to start by chatting about you, as your own experience is a big part of why you do the work that you do.

00:05:28

What food was like for Ragen growing up

I guess let’s start from the beginning and when you were younger. What was it like growing up in your household as far as food was concerned?

Ragen Chastain: It was an interesting experience. My dad was a cattle rancher for most of my youth, and sometimes he was the manager and sometimes he was a ranch hand. So we really waffled back and forth in terms of the amount of money we had. Sometimes middle class and sometimes quite poor. But always food secure, so very privileged and lucky in that way. But it was an interesting situation.

I was always bigger, but I was also a successful athlete, so I didn’t get a ton of body shaming early on. I think I was protected from that by my athletics.

Chris Sandel: Just so I have a sense of when this was, how old are you? Just so I can date this.

Ragen Chastain: Sure, I’m 45.

Chris Sandel: I’m 40, so you’re five years older. Just knowing whether, did you have internet at school, did you have a phone at school, all of those experiences. That’s going to be a no for both of those things.

Ragen Chastain: Yeah, I was an ‘Oregon Trail’ baby. My first computer that I had was my freshman year of college, but my school had a couple computers toward my junior/senior year I think.

Chris Sandel: What was your relationship with food like as a kid? I know you said it would wax and wane from times of feeling more middle class and times of not having as much, but how did you relate to food as a kid and then as a teenager?

Ragen Chastain: I feel like I had a pretty good relationship with food. Like I said, we were always food secure. My mom had a really good attitude around feeding us. There wasn’t a ton of food shaming hat happened. My dad, less so. My dad was a bit more of a food shamer and that kind of thing, but wasn’t as involved, obviously, in our feeding as my mom was. So I feel like I got to grow up originally with a pretty good relationship with food.

00:07:37

Her relationship to sport as a child

Chris Sandel: Nice. Then you said you were quite a sporty kid. What sports did you play?

Ragen Chastain: We moved around a lot, so I played whatever was available. Volleyball was a constant; I started playing that in fourth grade. I played soccer, I played softball, I was a cheerleader and a cheerleading captain. I did figure skating when we lived in northern New York because that was the sport there. I did dance and musical theatre. So whatever was around. Especially if it had a stage and a spotlight. [laughs]

Chris Sandel: Was that very much part of your identity growing up? Would you have said “I am the active one or the sporty one” or something along those lines?

Ragen Chastain: Here’s the thing. I went to incredibly small rural schools most of my school years. In those kinds of schools, you don’t do just one thing because there’s not enough kids. You’re in the French club, the Spanish club, choir, field hockey, whatever.

Music was my focus – I started playing clarinet in fourth grade, and I decided pretty early that I wanted to do that professionally, and I pursued that and actually ended up going to college on a scholarship to play clarinet. So music was my main thing, but playing sports was certainly a big part of my life.

Chris Sandel: Do you think the fact that you went to those smaller schools meant that you had an easier time in the sport sense? Like if you’d been at a bigger school, you maybe wouldn’t have been picked or you would’ve had more picking on because of your body or something along those lines? I’m just wondering if the size of your school had any impact on you getting away with things that maybe other people didn’t.

Ragen Chastain: It may have been. Especially I think about cheerleading. I was an excellent cheerleader, but I’m not sure that at my size, at a bigger school, I would’ve been supported. I started cheerleading in fifth grade and I was bigger then, so to be supported and to become a captain, I’m not sure that would’ve happened at a bigger school.

But yeah, it’s a benefit and a curse of a small school that you can do a lot of different things and you can excel within that smaller stricture. I would not have been necessarily at the level that I was considered had I been at a bigger school where there was more competition and more kids.

Chris Sandel: Which is then really nice, though, because it means you get to hopefully do sport the way that it should be in terms of it’s about having fun and play and all of that without the same pressures that can then come with a bigger school.

Ragen Chastain: Sort of. Different teams work different ways, but my volleyball team in high school was incredibly competitive, just at the level we competed with other schools our size and slightly bigger. It’s just a little bit different. It’s the same competitive spirit, just on a different scale.

00:10:30

How she developed an eating disorder

Chris Sandel: In terms of you and dieting, when did that come into fruition?

Ragen Chastain: My junior year of high school, my friend’s mom – who I am certain had the best of intentions – took me aside and said to me, “You’re going to lose that extra weight in these next couple years, right? You don’t want to go to college fat, do you?” That started a cascade. I hadn’t really thought much about losing weight prior to that, and pretty soon I didn’t think about much else. I started eating less and less and exercising more and more, and it actually devolved into an eating disorder between my senior year of high school and my freshman year of college.

Chris Sandel: Were you, as part of that, getting compliments? From the outside, were people really praising you for what you were doing?

Ragen Chastain: Oh, definitely. I got the most praise during the times when I was the sickest and the most involved in harmful behaviours.

Chris Sandel: From your parents as well?

Ragen Chastain: It wasn’t really a huge topic with my parents. It was more friends and people at the gym. Not just praising my body size, but praising my dedication. I became a fitness instructor. I got certified so that it would make sense that I was at the gym the amount of time that I was, like as a cover for my behaviours. I saw that in other folks, too; that was a thing that was fairly common. But yeah, it was mostly from that crowd.

Chris Sandel: How long did it take for you to realise “This is a problem” or “I don’t like where this is headed”?

Ragen Chastain: I collapsed on a treadmill and got taken to the hospital very briefly. My recovery is very atypical in that parts of it were very fast. I gained perspective in that small time and was like, “Okay, no, this can’t go on. This has to stop.” So that recovery was really fast.

I started getting outpatient treatment for my eating disorder, but at the same time, because I was still bigger – even at this time when I was as deep into this eating disorder as I could be and was hospitalised for collapsing, I was still ‘too big’. So I was being told by doctors that I needed to lose weight to be healthy while I was being treated for an eating disorder. Doctors who knew I was in treatment. And I remember one doctor in particular who said, “I mean, don’t go crazy like you did before, but you’re just a naturally bigger person, so you’re going to have to worry about this for the rest of your life.”

Chris Sandel: Which is horrible, horrible advice.

Ragen Chastain: Yeah, absolutely the worst thing. What I wish I could’ve heard was “You are a naturally bigger person.” That’s the kernel of truth in that total disaster. But I did not hear that at all.

Chris Sandel: Did you have people in the eating disorder team who were either saying “I don’t think she really has an eating disorder” or “I don’t think you really have an eating disorder” or anything from that? Or was it the eating disorder team really had your back and it was the doctors who were giving this other information?

Ragen Chastain: They didn’t so much have my back as they wanted me to separate these two things. They were like, “Right now, you need to focus on your recovery”, but the idea was once I was recovered and in a better place, then perhaps there would be some ways for me to lose weight to be healthy. So it was never like weight loss was off the table; they weren’t coming from a Health at Every Size perspective. They were just saying, “For right now maybe don’t diet since you’re like two minutes out of your full-blown eating disorder.”

Chris Sandel: Wow. Which is, again, just such a horrible message of “You can do this now, but what’s waiting for you around the corner is going back to the ‘light’ version of what you’re doing.”

Ragen Chastain: Exactly. Much later, Deb Burgard, who’s a brilliant therapist and activist in size acceptance and Health at Every Size, said, “They prescribe to fat people what we diagnose and treat in thin people.” When I heard her say that, it really clarified that whole period of time for me and let me really see that for what it was.

Chris Sandel: This is a thing whenever I’m working with someone with an eating disorder. I’m very much up front about, I am at no point ever going to say “You need to go back to restriction” or “You’ve had too much; now we need to rein it in” or anything along those lines, because I think that is such a fear for so many people. And given what you said, it’s not just a fear for many people; it becomes a reality of what’s advised for many people. I’m really explicit, I don’t want to ever be the person that is giving you that message.

Ragen Chastain: Yeah, I think that’s so important. It’s unfortunately incredibly common for people who are higher weight and dealing with eating disorders to experience fatphobia in treatment. I was reading someone talking about doing a challenge food with ice cream. Everyone had to eat two scoops of ice cream, and she was told, “You’re going to get a baby scoop.” So literally they were restricting her food by force, publicly, in a way that was so super clear that she should still restrict because of her size – in eating disorder treatment. The amount of weight stigma that drives eating disorder treatment for people with higher weight is a huge problem.

Chris Sandel: I completely, completely agree. And what was your diagnosis?

Ragen Chastain: At the time, it was the whole EDNOS diagnosis, eating disorder not otherwise specified, because I didn’t meet the weight requirements for any other diagnosis. You had to be at the time a certain amount ‘underweight’ to get specific diagnoses, and I was not ‘underweight’, so I was just EDNOS.

Chris Sandel: Today, do you think they would’ve given you the diagnosis of anorexia atypical?

Ragen Chastain: I think they may have given me the diagnosis of atypical anorexia. It was a bit more complicated because I used both food restriction and compulsive exercise, so I may still be diagnosed not with a specific diagnosis. But I just remember them telling me, “You don’t meet the weight qualifications to get any other diagnosis.”

Chris Sandel: Which, again, is just such a horrible thing. I work with clients all across the weight spectrum, and they’re all going through the same stuff. It’s the same thing. It’s not that the person in the higher weight body is having an easier experience or that they’re binging or any of those things that people naturally assume.

Ragen Chastain: Yeah. And the idea of atypical anorexia is so upsetting to me because the only reason it’s atypical is because they’ve ignored anorexia for so long in higher weight people. It’s not atypical. They should call it ‘against our stereotype anorexia’. That would be a more honest diagnosis.

Chris Sandel: I completely agree.

00:17:38

Her experience with recovery

So what did your recovery look like, then? Were you working with that eating disorder recovery centre? Was that the bulk of it, or what happened after that?

Ragen Chastain: My treatment was completely outpatient. I was working with a group therapy situation. That was fine. But like I said, my recovery mentally was pretty quick and pretty solid because within probably six months of starting treatment, I went on a doctor-recommended diet, and I spent years then doing diets. I had the experience that I later learned almost everybody does, which is I would lose weight short term and gain it back long term. But I was incredibly lucky not to ever experience a full relapse.

It became enough for my disordered eating brain to control my food to that extent and to be clear, “This isn’t disordered eating because my doctor prescribed it. This isn’t like what I was doing before.” And some of the things that were prescribed were very extreme. In one case it was a bit less food than I had been eating for a lot of my eating disorder, but I wasn’t allowed to exercise on that particular medically supervised programme. So it was a process of allowing my eating disorder brain to keep being supported within diet culture.

Chris Sandel: Which is then really hard because, as you said, it’s getting the seal of approval from a doctor or from someone who should know better in terms of what they’re recommending. For you to then say “I don’t think I should be doing this” is quite a step. You obviously got there, but it doesn’t surprise me that you ended up back in that place when that’s being recommended from people who have that authority.

Ragen Chastain: Exactly. And you’re being told, “If this isn’t working, it’s because you’re not doing it right.” Like, “I had an eating disorder. I can measure a quarter cup of rice. I’m doing this right. I’m doing exactly what you’re telling me to do and I’m gaining this weight back.” So it was really frustrating, and that’s actually what led me to do the literature review that pulled me out of it – this experience I was having where I was like, I’m doing everything right and it’s not working.

Some doctors would be like, “You’re obviously not trying hard enough” or “You need to do more.” And my experience with eating disorders at some point stopped me from saying – because “Oh, if you’re not losing weight, just do more exercise.” It’s this idea of eat less and exercise more as blanket advice no matter what you’re eating or how much you’re exercising. So I think actually having been diagnosed helped me see that as like “I’m not going to go down that road.”

Then some doctors would say, “Yeah, most diets fail, but you just have to find the right one.” So I was like, “Okay, let’s try something else.” I got stuck in that cycle for a long time.

Chris Sandel: You said the literature review. What happened as part of that experience?

Ragen Chastain: I got really frustrated and I decided – first, I had this experience in this medical centre where I wanted to quit and they told me I couldn’t quit. They were like, “Aren’t you tired of hating your body?” I was like, “My God, yes. I am exhausted from hating my body. I’ve been doing it like it’s a job and I haven’t gotten any thinner or healthier or happier, so yeah, I am.” I did quit, and I decided I was going to learn to love my body first, and then I was going to lose weight to be healthy, but I decided I was going to separate these two journeys.

So after my process of learning to really love my body and want to support it and see it as a friend, I decided to lose weight to be healthy. And my background is research methods and statistics. I was like, “You know, I never looked up a single study on any of these diets, so I’m going to do a literature review and I’m going to figure out the best diet, the one that works the most, and that’s what I’m going to do.” So I started reading all of these studies.

At the end of the literature review, I was so shocked by what I found that I went back and I did the whole thing again because I thought I must have missed something. What I found was there was not a single study – not even one – where more than a tiny fraction of people were succeeding at long-term significant weight loss. Success was often 5 to 10 pounds, which I could lose 5 pounds right now with a loofah and a haircut. I don’t need two years of Weightwatchers to make that happen.

So that was what finally pulled me up, because I was like, “Okay, I’m a fan of math and logic and science, and this is obviously not what’s right. What is there?” That’s what took me to weight-neutral interventions.

00:22:05

How she learned to love her body + how it led to fat activism

Chris Sandel: Which I want to talk about, but you breezed over something there that I think is super important, where you said, “The first step was I wanted to learn how to love myself and not hate my body”, etc. How did you do that? What was that path?

Ragen Chastain: I left that clinic and I sat in my car, and I was like, “I have no idea how to do this. I’m going to do it, but I don’t have the first clue.” I was trying to think about a place to start, and it hit me out of nowhere that I had spent so much time hating my body for not looking like a Photoshopped picture of someone else that I had not had a second’s worth of gratitude for what my body did for me.

I drove home and I got out a college-ruled notebook and I started writing down every single thing I could think of that my body did for me. And I got granular, like breathing and blinking and heartbeat and waste management and smiling, blinking, waving, everything. Then I became very conscious of my thoughts around my body, and any time I had a negative thought, I would replace it with gratitude for something from the list. Literally anything. I could be like, “Oh, I hate this body part” and then I’d be like, “No, no, I love it”, and if I couldn’t get to a place where I could be like “I love this body part”, I would just be like “Oh, thanks for breathing. You’re doing a great job breathing.”

It sounds hokey and it probably is hokey, but within a period of probably three-ish months, it really fundamentally changed my relationship with my body.

Chris Sandel: Wow.

Ragen Chastain: At the time, I did not know that there was a size acceptance or Health at Every Size community out there. It wasn’t quite like it is right now with the internet, so I just wasn’t aware. So I was just doing this work on my own, making stuff up. But doing that and then I started to ask questions about, “Where did I get these ideas about my body? Who profits off me having these ideas about my body?” and getting mad about that.

I’ve always been really social justice minded. I led my first protest in kindergarten. As a queer woman, I’ve done a ton of queer and trans activism in college. So I had that framework, but I had not yet applied it to body size.

Chris Sandel: Prior to that lady making that comment about “Are you going to lose that weight before you head off to college?”, how would you have said you thought about your body? Was it up until that point you had had a pretty good relationship with your body and you’d spoken to it kindly and been fine about the size of your thighs or your arms or whatever? Or no, you’d never really had a great relationship with your body?

Ragen Chastain: I definitely was aware that I was bigger than I ‘should’ be. And every once in a while, if I had a bad practice or something, a coach would be like, “Maybe it’d be better if you lost some weight” or whatever. But I also really appreciated my body. I was pretty successful in my own personal athletic endeavours and with the work I was doing playing clarinet. So I would say I had a pretty good relationship with my body. I was aware that it was not what people wanted it to be, but I also – and my mom was more like, “Wait and see. You never know how tall you’re going to get.” 5’3” is the answer to that, by the way, so not that tall. But yeah, I feel like I had a pretty good relationship with my body.

Chris Sandel: So for you, rather than starting from the ground up and trying to create something that had never been there before, it was more finding your way back to a place that you had inhabited for quite a while.

Ragen Chastain: Yeah, and really being a little bit to see, “Oh, there’s been this judgment on my body this whole time and I don’t have to participate in that.”

Chris Sandel: Considering you said, at least to your knowledge at the time, there wasn’t a size acceptance movement, there wasn’t a Health at Every Size, how easy was it for you to get your head around that? It’s one thing to say “I shouldn’t judge my body”, but it might be very difficult for someone hearing that when the whole world is doing that to them.

Ragen Chastain: What happened was this dance stretch. I started competing in ballroom dance, and I really thought the judging was going to be about my dancing. I’m not sure how I came to it with that level of naivete, but I had a background in dance, so I was good. I was a newcomer to ballroom dance, but not to performance. I got a lot of crowd support because I would smile and wink and involve them in dancing. So I really had a great time.

And then I had judges say things to me like “What a waste of talent at your size” and things like that. Then after one competition where I was sick, I was done competing, I was trying to get back to my hotel room and I felt like crap. I’m carrying all of my dresses and makeup and shoes, and this judge came storming at me and sort of pinned me against an elevator and said, “I couldn’t stand to look at you.” I had that moment like, do I go off on this person or just let it go? I was tired and sick, so I said, “Okay.” She said, “I couldn’t stand to look at you.” I said, “Okay.” She put her finger in my face.

Her problem with me was that my gown for waltz had spaghetti straps, so my arms were out. So she put her finger in my face and was like, “You have no business wearing spaghetti straps!” I was like, whoa. She said, “I talked to your coach and he said I could talk to you about this.” I was like, “I’m almost 30. You don’t have to ask permission to talk to me. In truth, I probably won’t choose to change the dress, but I appreciate you taking the time to tell me it’s such a problem for you.” I don’t know where that came from. But she stormed off, and in that moment, I was like, “Oh, this isn’t just a me thing. This is how fat people get treated, and this isn’t okay.”

So I had this shift. I was thinking about this entire thing as a personal journey. I had done this literature review. I had not talked about it publicly. I was a business operations consultant at the time. So I was just like, “This is my personal journey.” I wasn’t really envisioning that fat people are a group of people who are systematically oppressed, even though I was clear about that for myself as a queer person. I had that moment of like, “Okay, this isn’t a me journey. This is a thing that’s happening to fat people.”

That is when I started my blog, Dances with Fat. And very embarrassingly, in the first post – again, did not know there was a whole community who had been doing this since long before I was born, so the posts are very like “I’ve discovered this thing!” It’s ridiculous. But yeah, that moment, I just wanted to be a fat dancer, but I realised I was going to have to be a fat activist to get that done.

Chris Sandel: Which is great that that horrible situation then lit a fire within you to do something about it and then became a bigger thing than just about you.

One of the things I often say to clients is the opposite of that in that, don’t feel that you have to then become an activist for this. Often when someone’s in the early stages of recovery, there can be the feeling of like “And now I’ve got to take on the whole world.” It’s like, you just do you, you get through this, and at the end of this, if you want to make this your mission and your calling, fine. And if you don’t, that is completely okay as well, because I don’t want that to be the thing that gets in the way of someone actually getting to a better place.

Ragen Chastain: Absolutely. Activism speaks to me just because that’s who I’ve always been, and also, I have a ton of privilege. As a white person, as a cis person, currently neurotypical, currently able-bodied, and on and on and on. Part of the way I use my privilege is to really engage in activism to deal with the trolling and all of that, because the reason that people are activists is so that people don’t have to be activists. You shouldn’t have to gear up for a doctor’s appointment. You shouldn’t have to fear going to any body of water in a swimsuit. You shouldn’t have to engage in activism to live the life you want.

So the reason that I do activism is because hopefully someday, as part of a huge community of people doing this work, other people will never have to do it.

Chris Sandel: Yeah, and I think that is incredibly admirable. And you have a real skills with doing this in terms of the way you’re able to write, in terms of the way you’re able to speak. So I’m glad that you are on the front lines doing this.

Ragen Chastain: Thank you so much. I often say I have a dream job that I wish didn’t exist, which is to say with the world as it is, this is what I want to be doing. And I’m, again, very privileged and lucky to get to do it, but also, I wish that I could just go be a mediocre stand-up comedian somewhere and this work wasn’t necessary.

Chris Sandel: Well, maybe in your twilight years.

Ragen Chastain: [laughs] Yeah, there’s still time to be a mediocre stand-up comic any time.

00:31:08

Lack of evidence for long-term weight loss effectiveness

Chris Sandel: Let’s come back to the second part where you talked about the literature review and the evidence not really being there for weight loss. Can you talk a little more about that?

Ragen Chastain: Sure. The first thing I found out was this evidence doesn’t support weight loss as any kind of ethical evidence-based intervention for anything, and the second thing I asked was, how did we all get so fooled by this?

What typically happens is almost everyone can lose weight short term within about one to two years, and then almost everyone gains it all back long term, with up to 66% of people gaining back more than they lost. The weight loss industry knew that. In fact, if you go and look at Weightwatchers’ original filings, they are clear that they are a repeat business model. What they have done, brilliantly, is to take advantage of a biological cycle.

Your body’s first response to food restriction is to lose a little weight short term, but then your body is conditioned to survive, so it’s like, “I’ve got you. I’m going to make changes. I’m going to become a weight-regaining, weight-maintaining machine.” And that’s how people gain it back. So what the weight loss industry has done, brilliantly, is take credit for the first part of that biological response where you have the short-term weight loss and then blame people and get them to blame themselves for the second part of the biological response where they regain the weight, and then get them to come back to do that cycle again.

Chris Sandel: I think the thing is, because it can take time to have the weight regain, when people look around they’re able to say, “Mary’s lost weight and Tom’s lost weight” and you can see all these people around you who have lost weight, and that gets embedded in. It’s the equivalent of going to Vegas and not really understanding that everything is completely stacked against you, and yet there might be someone who wins big, but it’s not actually what happens for the vast, vast majority of people.

Ragen Chastain: Oh my God, I love that metaphor. I’m stealing it, with credit of course. Yeah, we have this culture where we praise weight loss, so everybody during their short-term weight loss is posting all their before and after pictures and their daily weigh-in and all of this stuff. Nobody posts their weight regain journey, or very few people. People tend to then withdraw.

What happens is, during this short-term weight loss, what they learn is that every single person they know and some randos on the internet like them better when they’re thinner, feel they’re a better person when they’re thinner. The weight regain, it’s not just the physical issues that come with weight cycling – and there are many – weight loss failure, one of the things that bothers me about this being considered a healthcare intervention is that failure is not benign. Weight cycling or yo-yo dieting is shown to have tremendous negative impacts on the body.

But it’s not just that physical health component; it’s also that psychologically, people are very aware because they’ve just been praised roundly by everyone they’ve ever met for being thinner, that being fatter is not what people like about them.

Chris Sandel: Yeah, the whole internalised and externalised stigma about this is, from my perspective, what is causing a lot of this health damage that is talked about as being from being overweight.

Ragen Chastain: And weight stigma itself – Peter Muennig out of Columbia did a series of studies; unfortunately, he only looked at cisgender women, but cis women who feel fine about their size have less physical and mental illness than cis women who feel they are too large regardless of their size. He also found that the stress of constant stigma was correlated with the same health issues to which being fat is correlated. So stigma itself is a problem. I do a lot of talks for public health professionals and students, and it’s one of the things I talk about. At the very least, interventions that are supposed to increase public health shouldn’t decrease public health. And weight loss messages are inherently from a basis of weight stigma and thus are decreasing public health.

Chris Sandel: There’s also great research – I’ve had Jeffrey Hunger on the podcast before, and him looking at so much relating to weight stigma. But there was a great bit of research looking at what people think of their own weight and whether they feel that they’re in a higher weight body or a lower weight body. And actually, what matters more isn’t the reality of the situation; it’s their perception of the situation.

You talked earlier about people praising people for weight loss, and that’s such a horrible thing, again, for people with eating disorders, but even for people who are just doing the regular weight loss merry-go-round, because you just don’t know what is going on with someone’s life. I had a conversation with a client recently, and she was praised for weight loss, and her response was, “My pet just died.” I was like, “I’m so glad that you were able to say that to people because I’m hoping that will then mean that the next time they find themselves in that situation, they’ll think better than making a comment.”

Ragen Chastain: Yeah. I had a blog reader who had someone tell her, “Whatever you’ve been doing looks great on you” and she’s like, “Yeah, stage IV cancer.” Praising weight loss is so dangerous, because like you said, you never know what you’re praising. Are you praising grief? Are you praising an active eating disorder? Are you praising a health issue? But even if a person is actively trying to lose weight, I’m still not going to praise that, because what I know is that 95% or greater chance they’re going to gain that weight back.

So whenever somebody’s before & after comes across my Facebook feed, I always say, “You look amazing in both pictures, and if you’re among the vast majority of people who gain back all their weight, just know that you’re valid and worthy at any size.” That is not often taken well by the person, or their friends and family who are supporting their current weight loss. But I just want to be one comment that when they gain the weight back, they know one person said, “You’re valid and worthy at any size, and this is an experience that almost everybody has. It’s not your fault.”

Chris Sandel: Yeah. I think it’s great that you’re able to make that comment. And I wonder how many people that actually sinks in as a helpful comment.

Ragen Chastain: I hear from people, I really do. I heard from someone, an old friend who had been going on a weight loss attempt, and I had made that comment. Reached out to me and said, “I gained all the weight back. I remember what you said, and I know I blocked you. I’m sorry.” We got back in touch and had a beautiful conversation. But I do hear from people who say, “I remember you saying this, and it really is helping me now.” So I keep saying it.

Chris Sandel: Awesome. That is really nice to hear. For listeners, please say the same to your friends.

00:38:06

Healthism, hypocrisy, + fatphobia

One of the things from your book – and this is something I’ve talked about many times before, but I really liked the way that you spoke about it in terms of we pick and choose which unhealthy activities we get upset about people having. So often much of this, especially around weight, is about speculation in terms of we speculate that they eat unhealthy food or we speculate that they do unhealthy things, and yet we know nothing about whether that’s the truth. And also, there are so many other things that we do know that are unhealthy that we just don’t pick on people about.

Ragen Chastain: Yeah, it’s an interesting thing. First of all, I always want to be clear: health and fitness by any definition, these are amorphous concepts. They are not an obligation, they’re not a barometer of worthiness, they’re not entirely within our control.

But it is interesting – in the United States, we’ve got American football, and this is an activity that is basically co-ordinated around the idea of athletes risking their short- and long-term physical and mental health in the hopes that they’ll someday score enough points to win a trophy and a ring. This is a billion-dollar industry and people paint their houses the colours of their favourite teams. And other sports as well, rugby, football – we call it soccer here in the States – this is common. Athletes get this pass, but fat people are told, “You’re not prioritising your health.”

An example is fat people being refused knee surgeries because they say, “Your lifestyle created this problem. If you continue to be fat, it won’t last as long” – as if simply getting someone out of pain isn’t good enough; they have to have the exact same outcome as a thin person to deserve to be out of pain for any amount of time. It’s ridiculous. But then you look at like a basketball player. Shaquille O’Neal got knee surgery, and he for sure caused his knee injury, and he was going right back to the lifestyle that caused it. But we celebrate that.

So there’s a real hypocrisy where people use healthism and ableism as a way to try to justify their fatphobia.

Chris Sandel: I think there’s total hypocrisy with it. Even if you move outside of the realm of health and fitness in terms of people working 60-, 70-, 80-hour weeks where they don’t necessarily need to – I’m not talking about someone who is trying to support a family with three jobs and that kind of thing, but someone who has no need to be doing that can be potentially causing themselves health issues by working in that way, and then they are completely praised for doing that.

Ragen Chastain: Yeah, there’s a CEO – I cannot remember for the life of me the name of the company, but he was criticised for how much money he made and how little the company paid to its employees, and he said, “You don’t understand how high-stress this job is. I have literally wept at the stress.” And first of all, the comment on Facebook was like, “Raise your hand if you’ve literally wept at a $40,000 a year job or less” and everybody’s hands would go up, of course. But also, this is a person choosing what he is acknowledging as a high-stress job, which has health implications. He doesn’t have to do that job. And yet we praise and support people who want to take on high-stress jobs.

And again, I think people should be allowed to do the job they want. I think they should be well-paid no matter what they do. I think everybody should have a thriving wage and paid vacation and incredible life. So I’m not saying if somebody wants to be a high-stress lawyer, that’s a bad thing. I just really want to point out the ways that there is hypocrisy around people who choose these lifestyles that we know can exacerbate or create health issues and how that is excused, whereas fat people are constantly blamed no matter what they do.

Chris Sandel: Yeah. If it’s a high-stress lawyer who is in a fat body, then they’re going to hear about it. But if it’s a high-stress lawyer who lives up to our society’s standards of what they ‘should’ look like, then they don’t hear anything about it. They’re just praised for excelling in life.

Ragen Chastain: And it creates a situation where medically, there’s a big difference between the kind of care they get. Both of those lawyers, regardless of the size of their body, would likely benefit from information about stress management and ability to take vacations, all of these kinds of things. But the fat lawyer will only ever be told to lose weight. And if they go to the doctor because they’re having symptoms of cardiac issues, they’ll be told that weight loss is the only thing that can help them. Their weight will be focused on, whereas the thin lawyer who’s having those same symptoms will be given ethical evidence-based interventions.

Chris Sandel: Yeah, they’ll be told have they thought about meditation, how much are they sleeping, those kinds of things.

Ragen Chastain: And also, “Hey, let’s do some scans, let’s get an EKG, let’s get a Holter monitor on and see what that looks like”, whereas the fat person will often be told, “Lose weight” without the same diagnostic treatment.

Chris Sandel: There were some sections in the book where there was this real juxtaposition between what someone was being told and the follow-up comments. It was like, “Your body makes you unattractive and unhealthy. You should be ashamed of the reflection you see. Now go take care of your body.” There was quite a number of these, but I really do think it sums this up really well in terms of the vitriol that people are told and then the “And now do something kind and caring about it.”

Ragen Chastain: Yeah, it’s so frustrating. People don’t take care of things they hate. If you get a gift and you don’t like it, you’re not putting it in a place of prestige and dusting that thing every day. So when we tell people “You are morally bad because of your body, your body is a sign that you’re a bad person, that you’re lazy, that you’re weak-willed, hate your body”, and we get that message so much – I did a very unscientific experiment in the early days of my blog where I counted the number of negative messages I got about my body in a 24-hour period. Then I extrapolated that to a year. Again, unscientific, but it was over 360,000 negative messages I would’ve gotten. It’s constant and incessant. So it’s very difficult to tell somebody “You’re worthless” and then say “Now go treat yourself like you’re worthy.”

Chris Sandel: It’s also difficult to think those comments have no bearing on someone’s health, like they are just innocuous and it’s got everything to do with what someone’s eating and if they’re getting enough sleep and if they’re moving, that receiving those comments from people online or in person is not going to have an effect on their health.

Ragen Chastain: Yeah, you can’t fat shame somebody for their own good. That’s not a thing.

Chris Sandel: No, I totally agree. I read Aubrey Gordon’s book recently, and I think hearing her story, it shows how much weight stigma is really a thing and how much that can take a toll on a body.

Ragen Chastain: Yeah. It’s real. So you’ve got your own sense of self that’s being beaten down every day, and then you’ve got a system that’s stacked against you, so even if you want to engage in health and fitness, you go to a gym and the first thing you see is a big wall of before & after pictures that make it very, very clear that they see you as a project and not as a whole person. Within fitness, within health care, there’s such a base of weight stigma.

Trying to wade through that and to have to advocate for every single thing – weight stigma hurts people of all sizes, but it does the most harm to those at the highest weights and those with multiple marginalised identities. Let’s say you go to a gym and the bench doesn’t accommodate you, so you can’t sit down. Or the doctor’s office, the chair in the waiting room has arms and you can’t fit in it. You’re actively being pushed out of this space and being told you’re not welcome.

When this is your day-to-day life, it’s very difficult to engage in self-care. And again, people get to put their own priorities and definitions around their health and fitness. What I want is a world where nobody’s obligated to participate in these things, but everybody is fully welcomed and included.

Chris Sandel: Definitely. Hearing that as well, though, you understand why people feel the need to diet and why they feel the need to change their body, because of the system that we’re living in. And that doesn’t mean that people should do those things; it doesn’t mean that someone can’t live in a fat body and have an enjoyable life. But it really does stack the deck. It makes it more likely that someone goes down that path, and that’s just a horrible situation.

Ragen Chastain: Yeah. What I came to was – I was helped by the fact that I’m queer. I never would compare the two directly because all oppressions come from different places and privilege differently, but I came out in the mid-1990s in Texas, which was an interesting time and place to be out. At the time, the idea of conversion therapy, like ex-gay therapy, was a thing that people really did. And it still is to this day, but it was part of mainstream in a way that I don’t feel it personally now. But I was very clear I wasn’t going to try to be straight to avoid homophobia.

As a fat person, what I came to realise was weight stigma is real. It does real harm. And I had spent at that time years fighting my own body on behalf of weight stigma, trying to appease my oppressors by changing myself. What I decided was that instead of doing that, instead of fighting my body on behalf of weight stigma, I was going to start fighting weight stigma on behalf of my body.

Chris Sandel: That is a good reframe there.

00:47:54

How Ragen deals with online hate

When you went online, when you set up your website, did you have any sense of the kind of hate that you would get?

Ragen Chastain: I actually didn’t have a sense that anybody would ever read that blog. I was writing for six people. One of them was my mom. And then the post I did about the number of negative messages I would get about my body in a year, somebody found that and submitted it to Jezebel, and they republished it and I got 10,000 visits in one day. I’m sure that was the most people who would ever see what I wrote. But I didn’t even have a ‘subscribe’ button. I didn’t have a way to contact me. It was just sitting out there.

So a friend who does SEO was like, “You’ve got to get yourself together here.” Jezebel asked for a follow-up piece, and that’s how my blog got known. But I also was just not aware of troll culture in the way that there were large groups of people who just sat around and harassed people. So yeah, that was a surprise.

Chris Sandel: And from a self-care perspective, how do you deal with that? At this stage it doesn’t affect you, and it did in the early days? Or where are you at with this?

Ragen Chastain: It was always surprising – again, I think because of the privileges that I have, it was never something that was going to make me stop. I had dealt with hatred in other civil rights work that I had done. I, again, wasn’t thinking – I hadn’t really experienced online hate where 5,000 people in one day send me horrible messages and emails and stuff.

I’ve dealt with it various ways. Sometimes I deal with it with humour. If they’re particularly creative, I’ll talk about it and give my pithy commentary. A lot of times I just ignore it. They used to be foolish enough to – they would all click on anything that I wrote, and that was amazing because I would get huge reader numbers. They actually helped me to get a lot of writing opportunities because of the amount of traffic I would get. And at some point, finally, after years, they wised up and now they keep their own archive of my work so that they’re only clicking on things one time. So that was helpful.

Mostly I just ignore them. Compassion is hard, but I try to pity – I can’t imagine what would have to happen for my life to devolve into being a person like that. So I try to work on that. I wrote a piece for a publication called Better Humans about dealing with online trolls, and that was really helpful and cathartic for me, too, to be like, “Here’s what I learned” to hopefully help people.

And like I said, I have a lot of privilege. Every second that they spend harassing me is a second they don’t spend harassing someone else who may not have the privileges that I have and who may be more harmed by it. So go ahead.

Chris Sandel: When I read about some of the stuff that you receive and also that others receive, it is always like, who is spending the time doing this? I’m always struggling to find time in the day to be able to do all the things that I want to do, and to be like, “This is how I’m choosing to spend my time” – yeah, it blows my mind.

Ragen Chastain: I call them my ‘there but for the grace of whatever’ fan club, because if you spend that kind of time on me, you’re a fan. I don’t care what you’re saying. And it’s more like a fan fiction club, because there’s a lot of writing about me that’s like there’s a grain of truth and then a whole bunch of made-up stuff. But yeah, it’s interesting.

I want to be clear, too, it has gotten scary. There have been threats, credible threats. They’ve shown up to events that I’ve been at and harassed me and taken photographs of my family and friends. It’s not all hilarious. But again, I just know that whatever they do that stops me, they’re going to do that every time. So if they make a death threat on a speaking event and I don’t speak, then they’re going to do that every time I have the opportunity to speak. So I just know I need to keep pushing past that.

Chris Sandel: But just you saying that, that someone’s put a death threat on you speaking, demonstrates how insane this really is. You’re talking about how we can give people unconditional love and acceptance and how we can give people genuine information about dieting and about weight loss and all of these different things. It is just incredible how much that stirs up in people.

Ragen Chastain: Yeah. And with everything in the world – I mean, you look at oppression, racism, poverty, all the things in the world that you could get that kind of excitement about and put that kind of work into. There’s a group that has over 6,000 people online, and all they talk about is me. Can you imagine? My mom found them and she was like, “I don’t know if I should be horrified or impressed.” I was like, “Yeah, same.”

But imagine, 6,000 people with that kind of time on their hands. Why aren’t you working on an atrocity? Why are you coming for me for saying I want people to be able to love themselves and access the world? That is unhinged.

Chris Sandel: It is. It really is.

00:52:59

Ragen’s speech on size acceptance + eating disorders

I want to talk about the keynote speech that you do on size acceptance and eating disorders. Are you able to give a little bit of what’s included as part of that talk?

Ragen Chastain: Sure. That was a talk I created for MEDA and then gave at a number of different places. Basically, what I wanted to look at was the ways that weight stigma is deeply embedded into eating disorder treatment culture. There’s a lot of ways – I had my own experience around that; there’s also the culture that surrounds it. We’re telling people to focus on their recovery in a culture that tells them that being thin by any means necessary is completely reasonable. And a lot of that is the way fat people are treated.

Going back to the ice cream cone story, when someone in eating disorder treatment sees that if you’re fat, you get less ice cream, that is simply going to reinforce their ideas about food restriction. And when the world is saying “Don’t get fat” – when it’s reasonable to create a surgery that takes a perfectly healthy stomach and surgically mutilates it to put it into a disease state to force behaviours that mimic eating disorders as a ‘treatment’ for being fat, then those eating disorder behaviours seem pretty reasonable to people.

So there’s that piece of it. There’s the fact that many people who are involved in eating disorder community have deep-seated weight bias themselves. People who are in treatment will be told, “We’re going to treat your eating disorder, but I promise I won’t let you get fat.” First of all, that’s not a promise you can make. Second of all, let’s not reinforce that fat is a bad thing to somebody dealing with an eating disorder. This is incredibly common.

These things are nuanced and difficult, but we’re not navigating them in a way that doesn’t reinforce weight stigma and thus reinforces eating disorder behaviours. The premise of the talk is that a size acceptance and weight-neutral healthcare paradigm are the only paradigms that can actually prevent eating disorders and can create a world where full recovery is much easier than it is now. For some people, full recovery is impossible because of weight stigma and because of our weight-based health paradigm.

Chris Sandel: Yeah, I’m in complete agreement with you on that. I do think that within the larger, wider world, there is so much weight stigma and weight bias and all of that, but it shouldn’t then be in eating disorder treatment. The problem that I have, so often, when working with clients is they’ve gone to inpatient, outpatient, they’ve tried so many different things, and it’s a real crapshoot of what someone gets when they sign up and work with different teams and all that because so often it is as you described. It is where there is this real bias in there. It is people giving advice that really they should not be giving to someone with an eating disorder.

Often, when I hear it, it sounds a lot like the people who are giving out this advice need to do their own work around food and body and their own relationship because that’s how it’s sounding. But when you tell that to someone who’s in the depths of an eating disorder, it’s just the worst possible thing that can be done.

Ragen Chastain: And again, harms people of all sizes, does the most harm to people with eating disorders in higher weight bodies who have a harder time getting diagnosed, who have a harder time being believed. I know people who literally reached out to their doctor for help and said, “I have an eating disorder. I’m not okay” and the doctor said, “Why don’t you just keep doing what you’re doing till you get down to your goal weight and then we can address it?” Like, you could die before then. Eating disorders are deadly to people of all sizes. That is, to me, the way this harm just keeps getting perpetuated.

And I absolutely agree, the doing your own work piece – there’s a part in the talk where I ask people to think about a series of questions, and they tend to feel pretty confident through the first ones about “How do you feel about bodies of all sizes?”, but then when I ask “How do you feel about if you personally gained a lot of weight?” – that’s where you can start to see your own internalised bias.

People will say to me, even within eating disorder community, people who are involved in treating eating disorders will say, “You’re so brave. I couldn’t do it if I were you.” They really honestly believe that’s a compliment. “If I were your size, I just couldn’t do anything, I don’t know how you manage” is not a compliment. It is an admission to me that you are coming from a place of deep-seated fatphobia and you have a lot of work to do. I’ve been there. I still am constantly scanning for internalised fatphobia. But we have to commit to that work.

Chris Sandel: Yeah. It can be challenging sometimes having these conversations with clients because I’m a guy who’s lived in a thin body my whole life. I’ve never struggled with an eating disorder. So I think sometimes I come up against the “What would you know? You don’t know how it feels” type thing. But I do genuinely believe that if my body changed and I was in a larger body, I would be okay with that. And part of that is because I put so little focus on that part of my life in that I eat in a way that I enjoy. I do sports and activities that have no bearing on the size or shape of my body, and that’s not my focus. I’ve really tried to make it something that is not so crucial to who I am and my identity and all of those things.

And look, I will never know until that happens or if it happens, but I feel like I’m fairly confident in that, and that’s the message I’m always wanting to get across to clients. What you weigh is the least interesting thing about you. Let’s find out the things that are interesting about you. Let’s find out the things that you are interested in. Where do you have strengths? All of those things, because that’s where we should be putting the focus.

Ragen Chastain: Yeah, and I think it’s also really beneficial that you help connect people with people who are higher weight and who are doing this work, fat activists and fat people within eating disorder recovery work, because having that kind of role model is so important. And also having the understanding – this isn’t just about a personal experience. It’s also about moving in and out of an oppressed group and the realities of that.

Chris Sandel: Totally.

Ragen Chastain: There’s the personal thing of “If my body changed, how would that affect my day to day?” within myself, but there’s also, “How would becoming a member of an oppressed group affect my access to life, affect my ability to do the things” – because one of the things that privilege does is it puts us in a situation where we don’t know what we don’t know unless we’re really doing the work of reaching out, of listening to what people who are having those experiences are telling us and internalising that and understanding that. That’s something I think with the podcast and your own work, you do, and is so important – to understand that part of privilege is not knowing. So I really appreciate all the work that you do to help get those of us who are in fat bodies out in front of different audiences and to be able to talk about this.

Chris Sandel: Totally, and I’m constantly recommending books and podcasts, and to hear all other people’s experiences.

01:00:40

What the reception has been to her speech

In terms of giving this talk, what was the reception when you’ve given this keynote?

Ragen Chastain: The first time I gave it at MEDA – MEDA is the Multi-Service Eating Disorders Association. It’s a national conference, and it’s based out of Boston. They do incredible work and have for a long time and are involved with people like Lisa DuBreuil, who has been doing this work at a very high level for a very long time. So they do this national conference, and I gave a workshop and then they asked me to do a keynote.

It was incredible. It was the first time I’ve ever gotten two standing ovations for the same talk. I got one at the end of the talk and one at the end of the Q&A, which was really incredibly sweet and powerful. The only people who didn’t stand were the people who owned eating disorder treatment centres because I had talked about how unethical it is to own both an eating disorder treatment centre and a weight management centre, where in one building you’re prescribing the exact same things that you’re treating in the other building, to bring back Deb Burgard’s idea. So they were less than pleased.

But that’s been the reception consistently. People who are involved in eating disorder treatment – they get it, they have light bulb moments, they continue to connect with me. I have talks that I gave in 2009 where people are still in touch with me about their work. 2009 being when I started doing this. But yeah, the reception was great. I’m sure there were people who disagreed, but the feedback I got was incredibly positive. Once I gave it at MEDA, I was asked to give that talk a number of other times in different places.

And I’m just one, I want to point out, of many people who are doing this work, many of whom have been doing it before I was doing it or doing it with less privilege than I have. So my work stands alongside and behind and on their shoulders as well.

Chris Sandel: Nice. You said you didn’t get the standing ovation from the eating disorder clinics. Have you been invited in to have more of a personal conversation with any of them? Has that happened at all?

Ragen Chastain: In some cases, but not in the cases of the folks – I’ve never been invited into an eating disorder treatment centre that has both an eating disorder component and a ‘weight management’ component.

Chris Sandel: Which I guess makes sense given your message, but hopefully they’ll at some point take it on board and get rid of the weight management wing.

Ragen Chastain: Yeah. This is why it’s important that there are a lot of us doing this work in a lot of different ways. There are people who do the work much more subtly than I do who may be able to get the ear, to make incremental changes. I do not do the work subtly. I say it is antithetical to ethics to do this. You cannot ethically have a weight management component of your eating disorder treatment centre. You can’t sell weight loss and eating disorders treatment at the same time. So I’m not surprised that they don’t call me, and that’s okay. There are other people doing the work, and we’re all doing different parts of the same big work. I’m just doing my little piece of it.

Chris Sandel: I have the same feeling as you do. A client sent me over the Instagram of someone they were following online and said, “I really like this person.” I went and checked out their site, and alongside working with eating disorders, they also do weight management. I was like, this is an instant red flag. I can’t see it any other way. If you’re offering those two things, there’s a problem.

Ragen Chastain: The research is very clear that eating disorders are a much more common outcome than long-term significant weight loss when we’re talking about intentional weight loss attempts. So it’s simply not ethical. There’s no way to do that ethically. And I understand people are fooled, and it’s not surprising that they are. There’s an entire board certification around ‘obesity medicine’ that is based around perpetuating interventions that don’t have an evidence basis.

So I don’t think it’s people’s fault necessarily, but also, my first priority has to be the people they’re harming and not them.

Chris Sandel: I completely agree.

01:04:50

Her training for an Ironman Triathlon

One of the things I remember from a while ago was that you were getting into doing an Ironman Triathlon. I just want to find out where you are with that.

Ragen Chastain: Oh my God, when I say it’s been a debacle, it’s been a debacle. It was supposed to be a two-year journey, and I think with Covid, we’re going on like Year 8. First of all, it was shockingly difficult to just get the gear and clothing I needed. Some of it just doesn’t exist. So at first I had a franken-bike where it was pieced together to work for my body size because they don’t make triathlon bikes for my particular body size. Triathlon kits didn’t come in my size. Finding a wetsuit was really difficult. So just getting dressed was a whole other thing.

But yeah, I tried and failed. I DNF’d my first attempt. I’ve done now some smaller triathlons. I’m still on that journey. I’ve decided rather than doing an Ironman-branded triathlon – because there are very strict time limits, and the time limits are what tripped me up. Not so much the distances. I’m going to just do a non-timed event, because what I wanted to do when I started this – it was part of a greater journey. I got a neck injury and had to walk, so I decided to do a marathon with my best friend. Then I did a second one because I learned I could get a Guinness World Record.

And it became – a big part of it was pushing outside of my comfort zone as my athlete. Like I said, I’ve played sports my whole life, but I’ve only ever done things I was good at right away. I quit track & field in the first 10 seconds because they wanted me to sprint and throw, but then when I got there, they were like, “We start every practice with a two-mile warm-up run” and I was like, “See ya later! No.” So I found out about the Ironman Triathlon and I was like, I can suck at three sports over a really long period of time. I definitely have gotten my money’s worth where that’s concerned.

But once Covid is over and I can safely get out – my partner’s high risk, so we’re being very, very careful about quarantining, but when I can get out, I do plan to go back into training for it. I want to complete this and then I want to never do it again. I want to find an indoor sport with air conditioning and comfortable clothes.

Chris Sandel: But here’s another area where you’ll be congratulated, if and when you complete it, for something that is unhealthy. There is no part of me that thinks doing an Ironman Triathlon is healthy by any means. And I would say the same for doing a marathon by any means. And yet we then hold that up and congratulate someone and say, “Look what you’ve done, you’ve done something so good for your fitness and health” etc., when it really isn’t.

Ragen Chastain: No. This is something I talk about a lot. First of all, just to reiterate – fitness, not an obligation, not a barometer of worthiness, not entirely within our control. I’ve done both; I can tell you for absolute sure that finishing a marathon and having a Netflix marathon are morally equivalent activities. Both a reasonable way to spend a Sunday.

My thing is, again, that nobody’s obligated to participate in fitness but everybody should be welcome. And if we’re talking about health, the research is pretty clear that 30-minutes-ish, five days a week, of moderate movement is where most of the health benefits come from. Nobody needs to do an Ironman or a marathon for their health, and in fact, you go to a point of diminishing returns and then to a point of doing harm. We get a ton of sports injuries that aren’t necessary because we don’t need to be doing this.

I happen to like to do these kinds of fitness-y things with my body, and it’s my body. I’m allowed to do that. But it does not make me morally better than anyone else, and it’s absolutely not about my health.

Chris Sandel: Yeah, completely. Yes, you are an adult. You get to choose how you want to spend your time, and if you want to do those things, by all means do them. I just think it’s interesting the way that we talk about “Oh wow, you do lots of marathons, you must be so healthy.” I’m like, hmm, I don’t necessarily think that that is true.

Ragen Chastain: One of the things I try to do that use the platform that doing these fitness-y things gives me to talk about that and to try to make it clear that the way we treat fitness as if it’s some kind of, like I said, barometer of worthiness or morality is really deeply misguided.

Chris Sandel: Yeah.

01:09:04

How she got into cooking

I remember hearing on a podcast something that was interesting in terms of you getting into cooking in your thirties.

Ragen Chastain: I realised in my thirties that – I obviously could feed myself, but I didn’t really know how to cook. I had the things I could make, and a lot of them involved like “dissolve sauce packet in boiling water” kind of situation. But I didn’t know how to cook. I got my grandmother’s recipes and I decided to cook through them. And this was pre-blog. I wish I could’ve blogged about this experience because they were more remembrances. It’d be like, “Make a roux” and so now I’m like, “What is a roux?”

So I got into scratch cooking for a while and developing that skill, and it became something for me that’s really relaxing. During the pandemic, actually, we wanted to be so incredibly careful and we also wanted to save money because obviously I wasn’t speaking and our income changed. Luckily, my partner’s business continued, so we were very lucky in that respect. But I cooked everything we ate for nine months. We didn’t order any food out, any prepared food from the grocery store. I learned how to cook a bunch. We’d be like, “What would we eat if we were going to go out?” and then I would learn to cook that. So cooking has become something for me that really is a relaxing, fun pastime.

Chris Sandel: Nice. That’s awesome that one upside of the pandemic is that you’ve been able to really enhance your cooking skills.

Ragen Chastain: Yeah. [laughs] I hate to say it’s an upside because so much tragedy, but it’s how I spent the time. My grandma’s recipes, I will say, the first one I cooked was for her chicken pot pie and the first line was “Boil two chickens.” I was like, “I’m sorry, what? Who has a pot that big, first of all? I don’t understand this at all.” So it was an interesting experience to cook through. I’m not as much of a scratch cook as she was, but hopefully I’m doing her legacy proud.

Chris Sandel: I’m trying to think if I have a pot that is big enough in the kitchen for two chickens. I’ve got this ginormous pot that I bought at some point for making stock or broth, so I think I could probably just squeeze them in. But yes, that’s quite an ask.

Ragen Chastain: Yeah, it was “Boil eight cabbages.” I’m like, at once? What is happening in your house? Are you cooking in an industrial kitchen?

Chris Sandel: How much freezer space does she have?

Ragen Chastain: A lot. They had their whole basement, I remember, and she had that huge stand-up – anyway, this is beside the point, but it was a fun exploration of what my grandma’s life was like.

Chris Sandel: How difficult was it getting into cooking for you? Did it feel – like you said previously with exercise or other things, if something was difficult you didn’t really get involved. Was that part of the thing with cooking?

Ragen Chastain: No, because that really only applied to fitness-y stuff. I was like, if I’m going to be doing sports, it needs to be a sport – because I’m a hyper-competitive person. So if I wasn’t good at a sport right away – like, it is not fun for me to struggle at basketball. People are like, “Let’s just play for fun.” No, it’s fun if we win. And I know that’s just my personality. So that was sports-related. But I’m happy to struggle and learn other things. Playing clarinet was a huge struggle. I learned piano and some other instruments. So I was ready to struggle and ready to fail with cooking, and I did both of those things.

I really looked at it as an exploration and building skills. Like, “Okay, we learned there that that won’t work.” It was more of an exploration. I didn’t feel pressure.

01:12:36

The ‘vague future health threat’ + ‘everybody knows’

Chris Sandel: There was something else in your book I really liked where you talked about the “vague future health threat.” This has been something that gets pulled out a lot. Do you want to mention what that is?

Ragen Chastain: Sure. It’s a combination of fatphobia and healthism and ableism. Again, health is a complicated thing to talk about because we do put more value on our health, but for a fat person, if they say “I’m healthy” or whatever, “I’m following my HAES weight-neutral health journey and I’m happy with where I am”, people will be like, “It won’t last. In the future, you’re going to get sick or you’re going to have mobility challenges” or whatever.

This is a thing that gets used a lot as “So you have to lose weight to avoid this.” It’s messed up in a lot of cases, one, because it’s this combination of fatphobia and healthism and ableism. Two, because you’re telling somebody to do something that will decrease their health in order to avoid hypothetical future situations. And three, because these things happen to people of all sizes. It’s just that when you’re fat – if a piano being carried by a flock of pelicans got dropped on me, somebody would blame it on me being fat. That’s just how our culture is.

So it becomes this issue where thin people get treatment – not always, obviously; there’s a lot of privilege and access issues here. But as a general thing, thin people get treatment and fat people get blamed.

Chris Sandel: Definitely. I think connected to this or just before this in the book, talking about the “everybody knows” piece, where there’s this common wisdom that’s not really wisdom based on what people think is the right answer, and that just gets thrown at people as well. Like “everybody knows this.”

Ragen Chastain: Exactly, and this happens at every level. I was recently on the show The Doctors.

Chris Sandel: I do not know that show.

Ragen Chastain: It’s a show in the United States, a daytime show. Two doctors host and they bring on guests. In this case we were talking about weight-neutral health, and I was on there with Dr Greg Dodell, who’s an endocrinologist who practices from a weight-neutral perspective. They had a doctor who came on, Dr Jampolis, I think, and she is from a weight loss perspective.

I at one point listed a bunch of studies to support what I was saying, and her response was “I’m sure I could find 15 studies that say the opposite.” [laughs] And then they edited out my response, so if you watch the show, you won’t see where I was like, “Actually, I welcome you to try, but you won’t, and it’s not ethical to treat patients based on what we think we could find if we read the research.” But this is a very common thing. It doesn’t matter how much research and how many facts we present; if we think that “everybody knows” is a reasonable response to that – which we do when it comes to weight loss – then it’s impossible to have any kind of productive conversation or debate.

01:15:35

Are people becoming more aware of weight stigma?

Chris Sandel: I know. I’m trying to get a sense of this, and it’s hard because of the bubble that I live in – does it feel like we’re turning a tide with this? Does it feel like actually, people are starting to take weight stigma more seriously or are starting to take a weight-neutral perspective more seriously? Or it’s hitting the masses more now than it was five years ago? Do you have a sense of that?

Ragen Chastain: I do feel like there’s change happening. Like I said, I started giving these talks in 2009, and I talk to genera audiences and I also talk to healthcare audiences about the research around best practices for caring for higher weight patients. And I see a real difference in both of those audiences in terms of who was forced to come, who wanted to come, how hostile the Q&A is. There’s real changes here.

One of the things that is really frightening to me is the way that companies like Novo Nordisk that sell weight loss drugs are co-opting that right now. They’re doing these big anti-stigma campaigns, and they just did a big video with a bunch of stars from medical dramas with the message that “we shouldn’t stigmatize fat people, but we should definitely eradicate them from the Earth and make sure no others ever exist.” First of all, that’s not a non-stigmatizing message, and second of all, it’s not driven by care for fat people; it’s driven by profit. They have told the press that they are hoping their new weight loss drug doubles their ‘obesity’ sales.

So this is a huge marketing campaign that is taking all of the work that fat activists have been doing since the ’60s and before and co-opting all of it to sell their drug, and it makes me sick. It is so unconscionable, it is so wrong, and it is so insidious and hard to see if you’re outside of this. People know now weight stigma is a thing, so I really – sorry to hijack the conversation for that, but it is important that we understand that this is happening and that you can’t have a message that is anti-weight stigma and pro-weight loss. That doesn’t work.

Chris Sandel: Totally. I’ve done a whole podcast episode on this before and talked about it. I’m blanking on the guest who I was chatting with about it, but I’ll put it in the show notes or in the intro when I record it. But she used the analogy of it’s basically like saying we shouldn’t have homophobia – so that we can recommend gay conversion therapy. It does not make sense to talk about weight stigma from the perspective of then recommending something that is going to change that person’s body to make them look less stigmatized or like they shouldn’t be stigmatized. It makes absolutely no sense.

Ragen Chastain: Yeah, that message, “I don’t want to stigmatize fat people, I just want to eradicate them from the Earth” is not actually in any way a non-stigmatizing message.

Chris Sandel: Yeah, I think that is something that we really need to be wary of. I’m keeping an eye out for what keeps developing with this, because in other ways, it does feel like things are moving in a better direction in terms of I’m seeing people talking about anti-diet message and intuitive eating popping up on big podcasts that I would never have expected them to be appearing on and that wouldn’t have happened three or four or five years ago. So in some ways, it does feel like it’s getting better.

I’ve got a client who’s just started studying as a dietitian, and as part of it, on day one, they’re talking about Health at Every Size. And actually, you are linked as part of one of their reading materials for the course, and I’m like, this is absolutely amazing that this is where they’re starting someone out.

Ragen Chastain: I don’t mean to downplay it. There’s been a ton of progress. It is, I think, getting better, and the word is getting out there. There are more accommodations being made. That is all stuff to celebrate, and now it’s just about continuing to do the work moving forward and making sure that we are crediting the people who started it and who continue to do the work.

There’s the body positivity thing that happened where something that was created for radical fat activism kind of got co-opted by chunky white women. So we have to avoid that happening with the ideas of weight stigma and anti-dieting.

Chris Sandel: I agree.

01:20:09

“What if I’m wrong?”

There was also a great bit in your book at the end, which is the “What if I’m wrong?” section. I think this is really useful because this is a conversation I have often with clients. Do you want to explain this?

Ragen Chastain: Sure. I come from a background of research methods and statistics, which says that I always have to say science says we always have to admit “I could be wrong.” And anyone who isn’t willing to admit that isn’t somebody I would take advice from.

For me, I was like, what if I’m wrong about this? What if I actually would live longer if I kept dieting? And I decided, I tried that for years and years, and it was miserable. So if I’m wrong, I would rather have whatever time I have living the way I’m living now than more years of that.

Chris Sandel: And I totally agree with you on that. I guess the difficulty I often come up against with this is the more someone is in the depths of an eating disorder, the least amount of awareness they have around these things. And often the more their life has fallen by the wayside in numerous ways. So it can be harder to realise that because you have acclimatized to how bad things have become, and that has become the norm, and you’re living at a 1 out of 10 and you don’t realise that it’s a 1 out of 10. It just feels like this is what life is. So it becomes a harder message for someone to take on.

But what’s interesting is the more someone moves along in terms of their recovery, the more they’re able to see how true this is and they’re able to notice, “Oh wow, I can see how much I’m now able to focus” or “I can see how much I’m now warmer all the time or I’m able to sleep through the night” or whatever it may be. There’s more of these things that start to change that allow someone to see how true a statement that is, but in the beginning it can be a very difficult thing to wrap their head around.

Ragen Chastain: Yeah. And the more we create a world that says whatever kind of body you recover into, you’re going to be able to thrive, and there’s no better or worse size body to have, and dieting is not something to engage in to improve your life or your body – the more that we have a world like that, the more eating disorders will be prevented and the more people will be able to access full recovery.

Chris Sandel: Totally. There is a biological component to an eating disorder, or at least with anorexia, where it’s not just driven by a desire to lose weight or anything along those lines. You can create anorexia in the right kinds of mice or rats, and they are not talking about what their body shape or size looks like. So there is a biological component to this, but it makes it so much more difficult to deal with that biological component if you’re living in a society that praises thin bodies and tells people that they should go on diets and all of these things.

Ragen Chastain: Absolutely. And yeah, sorry, I didn’t mean to imply there – eating disorders are complex biopsychosocial illnesses, so there are a lot of components. I’m just thinking about what kind of world would prevent the most eating disorders and would make recovery the most possible for those who are dealing with them.

Chris Sandel: Definitely. And we live in a world that is ramping up the types of activities that people participate in that makes it more likely, if they have the biology, that they’re going to fall into that state, and getting them to do those things under the guise of looking after their health or that this is what you need to do to be successful, etc. So yeah, I’m in complete agreement that the more we can have a society that cares less about how people look and the shape of their body and that everyone is accepted, the easier time we’re going to have with eating disorders, the less people are going to find themselves in that position to start with.

Ragen Chastain: Absolutely.

Chris Sandel: Ragen, this has been awesome. Is there anything we haven’t gone over or chatted about that you wanted to go through?

Ragen Chastain: Not that I can think of. We’ve talked about a lot of stuff. [laughs] It’s been thorough, this interview. Thank you.

Chris Sandel: No, thank you. As I said at the top, I’m a huge fan of your work, and you have been referenced a lot on this podcast. So I’m glad that we finally got to chat tonight.

Ragen Chastain: I’m really honoured by that, and again, so grateful for the work that you’re doing and really grateful to get to be a little part of it today. Thank you very much.

Chris Sandel: Awesome. The final thing is just where should people go if they want to hear more from you, read more from you? I’ll put all this in the show notes, but you tell the audience where they should be going.

Ragen Chastain: My blog, https://danceswithfat.org, is a home base for all of my work. From there, you can find all of my social media, you can find past blog posts, other writing. And then I’ve recently started something called the Weight and Healthcare newsletter on Substack. That is where I’m writing specifically about the intersections of weight science, weight stigma, and health, including health care practice and public health. So if you’re interested in those topics, that’s https://weightandhealthcare.substack.com.

Chris Sandel: Perfect. I didn’t know that, so I’m glad you mentioned that, and I will go and check that out.

Ragen Chastain: Cool. It’s something I started recently. I really wanted to write about these topics specifically and have a place where people could go, because my blog covers tons of different topics. So if somebody wants to dig into healthcare, I wanted them to have a space to be able to do that.

Chris Sandel: Perfect. I recommend that everyone check that out. Thank you so much again for coming on the show.

Ragen Chastain: Thank you so much. I’ll talk to you soon.

Chris Sandel: So that was my conversation with Ragen Chastain. She really is an incredible human being, and I’m so glad that she’s out there doing the work that she is. Her book Fat: The Owner’s Manual is fantastic, and I highly recommend that you check it out.

01:26:27

My recommendations for this week

There are two recommendations that I want to make for things to watch and read.

The first is a film called Licorice Pizza. I actually took the day off last week on Tuesday, and Ali and I had a date day where we had lunch and we went to the movies. This is the first time I’d been to the movies since the pandemic. I love going to the movies, and it’s something I used to do a lot, and I’m excited about starting to do again more. We went to a cinema near us called The Everyman, and it has couches in the cinema and there’s tables in the cinema so you can eat a meal and have a drink in the movie. It was nice to have some food and a glass of malbec while watching a daytime movie. And because it was a Tuesday and the middle of the day, Ali and I actually had the whole cinema to ourselves, which was lovely.

So Licorice Pizza is the new film by Paul Thomas Anderson, and it’s probably been two decades since I’ve seen Punch-Drunk Love and Magnolia and Boogie Nights, which were three of Anderson’s earlier films, and I thoroughly enjoyed them. I remember seeing There Will Be Blood, which was another one of his films, and just didn’t get it as a film, and then I hadn’t seen his more recent films like The Master and Inherent Vice, but when I watched the trailer for Licorice Pizza, it looked like an easier and more fun film than his other more recent offerings.

It’s set in the 1970s and follows the lives of Alana and Gary, who are 25 and 15 and growing up and the things that they get up to. It’s very much a coming-of-age story that’s both soft and moving but also really funny. It’s paced really well. It feels like it’s a long film, but not in a bad way. It’s actually quite nice. Lots of things happen, but it’s at a pace where it feels like the story is slowly unfolding.

The two leads in the film, for both of them it’s their first film, and they really are incredible. Much of the film and the script feels very natural and almost improv-like. To act in this way is actually incredibly difficult. So the performances they both give are outstanding. The whole time I was watching, I was thinking the male lead reminded me so much of a young Philip Seymour Hoffman, and then later I found out that it was actually his son, Cooper Hoffman. Then the female lead is Alana Haim, who’s one of the sisters from the band Haim. In fact, all of the Haim sisters and even the Haim parents are in the film, but Alana Haim, the main actress, is definitely going to have a solid film career, because she’s outstanding.

It has the added bonus of having the film score down by Jonny Greenwood. I’m a huge Radiohead fan and they’ve been my favourite band for the last 25 years or so, and Jonny is the lead guitarist of Radiohead and has now gone into doing musical scores and writing symphonies and basically being phenomenal at whatever type of music he puts his hands to.

So I highly recommend checking out the film. It was lovely to look up what was on at the cinema and find something other than a Marvel or a DC or a franchise film. I was not disappointed at all. It was one of the best films I’ve seen for a while. It’s called Licorice Pizza.

The other recommendation is for a book. It’s called Four Thousand Weeks by Oliver Burkeman. This was suggested to me by a friend. He’d heard him interviewed on Sam Harris’s Making Sense podcast – it used to be called Waking Up – and then he’d ordered the book and absolutely loved it. The title ‘Four Thousand Weeks’ refers to the average number of weeks a human being lives, and the subtitle of the book is ‘Time and How We Use It’.

On the surface, this could sound like another book about productivity and how we should maximise our efficiency, but it’s actually something quite different. Burkeman had actually spent a decade as a ‘productivity geek’, to use his own term, looking at all the various hacks for better managing of one’s inbox or how to get more done to have more free time, to have more spare time. He’d actually written about this for about a decade for The Guardian. But what he’d found was that the more he did all of these things and tried to implement Inbox Zero and all these different hacks, the more he ended up being more busy and more miserable and feeling like he wasn’t on top of things.

This is something that I have definitely noticed over the many years I’ve been running my own business. I remember many years ago, before I had a child, I was doing 50- or 60-hour weeks. Many days, I’d get up at 4:30 a.m. or 5 a.m. and try and get a head start and get on top of everything I wanted to do. But no matter how much I worked, there was always more to do. I never felt any less busy.

The book really is an exploration of our failed attempts to fit more into our lives and use hacks to get more done. It feels kind of like a self-help book meets a book on philosophy, with the core message being about embracing our limits. So rather than pretending like we can fit more and more in, we need to realise that we are only ever going to achieve the tiniest sliver of all available options that are on offer to us as humans. So we should embrace that we have limited time on Earth and limited attention and spend this more wisely. This spending it more wisely should include more leisure time, more procrastination, more time with other human beings, more time including things for the sake of it rather than some benefit that is going to be bestowed on us at some point in the future.

I can’t do the book justice here in trying to describe it, but I’ve thoroughly enjoyed it. I’m using it myself to create more space in my life to feel less stressed and busy and to just start to frame things differently. I am finding it all rather liberating. The book is called Four Thousand Weeks by Oliver Burkeman, and I highly recommend checking it out.

So that is it for this week’s episode. As I mentioned at the top, I’ve just opened my practice again to new clients. If you want help with an eating disorder or disordered eating, chronic dieting, poor body image, exercise compulsion, getting your period back, or any of the topics that I cover as part of this show, then please reach out. You can head to www.seven-health.com/help for more information.

I’ll be back next week with another episode. Take care, and I’ll catch you then.