Transcript
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Welcome to Big Sexy Chat.
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Today we're diving into the critical topic of medical weight bias with the brilliant Regan Chastain.
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As a speaker, researcher and advocate, regan is on a mission to transform healthcare by challenging weight stigma and promoting respect for fat bodies.
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From her groundbreaking weight and healthcare newsletter to actionable ways we can combat bias, this is a conversation you don't want to miss.
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Hi, welcome to Big Sexy Chat.
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I'm Crystal, I'm Murph.
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We're just two rat fatties sitting around chewing the fat Twice a month.
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We'll be chatting about current events hot topics sex, sex toys, fat politics, fat community cannabis, cbd you name it.
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We're going to talk about it.
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We are very excited to have you a part of our community.
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Welcome and enjoy.
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Hey there, welcome back to Big Sexy Chat.
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My name's Crystal and I am so honored today because of all my amazing co-hosts.
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Is here with us tonight, Murph.
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And then we also have the privilege of having an amazing guest on tonight, Regan Chastain and I'll tell you more about her in a second, but I want to give Murph and Regan a chance to say hello, Hi.
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It's so nice to see and talk to everybody, hey everybody.
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I am so excited to be here.
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Thanks for having me, y'all.
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Thank you, regan, thanks Merv.
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Okay, so let's get into this.
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Regan, last time you were on our show, or the first time, first and only time, I think, we had you talk about dealing with your family members that supposedly love you at the holiday time, when they want to comment about our bodies and what are some things that you.
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Before we get into the strategies for dealing with anti-fatness in medical care, before we get into that, just could you give us a couple comebacks that we might be able to just sling at our family members, just like just to shut them down.
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Sure.
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So I, first of all, I want to say the most important thing to remember always is that this is becoming your problem to deal with, but this is not your fault.
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This shouldn't be happening.
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And so, even if it's a situation where you can't or don't want to respond, putting some space between you and the comment by realizing like, oh yeah, this is anti-fatness and I'm going to have to deal with it, but it's not my fault, can help you from internalizing the negative messages and help you kind of move away from that situation feeling okay Some of my favorites.
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So when someone says I'm just concerned for your health, I like to say, oh, please, unburden yourself.
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I don't need that from you at all.
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I have like a whole group of healthcare providers who support my health, so we can just have like you can just be my aunt or whatever.
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There's also a three-step boundary setting process that I use, where the first step is to say what you need, and you might do this before the holidays if there's a repeat offender, right?
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So hey, you might not realize it, but every time we see each other at the holidays, you say something about my food or weight and I just need to talk to you about that, because it's not okay for you to do that.
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I need you to stop and you can explain why or not.
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You can say like I'm working on my body image, or my therapist says it's harmful to me, or you can just say I don't want you to do this anymore.
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And then the second step is setting a consequence, and it doesn't have to be something big, but it does have to be something you can follow through with for sure.
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Right, so you might say, if it happens again this year, I'll just take my plate into my room or I'll leave and we'll try again next holiday, or I'll just have to stop interacting with you this year.
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Right?
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Just something that you are sure that you can follow through with.
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And then the third step is, if it happens, follow through and make sure the person understands they are experiencing the consequences of their actions.
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Right, you know what we talked about this.
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I said it wasn't okay.
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I told you that if you did this I would leave, and you did it, and so I'm leaving and I hope next time you can act better and respect my boundaries, and so that can be a really helpful tool to negotiate and you can, like I said, you can set that boundary ahead of time, or you can do it in the moment, at Thanksgiving dinner, and just be clear, because what happens when people step on boundaries is that they want to turn around and victim blame, right, oh, why are you ruining dinner?
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And so, being clear, I'm not ruining dinner, you ruined dinner.
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I made a simple, clear request and you wouldn't respect it, and so I'm going to do what I need to do for myself and I hope the rest of you have a great time, and so I think that can be super helpful in terms of just navigating those situations Hashtag boundaries.
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Boundaries are sexy.
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Those are the best ones.
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I love to say something along the lines of ew, it's getting a little creepy that you're monitoring my body so much.
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Is there something I should know about?
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That kind of makes them feel, oh shit, which is what I want.
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I want them to live.
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One of the things I like to say is you know, if it's a comment of like, oh, I can't eat that, or whatever I usually like, touch my belly and say you might end up looking as good as me.
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I wouldn't do that either.
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I absolutely love that.
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That's great.
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Thank you both, and we'll have to.
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Definitely.
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We'll tag our previous episode with you in the notes for this show so people can listen to both if they want to.
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We happen to be recording the week of Thanksgiving 2024.
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So that's why it came into my mind that we should give people a few zingers.
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Although we won't have it out before Thanksgiving, we'll have it out before the next holidays.
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But I want to give you a proper welcome before we get started too far into this.
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Reagan, for people that don't know Reagan, you should know Reagan and her website and her sub stack is weighthealthcarecom.
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Is that right?
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Reagan is a blogger, a speaker, a researcher, fat activist, fat liberationist.
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I'm going to call her a national treasure.
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I know I've called you that before, but that's how I feel, and I know that you're all helping us and coaching all of us to reclaim the word fat.
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It's a neutral descriptor.
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If you take the zing out of it.
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You don't have any more pain when people call you fat because you have no shit on fat.
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Captain Obvious, let's see you help us with dealing with the haters, coping with the haters.
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You're doing diversity.
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You're trying to teach people in medical schools and other places like that about how to deal with fat bodies, how to stop pathologizing our bodies.
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You do it all.
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You're an amazing speaker and you do so much for all of us.
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I don't even know if all of us could figure out how much you've done for us.
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I know it's far-reaching and I'm so grateful.
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So thank you for being here tonight.
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We're really happy to have you again.
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Oh, that's incredibly kind, thank you.
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I'm absolutely blushing over here, and you both do such incredible work, so I'm honored to be in this company and super excited to get to talk about this.
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Yeah, we're really grateful.
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One of the things that I think is fun is when someone's new to the fat liberation community and they're like, oh my gosh, have you heard of Reagan?
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I'm like, yeah, like, welcome to the club.
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It's pretty great.
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Yeah, I'm familiar, it's a good one, good one.
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So, reagan, tell us what you're up to these days, tell us how you're.
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I know you have all kinds of different things you do.
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You have your seminars, your webinars, but tonight we're really looking for strategies for dealing with anti-fatness in the medical world, and we all know it exists.
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We all know that.
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We all probably know people who've died because of the neglect and or been maimed by having their stomach amputated.
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So but how do we go and have them take us seriously, even though they consider us to be, I guess, some you know horrific thing because we're fat and because they believe that thin and health go together and fat equals unhealthy?
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Yeah.
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So I just to back up a tiny bit my so my area of expertise is the intersections of weight science, weight stigma and healthcare, and so one of the things I have, I've developed also sort of a subspecialty, as it were, in the ways that the weight loss industry has and continues to infiltrate and manipulate the healthcare industry, and it's almost impossible to overstate the influence that it has and continues to infiltrate and manipulate the healthcare industry.
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And it's almost impossible to overstate the influence that it has and continues to have on healthcare for higher weight people, on the idea of just, first of all, making up words like quote-unquote obese and quote-unquote overweight, words that were made up for the express purpose of pathologizing bodies based on shared sides rather than shared cardiometabolic profile or symptomatology, like we would see in an actual disease diagnosis.
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And now it's being pushed further, in particular by Novo Nordisk and Eli Lilly with their new GLP-1 drugs, to say, oh, quote unquote obesity is a chronic, lifelong, relapsing, remitting disease.
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And these definitions have been created and are being morphed specifically to serve the purposes of the weight loss industry.
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But they are so good at infiltrating and manipulating the healthcare system that they've really gotten this message all through healthcare and they conduct medical education, they conduct symposiums, they conduct grand rounds.
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It's really wild, not to mention all of the work that happens in the background and through their sort of astroturf organizations, which are groups that claim to be patient advocacy groups but are in fact almost fully funded by and acting as a lobbying arm for the weight loss industry.
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The biggest one here in the States is the quote Obesity Action Coalition, but there are many others and it's sort of an international web, most of which are now being predominantly funded by Novo Nordisk and or Eli Lilly.
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So that's sort of what we're dealing with when we walk in is a practitioner who is very likely of what we're dealing with when we walk in is a practitioner who is very likely.
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Now there are straight up fat phobic healthcare providers.
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Right, they have explicit bias toward fat people.
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They have.
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They take us less seriously, they give us less time, they ignore anything we say and focus in on weight loss because they think that that's we're only worthy of care once we get thin.
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That is absolutely a problem.
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That happens and weight stigma in many ways can be fatal, and weight stigma in healthcare certainly can and has been fatal.
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But there are also providers who are well-meaning and they might have implicit bias right subconscious bias toward higher-weight people because they live in the same like fatphobic world that we all do, but they really believe that what they're doing is the best for us.
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They're simply wrong about it.
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And then there's a power imbalance there between a patient and a doctor.
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I predominantly get paid to talk to healthcare providers about this, to teach healthcare providers and as a patient, it can still be difficult or even impossible for me to get weight neutral care from a doctor because of the power imbalance that exists there.
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So that's sort of all the bad news.
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The sort of good news is that we can use some strategies to help us get the care we need, and the first thing that I always say is I fully endorse doing what it takes to get the care you need right.
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So there's several strategies.
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We can start by asking for weight-neutral care, and we can do that before an appointment.
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If we're talking about a non-emergency appointment, right.
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If we're choosing a new provider, we can call ahead to the office, either anonymously we can have a friend or advocate call but we can say something like I'm looking for a provider who will provide weight neutral care, which means that they don't recommend weight loss as a health promoting behavior.
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Is there somebody here who can do that?
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Reagan, are you still doing some of that?
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Were you advocating helping people specifically one or 1% of time to go help them with their medical appointments?
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So I'm a board certified patient advocate.
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Okay, that's what it is.
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Yeah, I don't have the kind of time that I need, with everything else that I do, to do a lot of advocating.
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Typically, if I'm advocating for an individual, it's somebody in an emergency situation or somebody in a complex medical situation.
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But what I?
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did just finish is I created a course about weight-neutral advocating that's being put out through the Association for Professional Health Advocates, so people take the course.
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They have to pass a test and make a pledge about how they'll treat higher weight patients who ask for weight neutral care, and so I'm super proud of that and I'm super excited that it's something where it will be just the few of us who are doing it right now, but we'll be able to train more people who want to understand how to do this kind of advocacy.
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Right on Congratulations.
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How exciting for you and all of us.
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Thank you so much.
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I was super excited to get that opportunity and AFA was amazing around doing it.
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But yeah so, and speaking of advocates, you can take an advocate with you, and an advocate might be someone with training.
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It might also just be a friend or family member.
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What we see is that, even if the person doesn't have any medical knowledge, even if they don't talk through the whole appointment, just having someone else there tends to create better behavior from a health care provider.
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I have noticed that they are much more polite when there's somebody there witnessing them.
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Yes, yes, and this, sadly, is something that folks with multiple marginalized identities and with different marginalized identities can also utilize and, again, sadly, it can be helpful if it's someone with more privilege than you have and that can, and that it obviously it shouldn't be that way.
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Obviously it's wrong on every level, but in terms of strategies and the reality, that's something that can be helpful.
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I'm really glad that you're saying that, because I think you know there's very little opportunity to level the playing field.
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I work in healthcare and so I recognize how entrenched that entire culture is and so you know, I think, while it's not okay by any means, you have to take any advantage that you possibly can get and having an advocate that is somebody that has more privilege than you, it really will change the situation.
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I appreciate you saying that.
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Yeah, no, thanks, and thanks for the work that you do within healthcare to try to make the spaces better.
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So, yeah, so taking somebody with you can be really helpful.
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You can call ahead, like we talked about, and in my experience if you call ahead you might not get the answer you want, but they are typically honest about that.
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But even if they say, yes, you want to check in at check-in, right?
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So when you get there for the appointment and you check in, you have to say, as a reminder, I'm looking for weight neutral care.
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So please make sure the provider knows not to recommend weight loss or discuss my weight.
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And you know I'm going to decline weigh in.
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You can talk about that.
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Then you can talk about it when it's time for weigh in, and then you can.
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There's some sort of quick phrases to try to avoid the conversation, right, because what they tend to do is, no matter what's wrong with us, there's a tendency to blame it on our weight, right?
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If we're like, oh, I lost two socks in the dryer this morning, it's oh, that's obesity-related sock loss, such a shame.
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So we can say what do you do for thin people who have this issue?
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Because all of the issues, even those that they call quote-unquote weight-related or quote-unquote obesity-related.
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The issues even those that they call quote unquote weight related or quote unquote obesity related health issues, are health issues that people of all sizes get.
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That get called weight related when fat people have them, which is not remotely scientific Right.
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And so we can start kind of bypass the conversation by saying, hey, what would you do for a thin person?
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With the same presentation and I want to be clear none of what I'm saying is foolproof.
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I was physically in a room advocating for a patient with knee issues and she asked the orthopod that question and he said, oh, I don't have to talk to thin people about knee issues.
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And I was like, are you kidding me right now?
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Come on.
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Right, like I don't know.
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I was out in the waiting room.
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There are a lot of thin people with knee wraps and crutches, so I feel like you do Right.
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So nothing is foolproof and some doctors will pull some nonsense, but there are strategies you can try.
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You can also try the sort of combination of saying you know what I will Thanks for talking to me about that whatever, diet, pharmacotherapy, surgery I'm absolutely going to check that out.
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But for today I was hoping we could focus in our limited time on what I came in for, right, my sprained wrist, my severed arm, my whatever is going on.
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So you can kind of try to redirect.
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Yeah, no, I'm absolutely going to start that diet you talked about.
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Like, there's no way I'm doing that.
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But if I don't want to fight and if I need, like a prescription refill, right, if you need a referral and you don't want to pick a fight, especially if you're in a managed care situation where you don't have the opportunity just to leave and find another doctor, or if you're in a rural situation, you know, or a situation where your ability to get another doctor is really limited and you have to keep peace with this particular provider, you can do that Like yep, I'll absolutely talk about that.
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I'm going to make another appointment to talk about that, though, because today I really want to focus in on, like my you know compound fracture of my ankle.
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That's great, reagan.
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One thing that I have started doing is I say, oh sure, sure, I'll consider that diet.
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Just go ahead and send it to my email or to my dashboard.
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Just make sure that the diet you're going to ask me to do is that there's definitely like a better than 2% success rate.
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I need something like 98% successful as opposed to 2%.
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If you find that diet, I'll absolutely review it free, so just go ahead and send it to me that way, and then let's get on with my eyeball problem or whatever the hell it is.
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Exactly and you can.
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So that's another strategy is, if you want to talk about this, you can.
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I, you know, I'll often say I treat my doctor's appointments often as like fodder for pieces I'm going to write, so I'm willing to like, try stuff, and I'm coming to this obviously with a tremendous amount of privilege White cis, able-bodied, currently neurotypical, currently like and all the knowledge that I have and that I do this.
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There's a massive amount of privilege, and so I feel like one of the ways I can use that privilege is to really push these conversations and these appointments, and so I do that.
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Something I should add to my comment is that I've never gotten one of those emails.
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So they can't seem to find that particular diet yet.
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And then I'm talking with Kaiser.
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About three years I've been using that strategy because, even though I asked them it over and over again, I oh, I forgot.
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Yeah, go ahead and send me that diet.
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And I've never, ever, ever gotten one from them, because that doesn't exist.
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And also, Regan, isn't that kind of malpractice to prescribe a diet when we know it doesn't SN work?
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That's not fair.
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They shouldn't be able to do that, I would agree with you.
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But it's not considered malpractice.
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In fact it's considered the standard of care that higher weight people and this is again the weight loss industry working overtime.
00:19:07.743 --> 00:19:22.619
They know that almost everyone loses weight short term and they know that most people lose weight short term and almost everyone will regain that weight within two to five years, which is why you don't see weight loss research that goes past two years, right?
00:19:22.619 --> 00:19:29.910
So they've manipulated the research, even the studies on Wegovi, the GLP-1 from Novo Nordisk.
00:19:29.990 --> 00:19:37.808
So they put out their four-year outcomes and the headline was oh, people maintained a 10% weight loss for four years.
00:19:37.808 --> 00:19:45.333
But when you look into the figures, they started out with about 9,000 people in a treatment group and four years later they had about 900.
00:19:45.333 --> 00:19:50.290
That's they had an 89.5 percent dropout rate.
00:19:50.290 --> 00:20:09.115
And like if a sixth grader doing a fruit fly science fair project lost 89.5 percent of their fruit flies and then, like, tried to draw a conclusion from the fruit flies that were left, like that kid is not winning the science fair, that kid is going to get a top from their sixth grade teacher about scientific method.
00:20:09.115 --> 00:20:21.624
And so it's ridiculous the lengths that they'll go to to manipulate this research and a lot of the work I do on weight and health care is deep dives into these studies and analysis of these studies.
00:20:21.624 --> 00:20:28.865
But yeah, so doctors really believe that weight loss is something that everyone can do if they try hard enough.
00:20:29.767 --> 00:20:47.482
Yeah, and that's interesting because, on the flip side of that, the insurance companies and the managed care plans actually make it requirements that providers have metrics that they have to hit in terms of addressing an individual's weight.
00:20:47.482 --> 00:20:59.961
So if they aren't prescribing a diet, if they aren't getting the weight written down in the chart, all these very specific metrics, they'll lose quality incentives, money from the plans.
00:20:59.961 --> 00:21:03.863
So it's embedded into the health care work.
00:21:03.863 --> 00:21:04.963
It's wild.
00:21:05.884 --> 00:21:17.631
Yeah, and I do want to say like, for example, very specifically for Medicare's incentive payment, there is a reduction in payment if they don't get BMI calculated.
00:21:17.631 --> 00:21:24.134
However, if the patient declines weigh-in, they're removed from the numerator and the denominator of that equation.
00:21:24.134 --> 00:21:28.357
I did a deep dive into this a while ago because I was like this is incredibly complicated.
00:21:28.357 --> 00:21:40.580
So if the patient declines, there's an opportunity to say the patient declined the weigh-in and then they're not held against that provider, but their electronic health record system has to make that possible.
00:21:40.580 --> 00:21:43.548
So it's possible that they'll have to work and create that change.
00:21:43.548 --> 00:21:52.721
And I also want to say, because often what happens is if we don't get enough BMIs calculated, we'll experience a drop in compensation.
00:21:52.741 --> 00:21:59.340
It's communicated to the patient as your insurance requires this and those are not the same thing.
00:21:59.340 --> 00:22:14.936
Your provider getting less money is not anything that negates your right to informed consent and refusal of the weigh-in of a weight loss intervention, of any health care intervention, right.
00:22:14.936 --> 00:22:17.910
So you still have the full right to informed consent and refusal.
00:22:17.910 --> 00:22:19.085
And it's not true.
00:22:19.085 --> 00:22:23.790
And the person who's doing your weigh-in, who tells you your insurance requires it, may actually believe that.
00:22:23.790 --> 00:22:24.752
Right.
00:22:24.752 --> 00:22:28.820
So I will say, oh, that's such a common misconception, like I can absolutely explain that to you.
00:22:28.861 --> 00:22:29.884
It's my area of expertise.
00:22:29.884 --> 00:22:34.186
But for now just please put patient to client and we'll like move forward with this appointment.
00:22:34.186 --> 00:22:36.255
What, what room am I going to my?
00:22:36.255 --> 00:22:42.861
I am famous for just saying no, thank you and then walking past them because you're not actually allowed to wander a doctor's office by yourself.
00:22:42.861 --> 00:22:49.461
So they will come with you at that point and you can sort of move that conversation down the hall and away from the scale.
00:22:49.461 --> 00:23:04.424
But yeah, one thing I will say to providers is you know, it's my understanding that about 95% of people or more will lose weight short term but gain it back long term and that that weight cycling has negative impacts on health.
00:23:04.424 --> 00:23:09.993
And what's interesting is more and more doctors say oh no, that's true.
00:23:09.993 --> 00:23:19.715
But then they'll say you just have to keep trying till you're in the 5% and like look, not everybody studies statistics and that's absolutely fine, but I did so.
00:23:19.715 --> 00:23:23.578
I can tell you for sure that's not how statistics work, that's lottery logic.
00:23:24.541 --> 00:23:24.884
Good one.
00:23:24.884 --> 00:23:25.404
I like that.
00:23:25.404 --> 00:23:28.563
It's so shitty that we have to think about all this stuff.
00:23:28.563 --> 00:23:29.365
It's so shitty.
00:23:29.365 --> 00:23:34.247
We should just be able to go to the doctor and just get taken care of and get the care we need.
00:23:34.247 --> 00:23:38.480
And I mean, I know we all have to put a lot of mental energy into before we go to the doctor.
00:23:38.480 --> 00:23:40.906
It shouldn't be like that.
00:23:40.967 --> 00:23:54.843
This is crap, man, yeah it's difficult enough to get health care in the United States in many other places as well, obviously, but you know, here in the States it's hard enough without having to like gear up.
00:23:54.843 --> 00:24:03.923
I teach mostly I talk to healthcare providers, but I do teach workshops to help patients navigate weight stigma, and right at the beginning I'm like none of us should be here.
00:24:03.923 --> 00:24:05.887
This shouldn't be happening.
00:24:05.887 --> 00:24:09.867
You shouldn't have to take a class to go to the doctor, and it can be.
00:24:10.671 --> 00:24:17.636
It can get dramatically worse in an emergent situation where you don't feel well enough to advocate for yourself.
00:24:17.636 --> 00:24:20.724
Perhaps, or perhaps you're not conscious, you know so.
00:24:20.724 --> 00:24:27.415
Having friends and family who understand what you need, being prepared for those situations is also really important.
