More than 90 million American adults are obese. Research shows that excess weight can increase your risk of certain health conditions, like heart disease and diabetes. But being overweight affects more than your health. Studies show obese people have a harder time finding a job and are paid less than thinner people.

Guest host Anita Rao talks to fat activist blogger Ragen Chastain and Penny Gordon-Larsen, professor and associate chair for research in nutrition at the University of North Carolina at Chapel Hill Gillings School of Global Public Health, about the misunderstood and complex nature of obesity.

Guest host Anita Rao talks to fat activist blogger Ragen Chastain about the discrimination that fat people face in the United States. Ragen blogs at danceswithfat.org, and she is the author of “Fat: The Owner’s Manual – Navigating a Thin-Obsessed World with Your Health, Happiness, and Sense of Humor Intact.” (Sized For Success Multimedia, LLC/2012).

Penny Gordon-Larsen also joins the conversation. She is a professor and associate chair for research in nutrition at the University of North Carolina at Chapel Hill Gillings School of Global Public Health. She studies weight and talks about the misunderstood and complex nature of obesity.

Interview Highlights

Ragen Chastain on the kinds of fat discrimination in American society:

When I was training for my first marathon some guys threw eggs at me from a car, so that's a pretty good example of where our culture is with fat people. And then just trying to get competent medical care as a fat person. I had run 18 miles the day before and I had a doctor tell me: You know, you've really got to start and it’s going to be hard but if you can do it it will change your whole life. I just need you to walk ten minutes a day.

Penny Gordon-Larsen on using body mass index as a tool:

I think BMI is a very good measure and for the majority of people BMI works great. But what BMI doesn't do is it doesn't tell you about the diet and exercise habits of the individual.

Chastain on diet study researchers:

And when they say success, often they mean less than 10 pounds over a five-year period. And so what happens is we're fooled because most people are able to lose weight short-term, but then almost everyone gains it back.

Even five percent of weight loss in an obese person can bring about clinically meaningful change, so it's important to consider that. - Penny Gordon-Larsen

Gordon-Larsen’s response to Chastain’s take on diet studies:

For most people, when you look at these studies that are published, they're publishing the average effect: the average effect may be as Ragen describes, not that big, in terms of successful weight loss. But if you look at the tails of the distribution, you find that some people – you can even take identical groups of people – put them on the same exact calorie and exercise program, and they will have differential weight gain or weight loss. So some people, you put them actually on what you think is a weight loss program, and they gain weight. Some people, you put them on that program, same exact program, and it's incredibly successful for them, and they lose a lot of weight on it. And then for the majority of people, they're somewhere in the middle.

Chastain on whether her activism tells people it’s okay to be obese:

This idea that if we have fat people out there succeeding at something other than weight loss or being happy in their bodies without trying to manipulate their size, that that's somehow promoting obesity, is actually ridiculous. People are the size that they are, and … We say, determine how you want to prioritize your health and how you want to get there, and it's okay if you do that at the body size that you are now, and it's okay if you love that body. Loving your body never being an obligation but always being an option. It's so incredibly important because what happens is, fat people get the message constantly, that we aren't healthy or happy or successful until – we will never be those things – until we become thinner, and fat people internalize that.

Gordon-Larsen on successful weight loss:

There's a really wonderful resource, the National Weight Control Registry. It's a registry of over 10,000 people who have maintained at least 30 pounds over one year of weight loss … They've been very successful at weight loss, and among those individuals, the trademarks of what they do really are one hour of exercise a day, they modify their diets, and they do weekly or daily weighing. And those kinds of healthy habits are again, I agree with Ragen, those are the things we should focus on. But there are lots of success stories out there about people who have been able to successfully manage their weight.

You're allowed to live a full and amazing and happy life regardless of your body size, your health, your ability. - Ragen Chastain

Gordon-Larsen on the difficulty of keeping off the weight an individual loses:

There are lots of physiological responses that your body will defend and try to return back to that original weight. And that's something that is physiological but also sends messages to you that you are hungry, you want to eat, so it's not just involuntary, it's also voluntary messages that are happening between your brain and your gut in [a] very complex physiological system. And that's what causes individuals to regain that weight. So that is a phenomenon we see across the board with weight loss, and so that's why you have to be careful and aware and it's not just a matter of losing weight and then stopping the behaviors. That it's really a life-long behavior change that you would be making if you are interested in losing weight and maintaining weight.

Chastain on the paradigm she’d like to see adopted:

Health at Every Size says again that health is not an obligation, barometer of worthiness or entirely within our control. It says that from a public health perspective, from a health care perspective and from a personal choice perspective, healthy behaviors are in our control unlike weight loss and are a better predictor of future health and body size. And also that we have to look at social determinants of health ... We have to look at the ways that racism, homophobia, transphobia, Islamaphobia, classism, ageism, healthism, ableism and more, misogyny, all affect people's health in a negative way and we have to look at eradicating that kind of oppression [as] part of public health rather than trying to make the individual's health the public's business, which is what's happening now, especially with fat phobia.

Resources from Penny Gordon-Larsen:

Best source for obesity information

American Board of Obesity Medicine

Obesity Action Coalition

OAC's National Convention

Evidence-based resources and approaches to weight stigma

Catalogue of obesity information resources