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--:-- Noelle King: On Friday's show, we talked about the economic potential of the drugs Ozempic and Wegovy. The biggest problem right now for the Nordic is producing enough. They cannot meet demand. Some of you told us to calm down. I really appreciated the listener who wrote to me saying, Ozempic can cut a percentage of body weight, but it's not the end of obesity.
--:-- Noelle King: Heard, chef. Many people who've lost weight on these drugs are thrilled. I'm 5'7", I'm 28, as of today. I am 198.8 pounds. I couldn't be happier. I'll go like seven hours, and I won't even think about food, and it's magical. But there isn't a single responsible medical professional claiming this is an end to overweight and obesity. And what's more, this is supposed to be the age of body positivity, fat acceptance, loving the skin you're in. Haven't we moved on?
--:-- Noelle King: Coming up on Today Explained, we really have not, but maybe we could. Support for Today Explained comes from BetterHelp. Let me tell you a true story. Last weekend, I got an email from a listener who wanted to discuss their problems with me. And I said, look, I don't think that this is about me personally. At least I hope it's not. Why don't you try BetterHelp.com slash Explained? Absolute truth.
--:-- Noelle King: As the largest online therapy provider in the world, BetterHelp can provide access to mental health professionals with a diverse variety of expertise. Find the one with BetterHelp. The one is not me, guys. Our listeners get 10% off their first month at BetterHelp.com slash explain. That's BetterHelp.com slash explain.
--:-- Noelle King: Having a night out with your friends is awesome. Dealing with hangovers sucks. Meet Senorita, the THC-infused margarita that lets you skip the booze, but keep the vibe. Made with real fruit, organic agave, and Himalayan pink salt, every sip is like a mini getaway. No fillers, no hangovers, just full flavor and a better buzz. Find your flavor at senoritadrinks.com. Use code VOX20 for 20% off. Must be 21 and over. This product may cause intoxication. This product has not been evaluated or approved by the FDA. This product may contain up to 0.3% THC.
--:-- Noelle King: It's Today Explained. I'm Noelle King. Alice Fullwood covers Wall Street for leading magazine The Economist. Weight and weight loss are often the province of magazines like Glamour and Cosmo. But about a year ago, Alice wrote a piece called The Economics of Thinness that would end up becoming, by far, she says, the most read thing she'd ever written. It was about the very real economic penalties that women face for not being thin.
--:-- Alice Fullwood: For most of my life, as long as I can remember, I have felt like there is this sort of pressure or this idea that the sort of right way to be, the right sort of way to look is to be thin. Here's how I went from thick to thin in six months. You want to keep the focus on vertical lines. Here's my easy breezy diet routine. It's how I stay thin with minimal effort.
--:-- Alice Fullwood: It seems to be sort of all around us in the ether a lot of the time. And it's one of those things that I had sort of taken almost as a sort of given. And one day I was sort of at home working and actually my husband called me into his office to show me a chart that he was looking at, which was on the CDC website, and it plotted BMI against income. And all over the world, there is a sort of negative relationship between BMI and income. So the richer you are, the thinner people tend to be. And what was really striking about this chart is that they'd broken out that line into men and women. And for men, there actually was no correlation at all. This sort of line was almost completely flat. But for women, the line sloped very sharply downwards.
--:-- Alice Fullwood: And I sort of in that moment had this realization that, you know, there's this sort of pressure that women feel, this sort of, you know, the vibes in the ether, I guess. It's not just, you know, vanity or magazines. Actually, you know, perhaps there's this really powerful economic incentive that being thin as a woman helps you to become rich in a way that it maybe doesn't for men.
--:-- Alice Fullwood: Do you think that women are aware of this on some level? Yeah, I think this is a sort of great point because it's obviously, you know, sort of a chicken and egg situation. Well, sort of why do beauty standards exist and why are they potentially enforced by the market? And I think there sort of is an underlying awareness. There is a sense that people that do well on TikTok and social media, they tend to be thin and attractive, people who do well in the workplace.
--:-- Alice Fullwood: But I also think there is sort of an element of you either don't sort of fully recognize or in some ways potentially sort of self-deceive. You know, a lot of the time when you talk to women about whether they want to be thin or whether they want to look a certain way, people say that they're sort of trying to lose weight for sort of wellness and health. The daily habits of thin people. If you are solely focused on thinness, losing weight and being skinny, you're not going to be successful in the long term. As I always say, when you focus on health, you lose weight as a side effect. But when you focus on weight loss, you lose health as a side effect.
--:-- Alice Fullwood: I was thinking about how my friends and I, when we're talking about expensive Pilates classes, we'll refer to it as like, it's an investment in me. And it's not like we're following that down the rabbit hole and being like, and next year I'm going to get paid more. But there is the language of economics when we're talking about like, oh, it's expensive, it's 50 bucks, but I'm going to do it. It is interesting.
--:-- Alice Fullwood: I did start to think about it in that sort of, you know, OK, you're almost making like a capital investment in yourself that will pay dividends. And you don't really know sort of when or sort of what those might be. But I think sort of in general, the sort of this way of thinking about the issue actually sort of makes a lot of sense.
--:-- Alice Fullwood: All right. So you saw this chart and you decided to report on whether there is an economic penalty for not being thin. Where did you start? I mean, the first thing I did was I went off and I sort of looked to see whether this was true in other countries. This sort of trend seems to hold in wealthy, developed countries. It's very different in developing countries, but it seems to hold sort of across the Western world.
--:-- Alice Fullwood: And then I started thinking about sort of the reasons that people often think that there might be this sort of negative relationship between weight and income, because that was not a new piece of information. That's something that I think a lot of people are aware of. The novel thing was that it only seems to hold true for women. And from that point I felt like a lot of the explanations people had come up with in the past for why there might be a negative relationship between income and weight you know they didn't tell the whole story.
--:-- Alice Fullwood: So often they were things like you know if you live in poverty it very difficult to carve out time to go to the gym. Sometimes you don't have access to sort of fresh fruits and vegetables. It's sort of difficult to eat well. And I think all of those things are true, but they can't be the sort of main reason for this correlation because they would hold true sort of equally for men and women.
--:-- Alice Fullwood: So there sort of has to be something else going on here. And then I sort of started reading a lot of the academic literature on, you know, in the workplace, if you look at women's wages and you sort of control for things like their degrees that they've taken. So bachelor's, master's, doctoral degrees, if you control for the types of jobs they do, all these kinds of things. Is there still a sort of wage penalty for BMI or weight? And a lot of the literature does sort of back that up. There does seem to be a penalty for overweight women, particularly highly educated overweight women in the workplace.
--:-- Alice Fullwood: When we talk about, for example, like the gender wage gap, we can say, oh, for every dollar that a man earns, a woman might be earning somewhere between 60 and 80 cents. And those stats get like pretty firmly entrenched over time. Were you able to figure out if thin women make more money over time than women in bigger bodies? Could you tell us how much more money we're talking about or what that adds up to?
--:-- Alice Fullwood: Yeah, I didn't actually come up with a sort of neat as neater stat as the sort of like 80 cents on the dollar. But the figure that I put in the piece at least was that for an overweight or obese woman, so someone with a BMI of above 30, it is roughly as beneficial for her to lose 50, 60 pounds in weight to get her BMI back into that normal range as it would be to do an additional year of education. So about sort of half as valuable as getting a master's degree.
--:-- Alice Fullwood: Wow. That seems to be the magnitude of the penalty. And what you're saying is the same does not seem to hold true for men. I think we have to be a bit careful about that because there are papers that say that, especially for very, very overweight men, there are penalties in the workplace. I'm willing to believe that men are discriminated against, especially if they're very overweight as well.
--:-- Alice Fullwood: But I think that the distinguishing thing for me about how this seems to affect women is that it seems to be sort of very pervasive across all kinds of careers at every level of income. The relationship is so strong that it shows up at this macro level that you can sort of look at this chart of sort of generalized population of women and you can still see this sort of very strong relationship.
--:-- Alice Fullwood: So I wonder what you think about taking Ozempic or Wegovy or another weight loss drug. It is very expensive for sure. But what do you think about that as a rational choice, an economically rational choice?
--:-- Alice Fullwood: In terms of sort of whether or not it's rational to take Ozempic, I mean, it is very expensive at the moment. I do think given sort of where, at least sort of given the evidence I've seen on where the sort of relationship lies at the moment, it does seem like that would also be sort of a rational choice under the sort of framework that we have described.
--:-- Noelle King: Coming up, fat phobia and fat acceptance in the age of Ozempic. Support for today's show comes from Adio. What is Adio? Adio is an AI-native customer relationship management system built specifically for the next era of companies. They say it's extremely powerful, adapts to your unique data structures and scales with any business model.
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--:-- Noelle King: You can join industry leaders such as Flatfile, Replicate, Modal, and so much more. You can go to attio.com slash todayexplained to get 15% off your first year. That's attio.com slash todayexplained.
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--:-- Noelle King: Support for Today Explained comes from Upwork. If you run a business, you know that scaling your business requires the right expertise at the right time.
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--:-- Kate Mann: I'm Kate Mann, and I'm an associate professor at the Sage School of Philosophy at Cornell University, and I'm also a writer. Katie Granteson, Kate's first book was about misogyny. Her new book is called Un-Shrinking, How to Face Fat Phobia.
--:-- Kate Mann: You will perhaps not be shocked to hear that she believes the two are related. So during my final two years of high school I entered an all school the year it integrated in Australia as one of three girls. Oh I know. It was really a rude introduction to the subject of misogyny.
--:-- Kate Mann: And it meant that for me as a then chubby teen I really encountered an enormous amount of fat phobia which was the way misogyny manifested itself. I was called a fat bitch. I had that scrolled on my locker as well, which was doused with fish oil to be the kind of ultimate expression of misogynistic disgust towards a female body.
--:-- Kate Mann: And I ended up being voted the person most likely to have to pay for sex at the final high school leave disassembly. What a horrible place.
--:-- Kate Mann: Okay, so the idea I think generally for most of us is, okay, when you're a teenage girl, boys are terrible, and then everybody grows up and they grow out of this. Is that what you found happening?
--:-- Kate Mann: So things suddenly got better for me personally, and I was relieved to find that what I had encountered in those forms of bullying and cruelty was usually not nearly as explicit when it came to ways I was treated as a fat adult, but it was still there.
--:-- Kate Mann: And certainly my research into this backed this up, that fat phobia in particular isn't really getting better. It's actually on the rise according to some measures.
--:-- Kate Mann: Right now, there's a big body positivity movement underway. It definitely seems to have reached the mainstream. There are podcasts like Maintenance Phase, which is very, very popular.
--:-- Kate Mann: Guys, it's great over here. It is like genuinely so phenomenal. Whatever your size is, to get right with, the body that you have is the body that you have. Why don't you take care of it?
--:-- Kate Mann: Companies will have plus-size models. Fashion brands, fashion labels will have plus-size models. It definitely seems, if you're looking for evidence that things are getting better, I feel like you can definitely look around and be like, oh, yeah, I see it everywhere. Things are getting better.
--:-- Kate Mann: You're saying data doesn't necessarily show that. What data are you looking at? What are you finding?
--:-- Kate Mann: Yeah, so Harvard researchers in 2019 published a really interesting study showing that when it came to prejudice and bias across various categories, they looked at race, skin tone, disability, age, sexuality, and weight.
--:-- Kate Mann: And they found that anti-fatness, so weight bias, was the only form of implicit bias that was actually increasing. And it was also the form of explicit bias that was decreasing the most slowly.
--:-- Kate Mann: So one possibility is that we've seen more body positivity and more representation, but also pretty bad backlash to those progressive social movements.
--:-- Kate Mann: We know beauty standards. We know what's attractive and what's not attractive. It's not fatphobic to have a preference. It's not fatphobic to not be attracted to overweight people.
--:-- Kate Mann: You're not allowed to like yourself if you're thin. And God forbid you wear a bikini and say you're proud of your body when you're thin. Then you get routinely attacked.
--:-- Kate Mann: And at the same time, it's sending a signal to other women that they shouldn't want to better themselves. So I think it has a number of manifestations and that makes it something systemic that occurs across different sectors of life.
--:-- Kate Mann: So it happens in education. It means that fat children are more likely to be bullied in school. It's probably the most common basis for childhood bullying, according to the research I've seen.
--:-- Kate Mann: It's also something where teachers harbour negative stereotypes about fat students, holding that they're less able and less gifted as they gain weight, even though their test scores, objective measures of achievement haven't changed.
--:-- Kate Mann: It's something that we see in employment. And finally, we see huge gaps in terms of the treatment patients get within the healthcare system.
--:-- Kate Mann: So fat patients are subject to a number of really pernicious stereotypes. We're seen as lazy, non-compliant, weak-willed, having done this to ourselves.
--:-- Kate Mann: And doctors tend to blame any and every symptom that we come to seek treatment for on our weight, rather than looking at the true cause of those symptoms.
--:-- Kate Mann: It was very scary to sort of exist in a body that I thought was failing me and have medical professionals who didn't seem to take me seriously.
--:-- Kate Mann: So there was another really interesting and telling study of physicians that showed that physicians don't just harbour implicit bias against fat patients, they harbour explicit bias.
--:-- Kate Mann: They will say that they are less willing to help fat patients, that they regard fat patients as more of a waste of their time, and that fat patients are more likely to annoy them.
--:-- Kate Mann: There's a knee-jerk reaction I've seen to almost everything that you just laid out. And the knee-jerk reaction is, there are now drugs that can fix this.
--:-- Kate Mann: What was your first reaction when you started reading that there is a class of drugs that really seem to be helping people lose weight?
--:-- Kate Mann: So I want to be clear that I'm not against these drugs in any blanket way. But when it comes to weight loss, I do worry that these drugs are getting a bit overhyped for a bunch of reasons.
--:-- Kate Mann: One is just in terms of the math of it. So these drugs do have a greater effect, at least in the short term, than diet and exercise, which tends to take between 5% and 10% of people's weight off, and then the weight comes back really inexorably.
--:-- Kate Mann: Whereas these drugs look like they lead to an average of about 15% weight, according to pretty optimistic estimates under pretty ideal conditions with a pretty select group of patients.
--:-- Kate Mann: So it's more than diet and exercise, but it's not vastly more. And it does look like the weight comes back again, really inexorably following discontinuation.
--:-- Kate Mann: What is it that we're actually thinking when we're thinking, oh, Ozempic is the solution to everything?
--:-- Kate Mann: I do think there's a lot of anti-fat bias that can be betrayed by that reaction of, oh, fantastic, we can eliminate an entire class of people.
--:-- Kate Mann: And it's complicated because many people who are in that high weight category do want to lose weight and I don't want to be dismissive of that desire and it's being based in something real which is I think mostly fat phobia but there are also a lot of us who are happy with our bodies the way they are.
--:-- Kate Mann: The expressive potential of having this message around that says you really need to change your body because now we can and why wouldn't you want to change? It doesn't just feel insulting sometimes it can feel like we're not really welcome in the world anymore.
--:-- Kate Mann: That people just look at our bodies and wonder why we haven't availed ourselves of a solution to what for many of us seems like a bodily non-problem in simply having more flesh in our bones.
--:-- Kate Mann: And it's not as though, I mean, if we're talking about the U.S. today, it's not as though when we talk about people in bigger bodies that we're talking about this tiny, tiny, tiny minority.
--:-- Kate Mann: No. We're talking about many, many, many people. It's between two-thirds and three-quarters of Americans. Upwards of 70% of Americans are either overweight or obese, according to the BMI charts, which are super problematic.
--:-- Kate Mann: But nonetheless, about 70% of Americans have a claim to be somewhat fat. And yet, it is something where that doesn't necessarily drive more acceptance of fatter bodies.
--:-- Kate Mann: Rather, it drives a sense that we're a crisis, we're a problem, we need to be fixed or else in ways that don't always track the epidemiological evidence that suggests that people in the quote-unquote overweight categories aren't at greater health risks in terms of all-cause mortality than their so-called average weight counterparts.
--:-- Kate Mann: I want to draw kind of a crude comparison here, but bias or prejudice against minorities is a thing that happens. You encounter people who are different, who are not like you, and your back goes up and you think there's something wrong with them.
--:-- Kate Mann: And then more of those people move in. And then a couple of years down the line, the biases seem to go away. Like in polite society, we don't stare cross-eyed at people in interracial marriages, for example, because we're used to this now, right?
--:-- Kate Mann: Like America is just constantly changing society. And yes, we still do have racism and biases. But there are, I think there are theories that if you interact with people more, you become less likely to be prejudiced against them.
--:-- Kate Mann: Why do you think that is not happening with people in bigger bodies?
--:-- Kate Mann: What you've just laid out is a very good summary of what's called the contact hypothesis, that contact with members of marginalized groups will have this effect of diminishing prejudice.
--:-- Kate Mann: And I think, in fact, the empirical evidence suggests that the contact hypothesis is not especially reliable for any form of marginalization.
--:-- Kate Mann: But when it comes to fatness in particular, I think it doesn't work for a couple of additional reasons too, which is that a lot of fat people ourselves feel like there's a thin person waiting to come out triumphantly, like after the next diet or exercise plan or, you know, set of Ozempic shots or whatever it is, that we're really not fat people deep down, that somehow the thin person is going to emerge victorious.
--:-- Kate Mann: And so we don't really identify as fat people and lobby for political change and momentum. We don't demand thin allies stand up for us. And we don't really necessarily see this political platform building where people of a certain size, despite our ubiquity, we're not really standing together in solidarity.
--:-- Kate Mann: So yeah, I think the fact that a lot of fat people feel kind of ashamed and isolated and are trying to change not the world but our bodies means that we don't always get the political coalition building that would be desirable in this arena.
--:-- Kate Mann: Earlier this month, an article came out in New York Magazine, and this article asked rhetorically, it was written by a person in healthcare, and it asked rhetorically, what if Ozempic is just a good thing?
--:-- Kate Mann: Do you think it's possible at all that we may be freighting this with too much confusion over whether it's good or bad, or if I celebrate the existence of it, does that mean that I don't like fat people?
--:-- Kate Mann: Like, do you think possibly there's like a simpler way to cut through this?
--:-- Kate Mann: So I think we're certainly worried about this drug for some of the wrong reasons.
--:-- Kate Mann: So one point that that article made that I did like is, look, why should we insist that people do this the hard way when for many people losing weight through diet and exercise, it's not just hard, but nigh on impossible.
--:-- Kate Mann: Easier is actually better. It's just a fallacy to think that harder is better. I call this the harder, better fallacy in my work. It's very American.
--:-- Kate Mann: Yeah. If it's harder, that's actually worse or else being equal.
--:-- Kate Mann: So that particular story featured a patient of that physician who had a lot going on. She was unhoused. She was a wheelchair user. She was a type 2 diabetic, and she was put on Ozempic and she'd lost 10 pounds over a month.
--:-- Kate Mann: Why was the focus on her weight loss rather than the things that this woman obviously needed in her life, like access to fresh foods and reliable healthcare and a home?
--:-- Kate Mann: She needed housing. And yet the idea was, let's celebrate Ozempic is such a good thing because she lost 10 pounds.
--:-- Kate Mann: I'm just not sure this relentless focus on weight would do such a patient many favors.
--:-- Noelle King: That was philosopher Kate Mann. Her new book is called Unshrinking.
--:-- Noelle King: Victoria Chamberlain produced today's episode, Jolie Myers edited. Anouk Dussault and Laura Bullard fact-checked and Patrick Boyd engineered. I'm Noelle King. It's Today Explained. Thank you.
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