 Oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh, oh. From The Conversation, this is Don't Call Me Resilient. I'm Vanita Srivastava. I imagine fat people will be asked all the time now why they continue to be fat and why they're not on O's MPEC. It is presenting us with a supposed solution for a human variation that has existed for all time. There have always been fat people. There will always be fat people. It seems like everywhere I look these days on TikTok, on the sides of buses, in news headlines, I see Osempic. Osempic is that drug that was originally created as a diabetes treatment to control blood sugar levels. But it's now being used as a weight loss method too. And ever since it arrived in Canada, it's been in incredibly high demand. Racialized populations already experience diabetes at higher rates and have more trouble accessing healthcare, meaning they might be losing out on important diabetes medication. And the widespread use of Osempic could have a huge toll on body image, especially for fat racialized people. Fadi Shanuda is here with me today to unpack this. He is an assistant professor at the Feminist Institute of Social Transformation at Carleton University. Fadi's research focuses on anti-fat bias in medicine, fat and disability studies, and the intersections of racism, colonialism, and fat phobia. Thank you so much for joining us today, Fadi. Thank you for having me. So as a researcher who studies what you do, when you first started seeing this craze for Osempic as a weight loss drug, what were you thinking? I was thinking that trends are dangerous, ultimately. Yeah. I take issue with diet culture in general and any sort of weight loss trend, especially a weight loss trend that at its heart is trying to eradicate or erase fat people from society. And health trends are notoriously dangerous. Like so many trends in the past, they often lead to worse health outcomes for fat folks. Many of them leading people to gain more weight because of the consequences of restrictive eating and also the increased complexity than we have with our relationship with food and with moving and with our bodies. Osempic is heralded as groundbreaking, and to me, it really just falls in line with the hundreds or thousands of other weight loss trends that we've seen throughout our time. You're talking about the culture, this culture of weight loss and how it's pervasive. Can you give me an example of something that we've seen before that's caused a lot of damage? Yeah, I mean, there have been many appetite suppressants on the market, many drug appetite suppressants. There was one recently called plentitude. You take it and you feel full and therefore you're less likely to eat. And so therefore you lose weight over a small period of time. You stop taking the drug and of course, your body says, I'm starving, feed me, feed me, which it does after every time someone diets. And so your body doesn't understand why it's being starved, which is why 98% of diets fail. I'm gonna say that again, 98%. So 2% of diets are successful and most people who do diets and then stop regaining the weight that they've lost and additional weight because their bodies don't understand why they're being restricted from food, nutrition, eating, et cetera. I'm sure you've seen, I've seen like the TikToks, the whatever the memes, the Instagram posts. A lot of people are like, this is really working. As soon as you stop taking that drug, you gain the weight back, correct? We don't actually know. That's the interesting thing about Ozempic is that it's only been around since 2017. We go via the one that's specifically for weight loss that was invented by the same company, Novo Nordisk. That's the pharmaceutical company's name. It's only been around for a couple of years. And so we've only had people on it anywhere between five and six years. And we don't know what happens when you come off of it. Those studies aren't around. The only longitudinal studies that they have done on this drug, also when you are on it, have only been around two years long. So we only know of its effects for two years. I'm not saying it's dangerous. That's not the sort of impression I wanna leave the audience. I'm just saying that we don't yet know what happens to people when they come off the drugs. Ozempic, it produces a hormone in your body. And this is of course a side effect because it wasn't considered as a weight loss drug. Like you said in your opening, it was for diabetic treatment. And this hormone is produced in your pancreas, your stomach, and then eventually in your brain, and it tells you that you're full. And it doesn't allow you to get a glucose spike, right? Which is why it's used for diabetics because glucose spikes can be dangerous. So what happens to your body when you stop producing this hormone at such a high rate? And what happens to your body one year out, two years out, five years out? Those are not questions we can answer. We're talking about this drug as a weight loss drug, but actually this was a drug that was primarily, as you said, used for diabetes management. And we do know already that diabetes disproportionately impacts indigenous, black, and South Asian communities in Canada. How has this current Ozempic diet craze affected those diabetes patients? Diet culture affects everyone, but I think it affects communities of color differently because fatness has been always associated with blackness. There has been an association between fatness and anti-blackness. The foundation of our aesthetics today, what we consider beautiful and ideal, doesn't come from what's happening on TikTok. That's just reproduced discourse from hundreds of years ago, right? Sabrina Strings talks about this in her book Fearing the Black Body, how thinness became a characteristic of male rationality and moral characteristic. And in the adverse, in the sort of comparison group, you then had fat black women become the trope for sort of ugliness over consumption, ungodliness, et cetera. And so there you have the ties that bind blackness to notions of fatness as undesirable and as unwanted. I'm just wondering also the price of the drug, it's not a cheap drug, it's something like, I think $300 a month here in Canada and more like a thousand in the US. And it does make me wonder who can afford to use this drug for diabetes and the disparities that come with that as well. Yeah, there are some folks, of course, who have private insurance, who have access to the drugs. People who are over 65 get access to the drug for free. Hopefully the pharma care program that is being pushed through by the NDP works out and people can get access to many different types of drugs, but it is not cheap at all. And for people who can afford it, there is a supply chain issue, right? They cannot make it fast enough, this drug. And I think it does impact people who are diabetic, who can afford it because when you can't take ozempic, you're being forced to take another drug instead and switching back and forth between drugs is not a good thing. The side effects of the drug alone are nausea, diarrhea, vomiting, and they're supposed to dwindle after you take it for a long period of time. That's not always the case with everyone, but it is for a lot of people. But going on and off of it will mean that those side effects stay with people for longer. Yeah, the drug is really expensive. This company has made billions and billions of dollars since they invented this thing. And it's no surprise that just this morning when I was doing my final bits of research for this podcast, I stumbled across a Yahoo Finance article that said that now not interested in just treating people who are fat or people who are, quote, obese, but also finding ways to prevent obesity by using the drug. So again, the market share needs to increase. Always, always, always. And so like we've seen with other companies, like for example, likely seen with Noom that uses cognitive behavioral therapy, right? Which is how they differentiate themselves from every other diet, even though it's sort of the same thing. They've expanded their market to also prevention, right? And when I hear prevention, I often hear childhood obesity in line with that as well. So again, a market expansion to not just people who are eating above, but often then to say, we need to fight childhood obesity, right? And so we need to make larger markets, yeah. You know, I'm listening to you, I have to tell you that it feels very emotional. Like there's a lot of, there's a lot coming up for me as you're speaking. It's very profound what you're saying when you're talking about the historical link between racism and anti-fatness. And one of the things that I wanted to talk about is this idea that you talked about is like, will this make fatness invisible? Like you're talking about the prevention. And I think my brain always goes to this kind of, you know, dystopia sci-fi kind of moment where now we see like ozempic ads everywhere. They're on the bus. They're on the, you know, I just seen them everywhere. Like you said, it's been around since 2017, but all of a sudden it's right in our face. And it sounds like a little bit that what you're saying is this, this could be a problem in that it's presenting us with this one ideal of the body. It is presenting us with a supposed solution for a human variation that has existed for all time. There have always been fat people. There will always be fat people. It is presenting us with a solution to a human variation, i.e. fatness that has existed forever, but that is now not allowable in our society, right? I imagine fat people will be asked, right? All the time now, why they continue to be fat and why they're not on ozempic or why they aren't taking another semi-glutide. It already happens all the time to fat people. I mean, our bodies are a moral panic. They are costly supposedly, right? Our bodies are not as costly as they assume, but obesity, there's a number attached to it, right? As users of the healthcare system. Yes, right. We do hear that a lot. The idea of obesity, that there's higher rates of obesity in certain communities. And those communities end up costing us more because we have to treat things like heart disease and diabetes and et cetera. What's really interesting is that, bariatric surgery, which is another sort of response to fatness that has existed since about the 1960s, there's like nine different types of surgeries. Some of them just are about lap bands. So just about constricting the stomach. Some of them are about chopping the stomach, about 80% of the stomach out and making it smaller so that you get less food and less nutrition. Many of those surgeries happening in private clinics and when they go badly, which about 17% of them do, those people end up in a merge. And so that cost gets associated with obesity as well. When fat folks are trying to erase their fatness because they're being told that messaging all the time or from lots of different places, it also adds up. And also the fact that fat people don't like going to doctors and don't like accessing medical care because we're so often being reprimanded for being fat. I've been to doctors many, many times where they don't have a blood pressure cuff that fits my arm. So even the minimalist type of care, like what's my blood pressure, can't be measured, which is very dangerous for fat folks. That's so many times when they go to doctor's office, they're actually not getting the proper care treatment. There have been studies that have shown that doctors spend less time with us. Doctors won't prescribe the same diagnosis to a fat patient than to a thin patient or a straight-sized patient. And of course, when you fold in issues of race on top of all of those things, issues of gender. I'm sure that you get misdiagnosis, you get a lack of diagnosis, all those kinds of things that lead to very severe and dangerous outcomes. They lead to worse health outcomes, which then gets wrapped up in as fat people cost healthcare more. It's like, well, getting poor health. So obviously we end up sick. Right, right, right. You know, we're talking about this idea of the off-label use of ozempic for weight loss. And I read a Washington Post article. The journalist is also speaking about herself and her journey of weight loss and how she went on ozempic. It's a middle-to-upper-class white woman. And what she does is she talks about the disparities of this weight loss method and how exactly that there's higher rates of, I'm gonna use it in quotes, obesity in certain communities. She's talking about racialized communities. I think in the US, she's specifically talking about black communities. So in the cases of what she's talking about where someone might benefit from that off-label use of the drug, doesn't that also raise, and this is what she's saying, that it raises these racial and class disparities as well. It of course does. It creates two tiers in society, three tiers, right? If we're talking about people who have access to the drugs that can pay out of pocket, people who have access to the drug who can get through private insurance, and then people who can't get access to the drug. What's interesting is what ties all those three groups together. For those who are non-diabetic in those categories, they're all being perpetuated by diet culture and fat phobia, which really is everywhere in our world. The hatred of fatness and the fat people. Can we talk about that a little bit, the hate that you're talking about now? You problematized the use of obesity within the medical field. Can you talk a little bit about that, explain what that is? Sure. So obesity, the word itself is a Latin word and it means having eaten until fat. And so already we have a problem because fat people aren't necessarily fat for overeating. Fatness is a multi-factorial experience, right? There are both genetic issues and also environmental issues. And fat people have existed forever. And so not necessarily both a problem or a condition or disease. And so obesity doesn't come to describe a lot of people's experiences. Fat is much better a descriptor because the adipose tissue, the excess or extra adipose tissue that we carry on our bodies as fat people is called fat. And so to call us fat people is much better, much more a proper term. Because it's a descriptor, all you're saying is what we are. Obesity is problematic because it also comes from a measuring scale that is inherently flawed. I'm talking here about the body mass index or the BMI, which is a calculation of your height and your weight. And you get a number and that number corresponds to a chart and that chart gives you a, your BMI number. And that tells you whether you're overweight, obese or morbidly obese. And maybe unsurprisingly to some folks, the BMI is a very old math. It is very bad science. The same sort of math that the BMI uses is statisticians who were trying to develop between the normal and non-normal human scale. It's the same math that developed that was used in eugenics. And we know that eugenics led to the eradication of thousands of disabled, racialized and queer people. And of course the Jewish Holocaust and the eradication, institutionalization and sterilization of millions of disabled and mad people all around the world and in Canada decades before and after World War II. So it's important for us to tie the math, right? The simple sort of math equation that is done to the BMI to its history and to how all of those sciences, right, have been discredited. And yet many people are getting diagnosed in their doctor's offices with obesity using the BMI. It doesn't take into consideration muscle mass. It doesn't take into consideration the European body types and the calculations. It's just completely bad, bad math. I'm just wondering the idea of weight stigma. You talked a little bit about going to the doctor's office and weight stigma in healthcare and the stigma in society. We're problematizing the use of obesity within the medical field. You've also studied public health. So I'm wondering about that public health messaging when it comes to fatness. What patterns can you point to? What patterns are there for fat people in terms of public health, but also in terms of accessing healthcare? Public health is really interesting because awareness campaigns are a pretty important part of public health. We saw this in the pandemic with the importance of hand washing and things like that. Mostly it's about getting people knowledgeable about the issue. Fat people don't need awareness about dieting. Fat people are the best dieters in the world. They don't need further information. My issue with public health is that it focuses so much on the individual or on the failure of parents, especially around childhood obesity. I would much rather that public health be invested in the eradication of fat phobia. Part of the problem of being fat is that social and public spaces are not accessible to us. There aren't chairs that accommodate us in theaters. Flying is incredibly stigmatizing and restrictive and often painful. When you get on an eight-hour flight over to Europe, you can't use the toilet as a fat person in the plane. You might need two seats, which is incredibly expensive to fly internationally. And then when you come to issues around the doctor's office, again, there are not always chairs that accommodate fat folks. MRI scanners don't always accommodate us. Beds, hospital beds, don't do it. We talk about access as only being for disabled communities, but access is a very interdependent process. Everybody needs access of different types. And fat folks aren't often in that larger conversation. I know you were talking about the history of colonialism and the connections between fat phobia and colonialism and racism. And how is that connected under this public health messaging? I think it's done by really characterizing fatness as a problem in the first place, but as a problem of moral failing. It is a consequence of an irrational brain, an irrational body, one that then gets read, especially when the person whose fat is racialized as a consequences of their race. And so fat did become bad at some point. It wasn't always bad. And it became synonymous with dim-wittedness, with corpulence, with the idea that in fact it prevented rationality. And that all got tied up into connections with the quote-unquote characteristics of the African, right? And the characteristics of the indigenous. Caleb Luna, who's a fantastic scholar in the US, he talks about how the Europeans landed on indigenous land and they saw what indigenous people were eating. And in order to not become the indigenous body, right? They didn't eat that food. And we know this because we have sort of journals of the settlers that first came here. Indigenous people have been characterized as cannibals and there's this messaging that if left undominated, indigenous people would resort to ungodly consumption, right? So you have these discourses operating for over 400 years in the construction of very particular bodies in very particular ways. And it's not just about fatness, of course, right? We know lots of other histories that are operating alongside these, but fatphobia is another one of the assistance of oppression that works to perpetuate a certain type of violence. Do you think that the ozempic fad that we're seeing right now and that it's being used for this off-label thing, weight loss, how do you think that this is going to impact body image, specifically for racialized bodies or for gendered bodies? It is hard to see people disappear, half of their bodies disappear, and there to be a celebration of that for those of us who are fat and always will be fat. It's personally hard to see that the sort of joy that comes with loss. I think what it does to body image is that it just reinforces whiteness through thinness and access to social and cultural spaces. And it leaves fatphobia unaddressed, ultimately, and therefore continues to exclude fat people from all different spaces in our society. What do you think we need to learn from this moment? Call it the ozempic moment, but what do you think we need to learn from this? Yeah, I mean that economic disparity is alive and well. I think fatphobia is also alive and well and that we really hate fat people. The hatred of fat folks is very much still something that one can publicly be. And when we say we hate fat folks, what we're really saying is that we also hate racialized people, we also admire whiteness. We are wrapping up all of those discourses together. Wow. Fadi, this has been a really fascinating conversation. I'm gonna ask you before we leave, is there any glimmer of, is there something that you can point to that is a bit more helpful? There is something to say about the fact that the fat liberation movement, which has existed since the 1960s, is larger and more prosperous than ever. And that we are seeing a real uptake in people taking interest in fat studies and taking interest in fat liberation as a movement that's intimately connected to black liberation and connected to disability rights and the critical uptake in psychiatry and things like that. And the magic that exists really around fat joy and fat desire and fat love, when I think fat folks understand that there is this community of people and ideas that suggest that they are full of abundance and that abundance can be quite magical, it's really important. There's a wonderful scholar by the name of Hunter Shackleford from the US who talks about the joy of black abundance, type of corporealence that not everyone will get to experience, but those of us who do are quite lucky. Thank you. Thank you so much for your time today. That's it for this episode of Don't Call Me Resilient. Hearing Professor Phaedisha Nuda talk about fatness really alerted me to some of the challenges of accessing healthcare as a fat person and also to the big business of weight loss. If you're craving more information after that conversation, I've dropped some links in the show notes on theconversation.com. And feel free to let us know what you thought. Come find us on Instagram at Don't Call Me Resilient podcast or find me on Twitter at writevenita, that's W-R-I-T-E-V-I-N-I-T-A or email us at d-c-m-r at theconversation.com. Thank you for listening. Please come back next week to hear our last episode of the season. Follow the podcast so you don't miss it and please consider sharing this pod with a friend or family member or drop a review on whatever podcast app you use. Don't Call Me Resilient is a production of The Conversation Canada. This podcast was produced in partnership with the Journalism Innovation Lab. The lab is funded by the Social Sciences and Humanities Research Council of Canada. The series is produced and hosted by me, Vinita Srivastava. Bokeh Sai Si is our producer. Our consulting producer is Jennifer Morose. The audio editor for this episode was Krish Dinesh Kumar. Our regular audio editor, Remitula Sheikh is on holiday. Ataka Kaki is our marketing and visual innovation consultant. Journalism student, Kikachi Meme is our assistant producer and Scott White is the CEO of The Conversation Canada. And if you're wondering who wrote and performed the music we use on the pod, that's the amazing Zaki Ibrahim. The track is called Something in the Water.