The Money with Katie Show: “You Just Have to Keep Buying”: How Diet Culture Profits from Fatphobia

Release Date: January 22, 2025

Introduction

In the episode titled “You Just Have to Keep Buying”: How Diet Culture Profits from Fatphobia, host Katie Gatti dives deep into the intricate relationship between diet culture, fatphobia, and the burgeoning weight loss industry. Building upon the foundation set in Part One of the series on the economics of weight loss drugs, Part Two explores personal experiences, medical perspectives, and the broader socio-economic implications of GLP1 agonists like Ozempic and Wegovy.

Background: Part One Recap

Katie begins by recapping Part One, where the show examined the inverse correlation between income and weight predominantly affecting women in high-income countries. The discussion highlighted how weight stigma adversely impacts women's earning potential and drew parallels between societal attitudes toward wealth and fitness. Notably, the episode referenced Tressie McMillan Cottom's assertion:

“Being fat can be hell. Selling to fat people is profitable.” (Timestamp [03:00])

The episode also touched upon the rise of telemedicine and compound pharmacies capitalizing on the weight loss drug shortage, and introduced Lily, who shared her personal journey with GLP1 agonists.

Lily's Experience with GLP1 Agonists

Lily provides a candid first-person account of her ordeal with GLP1 agonists. Initially optimistic about rapid weight loss, Lily's enthusiasm turns to distress as severe side effects emerge after the third dose.

Key Highlights:

• Rapid Weight Loss and Side Effects: Lily reports losing 11 pounds in approximately two weeks, leading to extreme muscle fatigue and difficulty walking. She recounts:

  “I lost 35 pounds. I love bread.” (Timestamp [02:14])
  “Nothing's ever worked this quickly. This is a magic bullet.” (Timestamp [14:25])

• Medical Challenges: Attempts to seek medical help were met with dismissive responses from healthcare providers, attributing her symptoms to potential COVID-19 or other unrelated issues. Lily narrates the frustration of feeling unheard and unsupported by the medical system.

• Emotional and Physical Toll: The inability to maintain normal activities, coupled with emotional strain from worrying family members, culminates in Lily’s realization of the drug's adverse effects.

  “I didn't go to medical school, but I'm pretty sure this is not Covid.” (Timestamp [11:14])

• Final Decision: Ultimately, Lily decides to discontinue the medication due to the detrimental side effects outweighing the benefits.

Dr. Mara Gordon on Diet Culture and Medicalization

Dr. Mara Gordon, a weight-neutral physician, offers a critical analysis of diet culture and its medical manifestations. She defines diet culture as:

“The cultural influences that make us feel like we always need to be shrinking our bodies.” (Timestamp [04:35])

Key Insights:

• Diet Culture as a Scam: Dr. Gordon vehemently criticizes diet culture, emphasizing its role in perpetuating the multi-billion dollar diet industry. She states:

  “I hate being a part of it as a doctor. That's not why I went into medicine.” (Timestamp [36:54])

• GLP1 Agonists and Diet Culture: While acknowledging the potential benefits of GLP1 agonists, Dr. Gordon warns against their commercialization as diet tools, advocating for their use in treating genuine health conditions rather than as solutions for societal fatphobia.

• Impact on Women: Dr. Gordon discusses how weight stigma uniquely affects women, intertwining with misogyny to influence areas like workplace earnings and societal perceptions.

  “Women are judged on their appearance in a way that men are not.” (Timestamp [38:28])

• Size-Inclusive Medicine: She advocates for a shift from weight-focused healthcare to a more holistic approach, emphasizing actual health metrics over body size.

  “What makes you feel like you need to lose weight? Or what are your goals in trying to lose weight?” (Timestamp [41:11])

The Economics of Thinness and Accessibility

Katie and Dr. Gordon delve into the economic dimensions of thinness, discussing how societal pressures and economic disparities influence access to weight loss solutions.

Key Points:

• Class Signifiers: Body type often serves as a proxy for social class, with thinness associated with affluence and moral virtue.

  “The ideal itself is manufactured and that the goal of inclusivity should ultimately lead us to neutrality.” (Timestamp [67:00])

• Access Disparities: Despite the high cost of GLP1 agonists, those who theoretically benefit the most from them—individuals facing weight-related stigma—are often the least able to afford or access these medications.

  “Many people who can absolutely benefit from medications cannot access them because of insurance issues and because of cost.” (Timestamp [51:53])

• Comparative Analysis: Drawing parallels with other medical conditions like prediabetes, the discussion highlights how medical definitions can be influenced by economic interests, leading to over-medicalization and unnecessary stigmatization.

Historical Perspectives on Fatphobia

The episode incorporates scholarly perspectives to contextualize current fatphobia within historical frameworks.

• Kate Manne's "Unshrinking": The book traces the medicalization of fatness to the early 20th century, intertwining it with racism and misogyny. Manne states:

  “Fatphobia wears a lab coat because it's dressed up as a medical fact in ways that I don't think reflect the complex relationship between weight and health.” (Timestamp [25:00])

• Sabrina Strings' "Fearing the Black Body": This work connects the aversion to body fat with the transatlantic slave trade, highlighting how thinness became a marker of racial and social superiority.

  “Middle-class and upper-class white women, they needed to watch what they eat... to show their Christian nature and also their racial superiority.” (Timestamp [27:09])

Medicalization of Fatness and Conflicts of Interest

The discussion transitions to the problematic medicalization of fatness, exploring how economic incentives can distort medical practices.

Insights from Dr. Mara Gordon:

• Selective Medicalization: Dr. Gordon distinguishes between medical needs and societal pressures, emphasizing that GLP1 agonists should address bona fide health issues rather than enforce societal beauty standards.

  “The real issues are... access to fresh foods, walkable cities, safe green spaces.” (Timestamp [53:26])

• Physician's Role: She advocates for doctors to focus on objective health metrics and support patients in defining their own health goals, free from societal pressures.

  “My goal as a doctor is to help my patients, sort through the different variables, interpret the different data, but ultimately it's their decision.” (Timestamp [55:59])

Final Thoughts and Analysis

Katie concludes with a critical examination of the notion that democratizing access to thinness through medications will alleviate cultural obsessions with weight.

Key Conclusions:

• Hierarchical Inclusivity: Allowing more people to attain thinness does not dismantle body hierarchies but rather reinforces them by making thinness more accessible to specific demographics.

  “They don't neutralize or challenge their accordant beauty or body hierarchy.” (Timestamp [65:08])

• Socioeconomic Indicators: Thinness continues to act as a class signifier, with access to weight loss solutions being intertwined with economic status.

  “The most important qualification for meeting the ideal is often just affluence.” (Timestamp [71:42])

• Health Implications: Stigma associated with body weight contributes to adverse health outcomes, often more so than the physical aspects of obesity itself.

  “The stigma itself can be as dangerous as, if not more than, the thing that it is stigmatizing.” (Timestamp [75:00])

Conclusion

“You Just Have to Keep Buying”: How Diet Culture Profits from Fatphobia” offers a profound exploration of how societal pressures, economic interests, and medical practices intertwine to perpetuate fatphobia. Through personal narratives, expert insights, and historical analyses, the episode underscores the necessity of rethinking our definitions of health and the role of medicine in combating, rather than reinforcing, harmful cultural norms.

Notable Quotes:

“Diet culture is a scam. I hate being a part of it as a doctor. That's not why I went into medicine.” — Dr. Mara Gordon [04:35]

“Being fat can be hell. Selling to fat people is profitable.” — Tressie McMillan Cottom (cited by Katie Gatti) [03:00]

“The stigma itself can be as dangerous as, if not more than, the thing that it is stigmatizing.” — Katie Gatti [70:00]