Podcast 119: Fearing the Black Body Part One with Sabrina Strings PhD – Why Health is about Access, Not Weight

Sabrina Strings, PhD is the author of the new book Fearing the Black Body: The Racial Origins of Fat Phobia. In this two-part interview, we discuss how she was able to connect racism with fatphobia, control of women’s bodies historically and through today’s diet culture, and how medicine’s use of the BMI metric is problematic and harmful. Dr. Strings shares why weight loss should not be part of the health equation and instead we should be seeking access to safe, nutritious food for all people at every size.

Sabrina is an Asst. Professor of Sociology at the University of California, Irvine. She was a recipient of the UC Berkeley Chancellor’s Postdoctoral Fellowship with a joint appointment in the School of Public Health and Department of Sociology.

She has been featured in The Feminist Wire, Yoga International, and LA Yoga. Her writings can be found in Signs: Journal of Women in Culture and Society, Fat Studies: An Interdisciplinary Journal of Body Weight and Society and Feminist Media Studies. Sabrina was the recipient of the 2017 Distinguished Contribution to Scholarship Article Award for the Race, Gender and Class section of the American Sociological Association. Fearing the Black Body is her first book.

More Sabrina: Book | Twitter

Listen here to Episode 119 here or read the episode transcript

Transcript

Rebecca: 00:00 Sabrina, welcome to Body Kindness.

Sabrina: 00:03 Thank you for having me on.

Rebecca: 00:05 I’m so, so excited for you to be here. I was actually watching some YouTube videos I found of you last night, and introducing you to my daughters of who Mommy was going to be talking to today. So thank you, I really appreciate it.

Sabrina: 00:19 That’s awesome actually. I forgot that those videos were out there. I think I know which one you’re talking about.

Rebecca: 00:23 You know nothing ever dies if it’s on the internet, right?

Sabrina: 00:26 That is so true, yeah, the eternal archives.

Rebecca: 00:29 Yes, exactly. I love to start the show by letting the listeners know how I came to find you and I really care deeply about bringing my guests on. So for you, I was doing as folks do and dawdling on social media, I want to say, a couple years ago actually. There was an article that was being shared in the health at every size circles, that you had won a very important award or a grant from the Hellman Foundation to write the book that I’m holding in my hand, called Fearing The Black Body: The Racial Origins of Fat Phobia. I bookmarked it and I was like, “When that book is done, I want to talk to her.” I just kind of made sure to follow you for a while, and so I was a fan before I even got the review copy in the mail. I would just love if you wouldn’t mind sharing a little bit more about yourself and the kind of work you do, to get started.

Sabrina: 01:26 Well sure. I’m originally from Pasadena, California. Actually that ended up being relevant to the story of how I came to write this book, because my family is from Kentucky, Tennessee, and Georgia, and my grandparents came to California as part of the second wave of the Great Migration in the 1960’s. My grandmother grew up in a Jim Crow segregated, all black community, a rural community in Georgia. She moved from there to Pasadena, California, and for the first time she’s living in an integrated community. One of the things that struck her, pretty much immediately, was the fact that almost all of the white women that she was meeting were on diets. She was like, “What is this?” So, as you might imagine, growing up in the 1940s through the 1960s in rural Georgia, not a lot of people were worried about losing weight. So it was a major triumph just for people to be able to eat regularly.

By the time I was in high school in the late 90’s, this was something that she would just pull me aside and ask me routinely, like why are white women on diets? Like what? For decades she had been puzzled by this, and I think in the beginning she would ask this question and I would be like, “I don’t know. I don’t want to think about this right now. I’m 16 years old, who cares?” But later, I started to realize that this is actually a very important question that people had not interrogated before. So it was in graduate school, nearly ten years after our initial conversations, that I began the work for this project.

Rebecca: 03:07 Because you had some element of resilience, right? Like I can’t be bothered by that crap, I’m 16, I want to enjoy my life. I actually think our culture now is much worse off. So I don’t know, do you think it was how you were raised, just in personal values to respect yourself, or what was your secret?

Sabrina: 03:24 On the one hand, being in a black family and living in the community that was integrated, I feel like my grandmother in particular did a lot of work to first of all provide us with healthy meals. So we always had collard greens and yams and baked chicken and macaroni and cheese, and the traditional southern cooking that my grandmother was a master at preparing. She definitely wanted us to have a pride in our heritage and also our appearance. My grandmother worked at Macy’s department store, and it was very, very fancy to be able to go in there, so you need to make sure that you presented yourself accordingly. But at the same time, as I mentioned growing up in an integrated community, it was pretty clear that maintaining a certain weight was important. So it wasn’t as if I was completely unaware of what she was talking about. I just wasn’t as invested in the question as she was, and I wasn’t as invested in the practice as I knew some of my white friends were.

For me, my thought was, “Okay, I think it’s important to maintain a particular type of figure, but it’s not of the Kate Moss type. It’s more of something that we would today call slim-thick. You want to make sure your waist is trim, but you have nice, strong legs and this whole thing.

Rebecca: 04:40 So there was still a conformity happening, right? Which from the book it started before any of us were ever born. There was still some rule that you were following that you kind of fit, so you didn’t feel the pull. The allure of dieting wasn’t going to be as rewarding to you.

Sabrina: 05:01 It was one of those things where dieting definitely did feel like a moral enterprise, although my desired outcome was not the same as for a lot of the white girls that I knew. So it felt like, yeah low fat diets, because you know this was the 1990’s and this was the height of SnackWell’s. It was like okay well you want to have your low fat diet with a couple of low sugar items, but nevertheless you get to indulge. So yeah, I was definitely aware of, and a participant in, the 1990’s diet culture, but I think I had a different orientation to that than some people.

Rebecca: 05:39 Well thank you for sharing that. That’s really interesting. I really want to also share a little bit about where I’m at. I’m an educated white woman, cis gender, hetero, I have a lot of privilege. I have thin privilege. I’m really interested in having a conversation with you, I’ve really benefited from learning from Ijeoma Oluo has been on the show before, Sonya Renee Taylor has been on the show before. Desiree Adaway, I use her cards for self reflection and journaling, I’d like to say all the time, but sometimes I’m just like, “Yeah, I’m all right.” Whenever I’m not all right, I pull a card and I journal and I get better.

Sabrina: 06:21 Wow.

Rebecca: 06:22 So I’m still very much in a phase of listening and learning, and at the same time I want to help myself and my family, I’ve got two young girls, and also the podcast listeners. There’s helping professionals who listen, there’s anyone trying to walk away from diets at any size, and I really want to help people create a better life, and outside the personal, help contribute to make the world a better place. I would just love to know, before we dive into the details of what you found in your very important, very academic, very well referenced book, is there a hope that comes to mind, like when you held your first copy, was there a moment full of hope that you have now that this book is out there in the world?

Sabrina: 07:18 You know I really appreciate that question, because when I began my research into this topic, I faced a lot of resistance. So there were my peers in graduate school, and there were also faculty members that I met at a variety of institutions who thought A, hasn’t this already been done? B, is this academic? And C, is this something we can know or should care about? So it was a really strange mix of reservations. These three things are, they simply don’t go together.

Rebecca: 07:50 Can I ask, was there a race issue in those questions, or was it just, I don’t know, ignorance is the word that’s coming to my mind?

Sabrina: 07:58 It was mostly men.

Rebecca: 07:59 Okay, gender. Okay.

Sabrina: 08:01 I do want to point that out. Yeah, it was mostly men, but not exclusively, and mostly white people, but again not exclusively.

Rebecca: 08:07 Okay, all right.

Sabrina: 08:08 There was, yeah, I mean so I actually began some of the earliest research on this project in about 2007 or 2008, and we have to keep in mind that this was the height of the obesity epidemic rhetoric.

Rebecca: 08:19 Right.

Sabrina: 08:20 Yeah, so the mid-2000’s was really the time in which all of America was sort of on tenter hooks, we have to figure out how to get all Americans to lose weight. So here I am saying, “Oh you know what, there might be an alternative history to what we’re describing. It might not actually just be health concerns that is motivating this terror.” So people really did push back against that. It wasn’t until maybe about five years ago that I started to see a significant shift. So I do feel hopeful now that people are starting to think differently, like wait a minute, the science of obesity is actually rather weak, and I might even call it pseudoscience for the most part. So what is driving this aversion to fat people, and how can we rethink our orientation to health outcomes in a way that does not prioritize weight loss?

Rebecca: 09:12 Right. Yes. So I just want to acknowledge, yes 2007, this thesis and book proposal would have been radical. Now that you make those connections, absolutely I could see that and I’m tracking with you. So Body Kindness came out and I sold the idea in December of 2014. It actually wasn’t called Body Kindness though, it was going to be a superficial book called Happy Hours. I was like, “No, no, no. I actually want to write about something more meaningful.” But anyway, it came out around January 2017, and even then it was. Some people still, like they’re picking it up now and it’s a revelation, being good to your body. So I’m tracking with you along with the SnackWell’s comment as well. I think that what I’m seeing, I just love the hope that you’re expressing for the book, because what I’m seeing is that there is this more of a mainstream awareness about body positivity.

In the medical realm, I’m seeing a little like, “Let’s not do weight stigma. Let’s be nice to people while we perform weight loss surgeries.” Or “Let’s not body shame someone if they come in with an earache.” That was in JAMA this year, and it’s like you can see the steps, but it’s not really fat liberation. It’s not really addressing the systems and the structures, but it’s certainly different. I mean when I was reading some of the history in your book, I used to kind of idealize, “Oh in another time and another place, it was probably better.” You actually point out in a lot of ways how it was, they weren’t even trying to hide their, like there’s a lot of diet in disguise going on now, but it was just like, “You suck and you’re eating too much, and so stop eating” like in Cosmopolitan when that first came out, as an example.

But yeah, so I’m seeing these shifts, but also this sort of, and you talk about health without centering weight loss, and I think that is absolutely key, because there’s this message that we all have personal control over our health. That if we dare have a disease or a problem where we need medical help, we should be shamed that we did something wrong. Literally, and I don’t follow Whole30, and it’s just one example of, “Hey this is for health. This isn’t a diet, it’s for health” but it literally says every bite of food either adds to your health or takes away from that. That’s kind of extreme, every bite.

Sabrina: 11:54 Yeah, that is. Right.

Rebecca: 11:57 So it comes back to this, I mean maybe there’s a question of we’re operating from the wrong definition of health if it’s going to center weight loss. What are your thoughts on that?

Sabrina: 12:10 I agree with that wholeheartedly. When we think about it, what we ultimately hope for, if we are genuinely concerned about the health of Americans, what we hope is that they might have access to safe and healthy foods, they might have access to the ability to move their bodies, and they might have the motivation and interest to actually eat healthier, and engage in healthy movements, and get enough sleep, and get enough water. So rather than trying to berate people for their weight, if we’re concerned about healthy practices, we can simply promote healthy practices and make them accessible.

One of the things I remember having as a question years ago on a panel that I sat on at Rutgers University, someone asked me, “Well, if we’re not telling fat people to lose weight, what do we tell them?” I said to them, “Why would we tell fat people anything other than the same thing that we’re telling thin people, which is that it’s a good idea to get enough fruits, vegetables, protein, and carbohydrates, and to eat enough to move your body and to get enough rest?” I mean effectively we don’t have to have separate messaging if the goal is the same.

Rebecca: 13:15 Yeah, I agree wholeheartedly with that, and there’s so many interesting insights from your book, but being trained in the medical model as a registered dietician, feeling so proud of my flexible, balanced plates. Here’s the sort of government guidelines, but be flexible, it might look like a peace sign if you’re out to eat or if it’s pizza night or grandma’s favorite mac and cheese. It might be half and half. And granted, clients really do find that really helpful, and then I read in your book about how government food guidance is really rooted in the need to control people at all cost. I’m like, “Part of the problem, part of the problem, part of the problem!” That just has been my life for the past several years. Accepting what is and trying to learn and grow, and accepting what is and trying to learn and grow.

Sabrina: 14:07 Yes. I’m also evolving as I’m thinking about this. It’s not as if I came to this in the 1990’s with the supreme awareness. I’ve learned so much even in the past couple of years, and I think when I first started this work there were a number of people who were writing in a way that felt liberatory, but they were still talking about portion control, and then over time I started to think, “Actually, this question of trying to tell people to eat healthy food, but not too much, which is the tagline of one of the more famous authors in this field.”

Rebecca: 14:39 Mostly plants, only things grandma would be able to say.

Sabrina: 14:42 Exactly. So you know exactly where I’m going with that.

Rebecca: 14:42 Yep.

Sabrina: 14:45 So I remember reading that and thinking, “Oh yeah. Okay, well this is the kind of thing that I believe in” and then later I thought, as long as we’re telling people how much they should eat, as if we know how much another person should eat, then we’re still in the same biopolitical model of population control that is not rooted in health concerns.

Rebecca: 15:05 Yeah. Yeah, and you know I grew up, thankfully we had WIC when I was growing up, and when we got the delivery we got more food. I was a little less hungry. We were always stretching a dollar and that, I mean I am in a totally different economic scenario, thank goodness, I’ll forever be grateful for it, but it’s like that doesn’t leave you. So when those messages were coming out, I was like, “I get the idea, and I am still feeling the elitism in it.” Because unless we have type of structure set up where people have the time to shop, prep, cook, clean, and do all those other things, because we’re making a living wage, okay then. But there always seems to be people who get excluded from these messages that sound like some sort of ideal utopia. Oh and by the way, you’ll get the everlasting promise of weight loss, you know?

Sabrina: 16:03 Yeah, some of the work that I did prior to publishing this book was around food security, which is the idea that everyone should have access to nutritionally adequate and safe foods. In the United States, something like 15% of households, so not people but households, are food insecure. Which means they do not have access to these kinds of foods. So when we think about the types of interventions that we can make as people interested in public health, this is where we can begin. It’s only one step. I mean as you talked about, even if we could make safe food accessible, then we still have the problem of individuals who live in marginal housing and don’t have access to kitchens. So what precisely do we expect them to prepare for themselves?

The relationship between poor health outcomes and poverty is staggering. That’s why scholars have long called it a fundamental cause of illness. What we need to work toward is thinking about how can we best support the entire population to have better access to nutritionally adequate and safe foods? It’s a difficult problem to address, but weight loss should not be central to that.

Rebecca: 17:17 Right. That’s where I feel myself evolving to more lately, is the sense of when I’m at a conference, thinking about the resources that it took to get me there, acknowledging who isn’t in the room. When I have the opportunity to speak, being able to acknowledge my privileges or write things that come from a place of noticing and acknowledging privileges, because I remember when I first started doing a nutrition private practice, I was like, “Oh insurance doesn’t really work for dieticians, so I’ll be out of pocket.” I remember this sort of, “Oh my gosh, people who need my care aren’t going to get it.” Then in the beginning it was like when something with a socioeconomic issue would pop up, I was like, “Oh well that’s not really my clientele. That’s not really my focus,” and I think that, that’s a message a lot of privileged people in medicine and health and wellness will jump to.

Again, back to that what definition of health are you using, I think we need to figure out who has the power in the system and what is the work that’s being done? Even though we need to keep doing our work, and keep our bread on the table, how can we acknowledge the privileges, verbalize the injustices, because those words, it has to do something to move the cultural dynamic. What would your thoughts be to that?

Sabrina: 18:46 As a person who is also privileged, now that I’m a professor and a middle class individual as well, I will say that this is something that is such a difficult challenge. Because on the one hand, also being that I’m a yoga teacher and practitioner, I can see that within the yoga community there’s so many resources targeted toward those persons who are financially able to access them. Plenty of yoga classes, meditation, stress reduction, sort of dietary advice, if you have enough money to be able to purchase access to these things.

I was recently having a conversation with a professor in public health, and he was saying to me that they’re starting to realize that for whatever reason, the fact that America is a place where there are so many people who are poor, and so many people who do not have the ability to feed themselves regularly, it is actually affecting the health of the middle classes. They wanted to try to figure out, “Wait, how is this dragging the middle class down?” I mean obviously the person didn’t say it that way, but I did point to the inherent callousness of the focus on how the poor are somehow making the middle class less healthy, but the reality is that that is in fact going on.

For so long we’ve sort of, or many people I should say, have put blinders on and just focused on hitting that segment of the population who has the money to be able to fashion a particular lifestyle of health and wellness for themselves, but now there’s a growing awareness in the public health community that if we do not take care of all Americans, then all Americans lose out and not just the poorest. So I think there is the beginning of a revelation surrounding that, but it’s going to take a lot more work in order to articulate precisely how it is that not allowing universal healthcare, not allowing clean and safe drinking water, not making allowances for people to be able to walk on the sidewalk because there’s no sidewalks, how all of these infrastructural problems affect all Americans, even those in the wealthiest communities.

Rebecca: 20:57 Absolutely. Then pivoting back specifically to the book, how we started about 2007 and the height of the, air quotes, obesity epidemic rhetoric, all those things that you just mentioned, that wasn’t what was given the attention. It was simply you’re eating too much and we’ve got to do something about your size. Can I read a little part from your book? It’s actually in the epilogue, but I think this is a good segue, I feel like starting at the end for the book conversation would be really helpful for listeners.

So this is from Fearing The Black Body: The Racial Origins of Fat Phobia: The image of fat black women as “savage” and “barbarous” in art, philosophy, and science, and as “diseased” in medicine, has been used to both degrade black women and discipline white women. For decades, white feminist scholars and historians focused largely on the impact of the “thin ideal” on middle and upper class white women. They claimed that the thin ideal was oppressive, but also suggested that they did not know how it developed. This book endeavors to address that question, adding a much needed intersectional component to the analysis of the development of fat phobia, and the slender aesthetic, revealing race to be the missing element in many of these analyses.

So that was my sort of I guess “wokeness” in “Oh my gosh, you’re right.” In all these feminist movements, like we really don’t know, and there’s enough there that you had to write an entire book on it.

Sabrina: 22:39 Yeah.

Rebecca: 22:40 So kind of starting from kind of what people are most familiar with, going to see a doctor, maybe going for an earache and recommended that there’s weight loss, that is something that wasn’t always the case. There was a transition which medicine decided to take health and weight on as this thing that they were going to uphold and hold women accountable to, to control. Can you share a little bit more about what you found in your research to that point?

Sabrina: 23:13 Yes, definitely. Thank you for reading that quote, because I think it nicely contextualizes the points that I’m trying to make in the book obviously, and then also in this conversation. When we look at the work of someone like Barbara Ehrenreich, who had written about medical sexism, what they have revealed is that historically when the institution of medicine was formalized and professionalized in the United States, one of the key groups that doctors, who were largely men, were interested in trying to reform and turn into idealized healthy citizens, were women. So women’s bodies have long been a focus of control and a locus of medical intervention.

What happened was that in the late 19th and early 20th centuries, there was this sense that American women were too slender, which when you first hear it is like, “Wait what?” But then I’m sure we’ve also heard of the stereotype of Americans being the Yankee, Abraham Lincoln figure in fact. So while maybe not everyone has heard of that, but nevertheless that was a particular stereotype that did exist in the United States for a number of years.

So what was taking place was that during that particular period, and the idea was like Americans are for some reason just naturally slender, doctors were suggesting it’s actually very important for women to gain weight because we know that women with a particular amount of fat in their bodies, who are just fleshy and curvy enough to sustain pregnancy, are the ones who are going to be the foremothers of the next generations. So you can find articles about this in JAMA, and the American Journal of Public Health, that are really focused on this question of how to get women to gain weight. It wasn’t until around the 1920s or 30s that there started to be a shift, and the idea was that actually, we need to get women to be focused on losing weight.

Rebecca: 25:17 1919, I think, the scale was made. The penny scale went from like, “Oh this is entertaining while we’re waiting for the movie to start,” to “Oh wait, we’re making a lot of money on these. We can get it into the size that can fit in a bathroom and now we’ve got to create a need for it. So let’s put the woman in her rollers, holding her coffee cup, standing on the scale, and saying weigh yourself every day for health.”

Sabrina: 25:40 Yeah. I remember seeing an advertisement, I believe this one was from a little bit of a later period, maybe the 1940s, of a woman in a bathrobe, just like you’ve stated, standing on a scale, looking down at it, and she’s with her daughter, and her daughter is also looking down at the scale.

Rebecca: 25:40 Oh no!

Sabrina: 25:58 Yeah. A very troubling image, but supposed to be a form of bonding. The mother is inculcating her daughter, introducing her to this particular understanding of what it means to be a woman, and a healthy woman. So this is supposed to be celebrated, it’s a good thing. This is an example of good mothering.

Rebecca: 26:21 That is awful.

Sabrina: 26:23 Yeah.

Rebecca: 26:23 Yeah. I do feel today, in my experience as a mom, and when people are like, “Oh my gosh, I have a question for you” or I had a recent podcast with another podcaster, author, and mother, and we titled it Please Don’t Screw Up Our Kids, kind of like that feeling. That oh my God, somebody talked about cheese and weight gain, or whatever it was. That’s that feeling. So I do think that there’s that, for the people who are aware, you know I’m kind of struggling with body image here, I’m kind of done with the diet rollercoaster, and they don’t know what to do with themselves, and they don’t want to screw up their kids. Even hearing from you, now I’ve got to find that image, though I don’t really want to look. That idea of telling people this is what it takes, this is how you help your kid think about health, I mean the countless number of people who have been harmed by weighing themselves and kids being put on diets at three, and eating disorders.

Sabrina: 27:23 Yeah, oh my gosh.

Rebecca: 27:24 So, so much harm.

Sabrina: 27:26 Yeah.

Rebecca: 27:26 Can I share one of the most chilling things to me, like the hairs on my arm just stood up, it’s in chapter eight, Fat Revisited. Maybe this is because this is my time, but I was really like, “This ain’t right.” That came out of my mouth. I think it was 1985 was the year that black women were first included in health reports, and you say that until then racial or ethnic, like it was seldomly included in any type of medical analyses. I was like, “What? How do you not even include the people that you’re aiming to help?” That just sounded like racism and an injustice, and yet it’s very much true. What can you share with us about that?

Sabrina: 28:11 Yeah. So in the early 20th century through the mid 20th century there was this idea that we needed to reform women, but the women that they wanted to reform were white women, because the idea was that we are trying to create the best possible mothers for our nation. And if that’s the goal, they’re not focused so much on women of color. So women of color are the people that they’re trying to prevent from reproducing, and there’s fantastic work on this by a number of authors, but I’ll just mention Dorothy Roberts and Killing The Black Body, so all of the ways throughout the 20th century that they have tried to sterilize black women, to prevent them from reproducing.

It wasn’t until the 1980s in which democratic congress was actually starting to notice that there were tremendous health disparities according to race and ethnicity. So they thought, “We need to figure out why it is that minorities,” as they would have been called at the time, “are experiencing many more negative health outcomes in this country than white Americans.” So it wasn’t until after the civil rights movement and the feminist movement that people became much more invested and interested in trying to figure out why it is that people of color have worse health outcomes. So this is part of the reason why, for a number of years in the medical establishment, very little was known about what was happening in low income and marginalized communities.

Rebecca: 29:37 Can you share whether it was in the book or not, any sort of what did we come to find out about disparities? I know it was only in the last couple of years where I’ve been able to learn and read that experienced oppression, experienced racism, impacts a person on the cellular level.

Sabrina: 30:01 Yes, and there are just so many factors that contribute to health outcomes, which makes the focus on weight all the more egregious, because one of the things that I point out in the book, one of the consequences of them now deciding that they’re going to shift their focus from largely white populations to populations of color and try to figure out, well what is causing poorer health outcomes? They found their BMI’s are elevated, so it must be weight. Well tell them to lose weight. But in reality, there are so many factors. In addition to the food security issues that I mentioned previously, although I did not mention that communities of color, low income communities, female headed households, are far more likely to experience food insecurity than middle class, wealthier, or whiter communities.

So when we look at all of the factors that are contributing to health disparities, stress is a major component. Poverty, lack of access to safe drinking water and healthy food, it’s such a compounding number of things. I think that a number of public health scholars did a fantastic job of being able to articulate the ways in which maybe one or two of these things might contribute to worse health outcomes, but the difficulty is that it’s such a conglomeration of factors that are embedded, that it’s very difficult to be able to say, “If we change one thing, then we will change the entire system,” unless the one thing that we are changing is fundamentally trying to eradicate poverty.