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Journalism's coverage of weight and size

Carlos Carmonamedina for NPR Public Editor

In 2013, the American Medical Association officially changed its position on obesity, advising medical practitioners that the condition is a chronic disease requiring medical treatment, not an individual's failure. In 2018, the National Institutes of Health published a paper pointing out that the media had not yet caught up to the AMA, and instead continued to perpetuate the false belief that obesity is only a matter of self-control.

In 2023, health journalists everywhere are finally catching up with the science, as well as exploring and explaining the social baggage that often prevents us from having fact-based conversations about body size.

Today we address two listener letters about NPR stories. The first story is an interview with an author of a newly released book on cultural myths about "fat" people. The second story is a look at a new and expensive weight-loss drug getting results, but not always covered by insurance. Both listeners offered comments and asked questions that poke at this gap between cultural assumptions and medical knowledge.

We looked closely at both stories, as well as NPR's work on the topic of obesity. Read on to see what we found.

And we spotlight two examples of great NPR journalism. The first is a look into the connection between workplace relationships and job satisfaction. The second is a series of stories on a virus research station in Guatemala looking to spot the next pandemic.

FROM THE INBOX

Here are a few quotes from the Public Editor's inbox that resonated with us. Letters are edited for length and clarity. You can share your questions and concerns with us through the NPR Contact page.

Covering stories about weight, size and health

Audience members recently wrote to us about two very different NPR stories related to coverage of body weight. We analyzed the two stories and asked a couple of journalists what reporters should consider when covering these issues.

Alex Park wrote on Jan. 9: All Things Considered has waded into double-think where obesity is normalized, and journalism no longer needs rigorous questioning around important public-health issues. The interview with Juana Summers of Aubrey Gordon ... allowed Gordon to gaslight obesity as a health-choice rather than a societal health crisis. ... All Things Considered has spent ample time identifying and calling out anti-science bias around the climate change argument, but amplifies anti-health propaganda and ignores science wherever "identity" is involved.

Host Juana Summers' All Things Considered interview with author and podcast co-host Aubrey Gordon mostly focused on body image and understanding of what "fatness" means. (A longer version was also published by Life Kit .) It was a conversation about Gordon's new book, "You Just Need To Lose Weight" and 19 Other Myths About Fat People.

At the beginning of the ATC piece, Gordon clearly states that obesity is not a choice: "Researchers have been clear for years that our body size isn't solely or even primarily the result of our own choices." She also discussed the scientific shortcomings of body mass index measurements, or BMI.

The ATC interview also featured Gordon's perspective on the word "fat." The word "obesity" does not appear in the ATC piece.

The focus of this story was appropriately placed on the social implications of "fatness." It's a worthy topic to explore, and Gordon is a credible source based on her personal experience and her recent work as a writer on this topic. Finally, given that the average American is overweight, or plus-sized or "fat," as Gordon would say, it's important to explore the cultural burdens placed on a significant part of the population.

Jessica Rainey wrote on Jan. 30: Firstly, I appreciate NPR's attempts to present a full and accurate picture of today's issues which is why I was greatly disappointed with [Morning Edition's] oversimplification of obesity and weight loss. ... [It] reduced the issue to "maybe I should try changing my diet myself and exercise ..." As if that is all it takes to lose weight and as if it is only a matter of willpower. ... Please do better.

Allison Aubrey's Morning Edition report on the "breakthrough" weight-loss drug Wegovy focused on the challenges some patients face getting their insurance to cover the costs. The story exposed the conundrum: The drug is expensive, $1,400 per month, and if patients stop taking it, the weight comes back.

As he interviewed Aubrey about her reporting, Morning Edition host Steve Inskeep says, "Well, some people listening to that might say, well, I really shouldn't be starting this drug. Maybe I should be trying to change my diet myself or doing a little more exercise." Aubrey responded, "I think most people would like to lose weight by diet and exercise. But we live in a society where people are sedentary, in part due to our jobs. ... And the unhealthiest foods are the cheapest foods."

Inskeep's statement was not intended to imply that willpower is the solution. (NPR has reported on the connection between obesity and other factors, like genetics.) Instead, he was giving voice to a question that many listeners might have as they learn about Wegovy. Aubrey's response and the interviews she conducted provided a nuanced view of what it takes to lose weight and, more specifically, how the affordability of drugs like Wegovy is affected by health care options.

NPR's take on coverage of weight and obesity

Those two stories are just some of many NPR has published about "fatness," BMI and obesity.

Tony Cavin, NPR's managing editor for standards and practices, wrote in an email that like "any other topic NPR journalists need to be respectful of their subjects, interview multiple sources and make sure that their reporting is based on science."

"There are stories about 'weight' and health and there are stories about 'weight' and body image. I think the distinction is usually quite clear," he wrote. "There is lots of evidence that weight is a health issue and we should cover it as such. When covering a story about someone trying to achieve a certain look, regardless of possible health effects, we cover that as well."

Cavin said NPR journalists rarely use the word "fat" and it's often in quotes. He said "overweight" and "obese" are more precise, and that NPR usually attributes the definitions of those words to the CDC while giving more context.

Other journalists' thoughts on terminology

The Associated Press Stylebook currently doesn't have specific guidance on the terms "overweight," "fat" or "obese." Paula Froke, editor of the AP Stylebook, wrote in an email that the topic is on their list to consider in the coming year. The team devotes significant research and discussion when developing guidelines, she said.

"Generally, we also advise using terms that an individual or group prefers," Froke said. "That could apply to terms such as 'obese,' 'fat' and 'overweight.'"

We also talked with Tara Haelle, an independent science journalist who advises about reporting on medical studies, including those on obesity, through the Association of Health Care Journalists. She acknowledges that the topic is challenging: "'Fat' is the curse word for certain people. And 'obesity' is the curse word for other people. That becomes really challenging as journalists because 'obesity' is the medical term." But by being more precise, journalists can be more accurate and inclusive, she said.

Haelle recommends that journalists:

  • Use more nuanced language to describe being medically at risk because of weight, size or obesity. Even though weight or size can be linked to someone's metabolic health, studies show they aren't always, she said. Reporters can be more precise by using terms like "overweight and medically unhealthy" or "metabolically unhealthy obesity" when describing a person's related condition. Such conditions might include high blood pressure or insulin resistance.
  • Help the audience understand the perspective on body weight being presented, such as making clear whether information is being discussed from a medical or social point of view. For example, she thought the Morning Edition story did a good job of establishing this when Aubrey said Wegovy "is not a drug for cosmetic weight loss. This is a drug for people whose health is at risk due to obesity."
  • Put words like "fat" in quotation marks in written copy to acknowledge that the word carries different connotations for different people.
  • Show audiences that body image is much more than how people think they look. "Research shows that you can't separate mental health and physical health — they are intrinsically connected and one influences the other," she said.
  • "You can destigmatize being a certain size without saying that you should or shouldn't be that size," Haelle said. "Working to erase stigma doesn't imply condoning. ... We can work as the media to destigmatize these things without passing judgment on them."

    We appreciate these recommendations. Across the news media, reporting on body weight as a medical and cultural issue is evolving to be clearer and more accurate. NPR is clearly part of this transformation. In the two very different stories we looked at, as well as other coverage, NPR provided new insights, fresh perspectives and solid facts. It's likely that journalism will continue to grow in its awareness of the many complexities in covering weight-related topics from both health and social standpoints. As a conversational audio storyteller, NPR has the ability and expertise to let the audience in on this nuance. — Emily Barske

    SPOTLIGHT ON

    The Public Editor spends a lot of time examining moments where NPR fell short. Yet we also learn a lot about NPR by looking at work that we find to be compelling and excellent journalism. Here we share a line or two about the pieces where NPR shines.

    Work friends

    An NPR digital storyexplored research showing that connection to colleagues is a key indicator of how happy someone is in their job. While other types of relationships in life are necessary for well-being, friendships at your job are important because we spend so many hours working, Dr. Robert Waldinger, a Harvard professor of psychiatry, says in the piece. Health correspondent Rhitu Chatterjee examined the impact of workplace friendships and reported on practical ways to nurture those friendships in a working world that has changed dramatically in the last few years. — Emily Barske

    Virus investigators

    NPR Science Desk contributor Ari Daniel reported multiple stories about a small clinic and research outpost in rural western Guatemala called FunSalud, where locals look into illnesses. As part of NPR's series "Hidden Viruses: How Pandemics Really Begin," Daniel introduced us to the team who go out into the community to look for emerging diseases with pandemic potential. "If anything COVID and Zika and H1N1 have taught us, it's that you can't stick your head in the sand and hope that the next pandemic isn't going to arrive," said Dan Olson, a research director at the center. These stories are insightful and in-depth explorations of the work being done on the ground in one country to help prevent the next pandemic. — Amaris Castillo

    The Office of the Public Editor is a team. Editor Kayla Randall, reporters Amaris Castillo and Emily Barske, and copy editor Merrill Perlman make this newsletter possible. Illustrations are by Carlos Carmonamedina. We are still reading all of your messages on Facebook, Twitter and from our inbox. As always, keep them coming.

    Kelly McBride
    NPR Public Editor
    Chair,
    Craig Newmark Center for Ethics & Leadership at the Poynter Institute

    Copyright 2023 NPR. To see more, visit https://www.npr.org.

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