Do you know about medical-weight stigma? Are you someone who suffers from it and don’t know how to handle it? Do you find yourself trying all sorts of diets to lose weight? Are you aware of the many ways in which fat people are oppressed?

In this podcast episode, Dr. Cristina Castagnini speaks with Ragen Chastain about how she became a fat activist and how she now promotes health at every size.

Meet Ragen Chastain

Ragen Chastain is a speaker, writer, Certified Health Coach, and thought leader and full-time speaker and writer in the fields of Body Image, Health at Every Size, Fitness, and Corporate Wellness. She has brought her signature mix of humor and hard facts to diverse stages from Google Headquarters to Dartmouth to the Diabetes Education Specialists National Conference. Author of the popular blog danceswithfat, the book Fat: The Owner's Manual, and editor of the anthology The Politics of Size, Ragen is frequently featured as an expert in print, radio, television, and documentary film. Ragen is a three-time National dance champion and two-time marathoner who holds the Guinness World Record for Heaviest Woman to Complete a Marathon, and co-founded the Fit Fatties Forum which has grown to over 10,000 members. Ragen lives in LA with her partner and their two adorable dogs.

Visit her website, her speaking website and connect on Instagram, Facebook, Twitter, or YouTube.


  • How Ragen Became a Fat-Activist
  • Health at Every Size
  • Medical-Weight Stigma
  • Diets Exposed
  • Fat Phobia
  • Ways to Deal with Medical-Weight Stigma
  • The Problem with BMI
  • The Term ‘Health’
  • COVID 19 Stigma Against Fat People

How Ragen Became a Fat-Activist

Ragen started her personal journey researching how to find the best diet. Through her research, she found that there wasn’t a single study where more than a tiny fraction of the people were succeeding at long-term weight-loss. So she decided to move into a personal practice of health at every size. After attending a ballroom dancing competition, where a judge body shamed her, she realised that fat people were a class of people who were being oppressed and that she needed to become a fat-activist.

“It’s one of those jobs that I’m grateful I get to do it, there’s a lot of privilege involved in that, but I’m also sorry it’s necessary.” - Ragen

Health at Every Size

Health at every size is a paradigm for health that includes everything from personal decisions to public health messaging to physical and mental healthcare. The focus is on supporting health rather than manipulating body size as a path to health. It look at healthy habits, but also barriers to health, for example: racism. It is a health paradigm that is also social-justice informed.

Medical-Weight Stigma

Medical-weight stigma is a huge part of what harms fat people. To the point where people have died (from cancer) after being misdiagnosed. Or have been encouraged to enhance their eating disorder habits. What’s more, medical research doesn’t always include fat people, and tools/medical equipment often don’t accommodate fat people. This prevents fat people from going to the doctor because they don’t feel comfortable.

Diets Exposed

95% of the time, people on diets lose weight short-term and gain back the weight long-term. And two thirds of those people gain more weight than they originally lost. We’re talking about a medical intervention that is prescribed to 60-70% of the population that has the opposite effect the majority of the time. And then the people are blamed for it.

“Fat bodies existing is not and will never be the problem. The problem is fat bodies not being accommodated.” - Ragen

Fat Phobia

The term 'fat phobia' is people being treated differently because they are fat. This can be from street harassment to lack of accommodation. Fat people are also hired less, paid less, and promoted less than thin people regardless of their qualifications. This is made worse with people who live with multiple marginalizations, such as being fat and black, being fat and transgender, etc.

Ways to Deal with Medical-Weight Stigma

Call ahead and ask to be treated from a weigh-neutral perspective. Is there a doctor there who can provide that care? You have the right to refuse health-care interventions, such as being weighed. If you’re dealing with a healthcare provider who is saying you need to lose weight before you can receive the treatment, you can ask, “Well, what would you do for a thin person with this issue”?

The Problem with BMI

Weight isn’t necessary for most healthcare. Health and weight are not connected. BMI is not based on health. It’s a statistic from the 1800s based on racism, which is now used as a cheap proxy for insurance companies to make more money. All BMI is, is a slightly complicated ratio of height and weight. It’s not a health measurement. In order for the diet industry to thrive, they need to make being fat a health condition. In the nineties, the BMI was lowered by diet companies which resulted in many people becoming overweight overnight.

The Term ‘Health’

Health is an amorphous concept and is difficult to define. It is not an obligation. Health is not a barometer of worthiness. And it’s not entirely within our control. You can pursue health outside of a weight-loss paradigm. But, it doesn’t matter if we’re healthy or not, that should not make us a target for oppression.

“You’re valid. Your body is amazing. It’s worthy of care regardless of your size, or your health status. You can appreciate the body that you have. You don’t have to accept that your body is a sign that there is something wrong with you.” - Ragen

COVID 19 Stigma Against Fat People

The research that suggests that fat people are at higher risk of COVID is highly questionable. When you blame increased negative outcomes on people’s bodies instead of healthcare inequality, that’s a huge issue. During the 2009 H1N1 outbreak, fat people had a higher risk for severe negative outcomes. They weren’t getting sick more often, but they were having worse outcomes than thin people. It turns out, however, that healthcare providers gave thin people anti-viral intervention sooner than fat people. In the Pfizer vaccine’s own trials, 70% of the people were fat and they had the same efficacy rates as the thin people. The (negative) response that was reported on, was actually also true for old people and men in the same study group.



I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!


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