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Welcome to this month’s installment of the 5 Questions With… If you’re a new reader (welcome!) this is a series where we learn a bit about experts in the field. Previous interviewees include Dr. Lesley Williams, Mikey Mercedes, Aaron Flores, Dr. Gregory Dodell, Lisa Du Breuil, Dr. Asher Larmie, members of Medical Students for Size Inclusivity, Chrissy King, Jessica Jones, Leslie Jordan Garcia, Dr. Mara Gordon, Dr. Whitney Trotter, Dr. Anna Whelan, and Angela Goens.
Today we get to hear from the brilliant Maayan Simckes.
1. Tell us a bit about yourself and your work
I am an applied epidemiologist, which means I work in governmental public health. I did a masters in public health in epidemiology and a PhD. I currently oversee three teams that administer three large population surveys throughout the state. They reach families of young children, adolescents, and adults, covering a broad range of topics.
I am very much a generalist in the field – I like to work on a broad range of topics and have a passion for sneaking into public health spaces that are mostly ignored for various reasons. For example, I did my dissertation on policing and population health, which at the time was a very strange thing for a student in my field to pursue. And yet, I knew it was a societal issue that was lacking a public health lens to help address it. That desire to find the spaces that my colleagues often shy away from is one of the main driving forces behind my passion for weight inclusive methods in public health. That, and being really tired of being squeezed into MRI machines like a sausage into an increasingly snug casing.
2. How did you learn about the concept of weight-inclusive, body affirming care?
When I was in the first year of my doctoral studies, I was really struggling with mental health, stress, and trying to get through grad school. I ended up with a new primary care provider who suggested that perhaps I didn’t need to ALSO be on a restrictive diet. What?! I didn’t?! I’d been on diets on an off my whole life, encouraged by charlatan providers to keep at it. This was a big moment for me. A primary care doctor telling me, from her own fat body, that my fat body was fine as it was and then suggesting that there was no need for any lab testing to confirm it was astonishing. We did it anyway, at my insistence, and all came back fine, except of course my low vitamin D because we all turn into vampires when we live in the Pacific Northwest. She referred me to a dietitian (for the first time in my life) who began working with me through the Intuitive Eating Workbook. We explored some of my own misconceptions about weight and health, the ways that the past providers had led me astray, and how I could use my own strengths in epidemiology to affirm all of this new learning. This was all in 2016-2017. It took me another couple of years, until I was working in my first job after my PhD to have the real Aha! moment.
I was working on-site (I know, weird, right?) and kept seeing signs in the bathrooms and stairwells for local weight loss meetings, claims about taking the stairs and health, scales in the bathrooms, and other problematic messaging around food, weight, and health. I started to raise a stink about this with key teams at the agency responsible for workplace wellness, equity and inclusion, and more. I called myself “fat” for the first time in early 2020, and wow was that liberating.
I spent the next years moving forward in two parallel directions - weight inclusive workplace changes and weight inclusive epidemiology. This has been one of the most personally rewarding efforts of my career thus far, despite the fact that a large proportion of it has been done on my own personal time due to a lack of official support.
3. How have you/do you apply those concepts to your work?
Diving into weight inclusive epidemiology…
The short answer is that I helped get a new module of questions related to unhealthy weight control behaviors and disordered eating on our high school health survey 2023 and I participate in a number of spaces nationally where we explore how to advance weight inclusive methods in public health agencies and the intersection with disordered eating and unhealthy weight control.
The longer answer is that the more time I spend as an epidemiologist, the more I recognize practices in my field, assumptions, standards, norms, that don’t sit right with me. When a field struggles to advance when the science evolves, you end up with practices that can perpetuate misinformation at best and real harm at worst. I really started to notice this while attending a virtual epidemiologic conference during the height of COVID. I started to pose the question to fellow attendees if they too were seeing an issue with epidemiologists using methods that reinforced stigmatizing frameworks of thought. I was surprised how many chimed in to say that they were alarmed by the same pattern that I was. They were seeing stigma show up around disability, mental health, age, substance use, anti-fat bias, rurality, and more.
A fairly large group of us, applied epidemiologists from all around the country, got together after the conference and launched a new working group. Our mission was to design a best practice implementation guide for epidemiologists in the field to recognize how they could contribute to more inclusive, supportive, and data-informed practices. We set out to explore a single type of stigma, build a toolkit of resources and training materials, share it widely, and hopefully repeat the process with lessons learned for other types of stigma. We are thrilled with where the guide is headed and look forward to the chance to share it widely.
4. What’s one thing that you wish people who are still working from a weight-focused paradigm could learn/know?
It’s all a spectrum, moving from a fully weight-centric view of the world to being entirely weight-inclusive. Sometimes you might find that a person actually sits in two places at once along that spectrum – pretty common really. There isn’t a moment when someone shifts from being in the weight-focused paradigm to fully being weight-inclusive. It’s an iterative and deeply personal learning process and an unlearning process. We spend our lives being infused with misinformation about weight and health and, frankly, we may never be able to fully unplug from that particular matrix. It’s going to take time and doubts are all part of the process. Wade into the data and don’t be afraid of scrutinizing the reason for your own skepticism.
For the folks reading this who are already unplugged from the weight paradigm matrix, I have a humble request. If there’s someone who is trying to implement weight inclusive practices and they miss the mark on something, or there’s a person who asks a question that doesn’t land well with you because of the terminology they use, I hope we can choose not to write them off entirely. Our world has become very quick to make things all-or-nothing, you’re with us or against us. But when it comes to weight stigma and destigmatizing medicine and public health, the historical, cultural, ethical, and financial realities make it exceedingly complex and therefore slow to untangle. It can take a single person a lifetime to unlearn something if they ever do at all, and it can take a heck of a lot longer for organizations, fields, and societies to unlearn the same thing. How do we keep everyone at the table even if we aren’t all quite at the same spot on the spectrum yet?
5. How and where do we find you and your work?
If you are interested in seeing the weight inclusive best practices guide published sooner than later or you’d like to get involved, please email ragen at ragen@weightandhealthcare.com and she will forward your email to me!
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*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings’ Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison’
Thanks so much for this. As someone who opted out of an MPH because of the perpetuated stigma mentioned (and how shirty so many people in public health were when I brought it up!!) I am especially glad that someone is fighting the fight that I could not.