Speaker 1: In two thousand five, Katherine Flegal and her colleagues did
Speaker 1: a research study. Catherine didn't think it was going to
Speaker 1: be controversial. Unfortunately, that was a miscalculation on my part.
Speaker 1: It was a huge deal. Catherine was a researcher at
Speaker 1: the Centers for Disease Control and Prevention at the time,
Speaker 1: and the study she was working on looked at weight
Speaker 1: associated deaths. It actually found something surprising, something that ran
Speaker 1: contrary to a pretty core idea about weight. Their analysis
Speaker 1: suggested that extra pounds might not be so bad for you.
Speaker 1: When they published what they found, their study kind of
Speaker 1: went viral. I had to get a separate phone line
Speaker 1: just to feel the calls from reporters and criticism them
Speaker 1: came really quickly. This one professor had begun preemptively contacting reporters.
Speaker 1: The study had been featured in the Journal of the
Speaker 1: American Medical Association, a highly respected journal that vetted the
Speaker 1: work before publishing it. But an academic was going around
Speaker 1: telling the press that Catherine's study was bad. So by
Speaker 1: the time they talked to me, they had already talked
Speaker 1: to another person who had said that my stuff was
Speaker 1: rubbish and completely wrong and fatally flawed. And things like that,
Speaker 1: And something similar happened at a scientific meeting not long
Speaker 1: after the paper came out, and this other professor took
Speaker 1: the stage when he wasn't supposed to be speaking and
Speaker 1: just issue the condemnation of our article, just out of
Speaker 1: the blue. So what was everyone so angry about. Anyway,
Speaker 1: We were trying to estimate the proportion of this in
Speaker 1: the United States that were associated with different bm I levels.
Speaker 1: Cavin specifically for a CDC division known as the National
Speaker 1: Center for Health Statistics. That's the agency responsible for coming
Speaker 1: up with data to help make Americans healthier, And like
Speaker 1: Catherine said, she was focused on figuring out how many
Speaker 1: deaths in America were associated with different b m I s,
Speaker 1: or body mass index, which is basically a mathematical formula
Speaker 1: for estimating a person's body fat. In other words, Catherine
Speaker 1: was investigating the link between weight and death. But these
Speaker 1: weren't just numbers something to stick on a website or
Speaker 1: pamphlet somewhere and forget about a lot of things done
Speaker 1: at the National Center for Health Statistics are supposed to
Speaker 1: influence policy. At the time, body weight was already emerging
Speaker 1: as public health enemy number one. The deadly impact of obesity.
Speaker 1: The toll on Americans far greater than previously thought. Why
Speaker 1: are Americans so fat? The United States is the world's
Speaker 1: baddest developed nation, with an obesity right double of that
Speaker 1: in many European countries. The CDC had declared obesity a
Speaker 1: growing epidemic years earlier, and Catherine and her colleagues weren't
Speaker 1: the first to look at the subject. The paper that
Speaker 1: came out before ours estimated that obesity was about to
Speaker 1: overtake smoking is the major cause of death in the
Speaker 1: United States. Remember, at this point, there was also tons
Speaker 1: of awareness that smoking is bad for you, So the
Speaker 1: idea that being heavy could be more dangerous than smoking
Speaker 1: that really sent people into a tail spin. It looked
Speaker 1: like America had this big weight problem. But when Catherine
Speaker 1: and her colleagues sat down to do their own analysis,
Speaker 1: they came to a very different conclusion. Our paper didn't
Speaker 1: suggest that the city associated deaths were anywhere. They're likely
Speaker 1: to overtake smoking as a major cause of death. Using
Speaker 1: data from what's called the National Health and Nutrition Examination Survey,
Speaker 1: they examined the health of tens of thousands of Americans.
Speaker 1: They also tracked how many of those participating over the
Speaker 1: years had died. If you look at the number of
Speaker 1: deaths and you adjust for all these things like age
Speaker 1: and gender and socio economic data and so on, we
Speaker 1: get this many more desks than would be expected, and
Speaker 1: this many fewer deaths would be expected, making that comparison
Speaker 1: to normal weight. They basically wanted to figure out how
Speaker 1: many more people considered overweight or obese we're dying then
Speaker 1: would have been expected if they had been at a
Speaker 1: so called normal weight A. When they crunched the numbers,
Speaker 1: Katherine and co. Found that obesity wasn't about to pass
Speaker 1: smoking as a top cause of death in the US,
Speaker 1: not even close. They also found that the number of
Speaker 1: deaths connected to higher b m I s is actually
Speaker 1: pretty low, so it was a very different result. They
Speaker 1: find that fewer people with a b m I classified
Speaker 1: as overweight We're dying than would have been expected at
Speaker 1: a normal weight b m I. We didn't say that
Speaker 1: these things are caused or were protected, or that or
Speaker 1: we is protected. We just reported the numbers. Now, people
Speaker 1: have a lot of takeaways from that, but I don't
Speaker 1: feel responsible for all their takeaways. But to say the
Speaker 1: least they're finding was really unexpected. After all, carrying around
Speaker 1: extra pounds is supposed to be bad for you. That's
Speaker 1: the whole basis for medical categories like overweight or obese.
Speaker 1: This is the scientific foundation on which weight lost empires
Speaker 1: have been built. Where did that idea come from? Anyway?
Speaker 1: And is it even true? What Catherine and her team
Speaker 1: found called at least some of this into question, so
Speaker 1: other scientists freaked out. It seems like they decided the
Speaker 1: only explanation was that Catherine and her team had messed
Speaker 1: up somehow. That was easier for them to swallow than
Speaker 1: considering the opposite, that Catherine and her team could actually
Speaker 1: be right, that the relationship between weight and health could
Speaker 1: be different. The funny thing is this Catherine and her
Speaker 1: colleagues hadn't meant to call into question the very foundations
Speaker 1: of weight science. We just blundered into this. I mean,
Speaker 1: we weren't trying to cause a fire. Back to what
Speaker 1: Catherine and her colleagues found, It wasn't that there was
Speaker 1: no link between b m I and death exactly, but
Speaker 1: that link existed among people with higher b m I
Speaker 1: of thirty or higher, which is the cutoff for obesity,
Speaker 1: and especially thirty five or higher, and when the researchers
Speaker 1: added it all up, the total number of deaths tied
Speaker 1: to these categories of overweight and obees turned out to
Speaker 1: be pretty small. More people were dying in those years
Speaker 1: from car crashes and gun violence, and more people were
Speaker 1: definitely dying from smoking, so there was a very large difference.
Speaker 1: Before Catherine published the research, she also looked at a
Speaker 1: bunch of other studies. She wanted to know whether her
Speaker 1: team's findings were unusual. After all, their paper contradicted what
Speaker 1: most people think about weight and health, at least when
Speaker 1: it comes to the category of overweight. But it turned
Speaker 1: out that there's wasn't even the first study with findings
Speaker 1: like these. There's a lot of other studies that have
Speaker 1: shown this already, so it's not a big deal. Those
Speaker 1: other studies had also found little risk of death associated
Speaker 1: with having a b m I classified as overweight, But
Speaker 1: it was Catherine's study that for some reason really struck
Speaker 1: a nerve, and a lot of those tacks were coming
Speaker 1: from academics at one particular institution, Harvard, especially this one
Speaker 1: guy Walter Willet. At the time, Walter was the chair
Speaker 1: of the nutrition department. After another paper, Catherine wrote, he
Speaker 1: went around calling her work a pile of rubbish and
Speaker 1: said people should ignore it. The prestigious journal Nature actually
Speaker 1: ended up writing an editorial basically criticizing Walter's comments and
Speaker 1: saying he was oversimplifying the science. But there was more
Speaker 1: than just that. And then the Harvard School of Public
Speaker 1: Health group that was mainly, although not exclusively, the antagonists here,
Speaker 1: they decided to schedule a symposium at Harvard to basically
Speaker 1: to show what was wrong with my article. That's right.
Speaker 1: Researchers opposed Catherine's findings so fiercely that they put together
Speaker 1: a whole event just to talk about how much they
Speaker 1: hated it. And Catherine says that the conference organizers didn't
Speaker 1: even make it possible for her and her co authors
Speaker 1: to attend. As you can imagine, all of this was
Speaker 1: a lot for Catherine. This is getting really stressful. I
Speaker 1: had a very high adrenaline level, I would say, because
Speaker 1: I was always finding the weird attacks in places that
Speaker 1: I just would not have expected, like Wikipedia. The gist
Speaker 1: of all this criticism was that there were things Katherine
Speaker 1: and her colleagues had simply missed. They had found. The
Speaker 1: people living in bigger bodies were dying at similar rates
Speaker 1: to those in smaller bodies. But like I said earlier,
Speaker 1: it was easier for prominent scientists to imagine that Katherine
Speaker 1: and co. Were wrong, then that they're finding could be true.
Speaker 1: The explanation critics landed on, according to news coverage at
Speaker 1: the time, was that their numbers must have been off.
Speaker 1: After all, people can be thin because they're sick with
Speaker 1: diseases like cancer, or because they're elderly. The critics said
Speaker 1: that these sorts of things must have thrown off the study.
Speaker 1: They also said that Katherine's team didn't use enough long
Speaker 1: term data, but Katherine says, no, that wasn't it at all.
Speaker 1: The issue was that people had already meet up their
Speaker 1: minds about weight and health, and Catherine was undermining those
Speaker 1: preconceived notions. Catherine was basically an atheist, renouncing the gospel
Speaker 1: about weight and health. There's this real drive to say
Speaker 1: anything finding like that is unusual. It needs to be
Speaker 1: explained away. We need to get rid of this. How
Speaker 1: do we get rid of it? We've got to say, well,
Speaker 1: maybe it's because of ages, or maybe it's because of this.
Speaker 1: It's because of that, you know. So there's all you
Speaker 1: have to explain away in convenient findings. Catherine says this
Speaker 1: stuff wasn't really an issue, and in fact, she and
Speaker 1: her team said right in their paper that factors like
Speaker 1: illness and duration of follow up didn't have a big impact.
Speaker 1: So this was all based on pretty much nothing, But
Speaker 1: it was very influential, and this kind of stuff went
Speaker 1: on literally for years. Disagreements like these are actually a
Speaker 1: really key part of the scientific process. The whole point
Speaker 1: is to go back and forth about findings so people
Speaker 1: can trust that they're accurate. But the way Catherine describes it,
Speaker 1: the criticism crossed the line. What could have been a
Speaker 1: legitimate scientific debate evolved. Misinformation started flying, Like when one
Speaker 1: group claimed that Catherine's findings were renounced by the CDC,
Speaker 1: she says they weren't. When I asked the CDC about it,
Speaker 1: they didn't get back to me. So there's just all this,
Speaker 1: at least falsehoods lying around, and I didn't know what
Speaker 1: to do about them. Some of it was just kind
Speaker 1: of disrespectful about Catherine's skills as a scientist. The one
Speaker 1: who was kind of insults saying that my paper was
Speaker 1: my faintly flawed. That was nonsense. It was rubbish, that
Speaker 1: we made very simple errors that were completely wrong. Harvard
Speaker 1: didn't return a request for comment by our deadline. In
Speaker 1: an email to me, Walter Willett said that Katherine's paper
Speaker 1: quote was causing serious confusion among physicians and patients, with
Speaker 1: potentially dangerous clinical and public health consequences. He also says
Speaker 1: that many large analyzes have refuted the findings showing that
Speaker 1: overweight and obesity have poor health effects. It's clear from
Speaker 1: talking to Catherine that these criticisms rankled her because she
Speaker 1: cares a lot about the science. She retired from the
Speaker 1: CDC in and is currently a consulting professor at Stanford.
Speaker 1: But the attacks became personal too. Lisa and Darovitch, who
Speaker 1: was a PhD student at Harvard about a decade ago,
Speaker 1: said a professor there even criticized Katherine's weight, saying that
Speaker 1: was why her work couldn't be trust stid. I got
Speaker 1: very stressed trying to deal with this stuff and trying
Speaker 1: to respond to things that people were saying. This was
Speaker 1: Catherine's scientific reputation on the line, This is her career,
Speaker 1: and this loud chorus of scientific feedback is saying legal
Speaker 1: must be wrong. Legal is wrong. Legal is wrong. She
Speaker 1: must be wrong, or this must be wrong, or therefore
Speaker 1: she's wrong. But what if Catherine wasn't wrong? What if
Speaker 1: the dangers of being heavy have been overstated or misrepresented?
Speaker 1: A small but vocal contingent of experts and advocates say
Speaker 1: just that. They argue that weighing more isn't inherently bad
Speaker 1: for you. In fact, when people say that, they are
Speaker 1: mixing up correlation and causation, a classic scientific error. This
Speaker 1: is obviously counter to the predominant thinking. But the idea
Speaker 1: here is that we have been folk using on the
Speaker 1: scale too much and not enough on healthy behaviors. Our
Speaker 1: weight bias has become a major blind spot, something that
Speaker 1: keeps us reciting the same old lines about weight and health,
Speaker 1: even as a body of scientific evidence suggests that this
Speaker 1: way of thinking is wrong. We're going to get into
Speaker 1: that in this episode, and we're going to take a
Speaker 1: close look at evidence behind it. I'm Bloomberg News health
Speaker 1: reporter Emma Court and from the Prognosis podcast This is
Speaker 1: Losing It. There's some things pretty much everyone will agree
Speaker 1: is true. The earth is round, the sky is blue,
Speaker 1: and weighing more is bad for you. That's the message
Speaker 1: we get in a million overt and subtle ways every
Speaker 1: single day. Just look at who gets featured on the
Speaker 1: cover of fitness magazines. And then there's the actual messages
Speaker 1: people with bigger bodies get from their doctors, from friends
Speaker 1: and family, and even sometimes from random people on the street.
Speaker 1: Lose weight and you'll be healthier. Tracy Man, a psychologist
Speaker 1: who runs a health and eating lab at the University
Speaker 1: of Minnesota, puts it really well. The air we breathe
Speaker 1: is weight stigma. Treating people in bigger bodies poorly is
Speaker 1: so common that lots of people don't even notice it
Speaker 1: or think of it as discrimination. We've been brought up
Speaker 1: with views that it's not okay to be obese and
Speaker 1: that you need to be thin, and you, at least
Speaker 1: a minimum need to be trying to be thin. Tracy
Speaker 1: thinks that's why diets keep getting pushed over and over
Speaker 1: and over again, even though they don't really work for
Speaker 1: long term weight loss, not for most people anyway. Like
Speaker 1: she says, even if the deck is stacked against you,
Speaker 1: the expectation is that you should at least try to
Speaker 1: be thin. The message is persistent. Getting thin should be
Speaker 1: your goal, otherwise you're doing it wrong. The way Tracy
Speaker 1: put it really struck me. Wait, stigma is the air
Speaker 1: we breathe, and so is the idea that living in
Speaker 1: a bigger body means you're unhealthy. Think about it. When
Speaker 1: did you first hear that weighing more is bad for you?
Speaker 1: And how often have you heard it since then? Every month,
Speaker 1: every hour? Did you ever question why that's the case
Speaker 1: or have you always just accepted it at face value?
Speaker 1: I'm guessing that for most of us it's the latter.
Speaker 1: I've just heard it said that that you can be
Speaker 1: fat and healthy. Actually you can't think. I'm sure that
Speaker 1: you're excess if that is unhealthy, I don't think anyone
Speaker 1: is agons off with it. But how do we know
Speaker 1: that being heavy is bad for you? Tracy and others say,
Speaker 1: we actually don't. We don't know that. We know that
Speaker 1: people at heavier weights can have health problems, but they
Speaker 1: don't always, and it's not clear that weight itself is
Speaker 1: the issue. Here's the deal. Higher B M E s
Speaker 1: are at greater risk for a lot of different diseases,
Speaker 1: medical conditions, and depth. It's a really long list, so
Speaker 1: I'll just read it off the cdc S website. High
Speaker 1: blood pressure, high cholesterol, type two diabetes, coronary heart disease, stroke,
Speaker 1: gall bladder disease, ost arthritis, sleep apnian, breathing problems, many
Speaker 1: types of cancer, mental illness like depression and anxiety. You
Speaker 1: get the idea. You hear this kind of thing all
Speaker 1: the time, like from doctors who say, all of the
Speaker 1: chronic diseases that we deal with, high blood pressure, cardiovascular disease, diabetes,
Speaker 1: they're all related to weight problems. The CDC also lists
Speaker 1: some more vague sounding things as risks if you're heavier,
Speaker 1: like low quality of life and body pain and difficulty
Speaker 1: with physical functioning. You might be wondering what the connection
Speaker 1: is between weight and all these problems, the why of
Speaker 1: it all. Doctors and scientists are specifically concerned with extra fat,
Speaker 1: which they say can put lots of stress on the body,
Speaker 1: including pressure on bones and joints, and fat cells can
Speaker 1: lead to inflammation, affecting things like regulation of blood sugar levels,
Speaker 1: which can lead to diabetes. But again, the conditions I
Speaker 1: listed earlier are risks associated with higher weights, Like the
Speaker 1: doctor we just heard talking said, heart disease and diabetes
Speaker 1: and all the rest are linked with weight or associated
Speaker 1: with weight the reason for all that careful language. Here's
Speaker 1: tracy again. Weight is correlated with many problems, but correlation
Speaker 1: does not mean it's causing those problems. Correlation is not causation.
Speaker 1: That's kind of a big rule in statistics. Admittedly, I
Speaker 1: haven't been in a math class in a long time,
Speaker 1: but I remember pretty clearly that in high school one
Speaker 1: of our teachers actually had us banging on our desks
Speaker 1: and enchanted. Correlation is not causation. Correlation is not causation. Now,
Speaker 1: there are a lot of places where conflating correlation and
Speaker 1: causation becomes a problem. One of the classic examples has
Speaker 1: to do with ice cream and murder. Ice Cream sales
Speaker 1: increase in the summer, and so do the number of murders. Therefore,
Speaker 1: ice cream causes murders. Seems straightforward enough, but of course
Speaker 1: that's wrong. Murders and ice cream consumption both go up
Speaker 1: at the same time because of a third factor, rising temperatures.
Speaker 1: When it's warm, people eat ice cream, and just generally
Speaker 1: people are out and about more. They're doing more of
Speaker 1: lots of kinds of activities, including apparently committing felonies. Ice
Speaker 1: Cream may be delicious, but it is not to blame again,
Speaker 1: Correlation is not causation, and with weight, just like with
Speaker 1: ice cream and murders, there are other factors that could
Speaker 1: help explain what's going on, things like lifestyle. More on
Speaker 1: that in a minute. We want to understand why so
Speaker 1: many diseases occur so we can prevent them, and many
Speaker 1: diseases are associated with weight. Studies have also shown that
Speaker 1: when people lose weight, they lower their odds of developing conditions,
Speaker 1: including diabetes, and improve things like cholesterol levels. Evidence seems
Speaker 1: clear right losing weight is the way to improve your health.
Speaker 1: But the experts and advocates I spoke with for this
Speaker 1: episode tell a very different story. They say that we
Speaker 1: unfairly blame weight for really complex scientific questions and treat
Speaker 1: dieting as a quick fix. Except it's actually not a
Speaker 1: quick fix because, as we've learned in this podcast, losing
Speaker 1: weight long term is a really challenging and almost impossible enterprise.
Speaker 1: So what could be actually causing these diseases and other
Speaker 1: issues if not weight? Now, this is a subject that's
Speaker 1: really charged, so I ask you to reserve judgment. Here
Speaker 1: are experts out. It turns out that there are a
Speaker 1: lot of things that are correlated with weight, aren't so
Speaker 1: good for you, including being sedentary. Sedentary a k a.
Speaker 1: Not moving around a lot. This is actually a pretty
Speaker 1: big issue, and not just for people at heavier weights.
Speaker 1: Many many people live sedentary lives. We drive to work,
Speaker 1: we sit at a computer, that kind of thing. In fact,
Speaker 1: people in the Western world have been living like this
Speaker 1: for hundreds of years. We talked about that in episode two,
Speaker 1: how the Industrial Revolution shaped the conditions of modern life
Speaker 1: and modern dieting and made us all a lot more
Speaker 1: likely to just sit around on our butts all day.
Speaker 1: At a certain point, it starts to get tough to
Speaker 1: separate out how we live from how much we weigh.
Speaker 1: You get into a little bit of a chicken or
Speaker 1: egg thing. Here's Glenn Geyser, a professor of exercise physiology
Speaker 1: at Arizona State University. People who are overweight or beasts
Speaker 1: tend to be less physically active. They tend to eat
Speaker 1: unhealthier diets. That is on average what we see. But
Speaker 1: that doesn't mean that the weight is the problem. Means
Speaker 1: that it's probably the lifestyle. The problem is lifestyle, not weight.
Speaker 1: This is the problem that we have in America. We've
Speaker 1: got this disconnect. We think weight is the big issue
Speaker 1: when it's really not. It's the lifestyle that oftentimes goes without.
Speaker 1: Of course, weight is way more complicated than just lifestyle.
Speaker 1: Not all of it is in our hands. Your genetics,
Speaker 1: for example, are a really important factor too, but you
Speaker 1: can actually change your lifestyle. Higher weights are also connected
Speaker 1: to other things too. Here's tracy again. It's also correlated
Speaker 1: with poverty, and there's a ton of research showing links
Speaker 1: between poverty and health problems. Heavier people also experienced stigma.
Speaker 1: Often they're treated worse because of how they look. That
Speaker 1: has been shown to be correlated to health problems, even
Speaker 1: controlling for whatever the person weighs, and there's lots of
Speaker 1: reasons for that. People in bigger bodies often go to
Speaker 1: the doctor and just get told to lose weight, almost
Speaker 1: as a reflex. Doctors just assumed that weight is the
Speaker 1: issue and don't investigate what might actually be causing someone's
Speaker 1: health issues. And when things like that happen, people get
Speaker 1: sicker and they also avoid doctors. That's wait stigma in action.
Speaker 1: Wait stigma is incredibly prevalent, not just for medical providers.
Speaker 1: Doctors are the number two source of fat phobia and
Speaker 1: wait stigma outside of family. This is Veronica Garnett. Veronica
Speaker 1: is a dietitian and one of the leaders of a
Speaker 1: group called the Association for Size Diversity and Health or ASDA.
Speaker 1: And then if you're in a fat phobic we live
Speaker 1: in a fat phobic society and world. It is stressful
Speaker 1: to be treated poorly because of the way you look.
Speaker 1: Lots of evidence has suggested that stress is not good
Speaker 1: for people and can have all sorts of terrible effects
Speaker 1: on their health. It starts to feel like some kind
Speaker 1: of vicious cycle. We assume people's weight makes them unhealthy,
Speaker 1: and those assumptions then harm their health. It's also stressful
Speaker 1: to navigate a world that, just in general, was not
Speaker 1: designed to accommodate your body. Here's Annie Jansen, another one
Speaker 1: of asda's leaders. Annie is also a dietitian and has
Speaker 1: a master's in public health. Fat people's health is impacted
Speaker 1: by fat phobian weight stigma. Even outside of the medical realm.
Speaker 1: Chairs are are not accessible to all people. In restaurants,
Speaker 1: um and theaters, and other public spaces. UM people face
Speaker 1: direct hate and comments about their bodies when they're out
Speaker 1: in public, limiting their ability to participate in public life.
Speaker 1: Doctors are people affected by bias like any other person,
Speaker 1: and bias can also affect the scientists doing the studies.
Speaker 1: It's easy for people to find diseases correlated to higher
Speaker 1: weights when the research itself is biased um, and it's
Speaker 1: easy for people to accept that and not really be
Speaker 1: critical about how well done those studies are. There's one
Speaker 1: more thing, a really important thing. As we've established by now,
Speaker 1: people who live in bigger bodies are facing all this
Speaker 1: pressure to diet and lose weight. Losing weight isn't usually sustainable,
Speaker 1: though so many people gave weight back. This is known
Speaker 1: as yo yo dieting, or, in more scientific terms, weight cycling.
Speaker 1: There's actually a lot of evidence connecting it with health problems.
Speaker 1: Weight cycling is an independent risk factor for diabetes, hypertension,
Speaker 1: insulin resistance, and a slipidemia, which is essentially high bad
Speaker 1: cholesterol and or good are low good cholesterol. You'll notice
Speaker 1: that all of those disease listed are typically diseases associated
Speaker 1: with higher BMI. This is again something that studies have found.
Speaker 1: I know you're sick of me saying it, but correlation
Speaker 1: is not causation. So how come with weight we've thrown
Speaker 1: out this incredibly basic scientific principle. A lot of doctors
Speaker 1: and scientists would say that we have it, and that
Speaker 1: there's clear evidence extra weight harms health, evidence like the
Speaker 1: way people's health and prooves when they lose weight. But
Speaker 1: as I spoke with sources for this episode, I began
Speaker 1: to wonder whether we're just more willing to let correlation
Speaker 1: equal causation when it comes to weight, because we've already
Speaker 1: convinced ourselves that being thinner is better. By the way,
Speaker 1: not all of the findings about higher weights are bad.
Speaker 1: When it comes to a variety of diseases like heart disease, cancer,
Speaker 1: and diabetes, research has found a connection between obesity and
Speaker 1: longer survival. In other words, it looks like when heavier
Speaker 1: people get sick with these diseases, they actually might be
Speaker 1: less likely to die. This is again an association correlation.
Speaker 1: We can't go as far as to say that weighing
Speaker 1: more is the reason people with these diseases survived longer,
Speaker 1: though some scientists have said they think that could be
Speaker 1: what's going on, and longer survival is of course a
Speaker 1: good thing. Still, these kinds of findings don't go on
Speaker 1: the CDC website under obesity. Remember that long list of
Speaker 1: medical conditions associated with higher body weights. The government's web
Speaker 1: designers don't like go edit the page and add an asterisk.
Speaker 1: If they did, the website might say overweight an obesity
Speaker 1: put people at higher risk for diseases like diabetes asterisk.
Speaker 1: But people in bigger bodies who get diabetes actually live
Speaker 1: longer than people in smaller bodies with the same disease.
Speaker 1: Weighing more is supposed to be bad for you, and
Speaker 1: yet in certain cases it doesn't look bad for you.
Speaker 1: That's called the obesity paradox, and it does at some
Speaker 1: levels seem pretty paradoxical. But let's become a term that's
Speaker 1: used for just anything that shows obesity is good for
Speaker 1: you or might not be so bad for you as
Speaker 1: a paradox. Why is it a paradox because you don't
Speaker 1: expect it. That was Katherine Flegal again from earlier. Everyone
Speaker 1: already agrees that being heavy is bad for you. Anything
Speaker 1: that counters the narrative, well, it must be a paradox.
Speaker 1: Catherine's research also ran counter to the mainstream narrative, and
Speaker 1: a lot of people went to a good deal of
Speaker 1: trouble to discredit it and discredit her. But remember how
Speaker 1: before she published, Catherine went through other scientific papers. She
Speaker 1: actually found that a lot of articles had similar findings.
Speaker 1: That's why she was so surprised by the reaction to
Speaker 1: her paper. If that's the case, why did Katherine face
Speaker 1: this big wave of criticism and bad feedback about her
Speaker 1: work for years afterward. Now, when I look back, I
Speaker 1: realized that most articles kind of like ours, would not
Speaker 1: would not just publish the numbers they would come. They
Speaker 1: would start with something, well, everybody, it's really bad for
Speaker 1: you because it causes like X, y Z, And they
Speaker 1: would have all and it costs all us money. But
Speaker 1: even though it costs all us money, it is so
Speaker 1: bad for you, and less found this number, but don't
Speaker 1: pay any attention to it. In other words, most researchers
Speaker 1: would open their studies with a long disclaimer saying that
Speaker 1: extra weight really is unhealthy, even if that isn't exactly
Speaker 1: what their research suggested. I took a look at some
Speaker 1: of the scientific papers about the so called obesity paradox,
Speaker 1: and a lot of those articles are kind of like
Speaker 1: that too. They open with some variation of obesity is
Speaker 1: a big, big problem, will be to be bad. Obesity
Speaker 1: kills people. I'm paraphrasing, of course, and then the studies
Speaker 1: go on to say that patients with diabetes who are
Speaker 1: heavier actually die at lower rates, that when they get
Speaker 1: cancer they actually survive longer. To me, this is a
Speaker 1: story about bias, how it can affect even scientists who
Speaker 1: are supposed to be led by just the facts and
Speaker 1: the data. It's also a story about group think. Once
Speaker 1: there's a narrative out there and it's firmly settled, people
Speaker 1: don't want to complicate it. What if they're wrong, They
Speaker 1: would look pretty stupid. Catherine points out another piece of
Speaker 1: this that scientists are people too, people who have specialized
Speaker 1: in an area and get money to study it and
Speaker 1: whose career advancement depends on it, and like anyone else,
Speaker 1: scientists have goals, power, funding status. I think it would
Speaker 1: be career ending. Career ending. She's saying that because of
Speaker 1: how ferociously her work was attacked. That's what happens when
Speaker 1: you complicate the narrative about wait, or even when you
Speaker 1: undermine it. It's worth pointing out that complicating the narrative
Speaker 1: didn't end Catherine's career. Those things did get pretty unpleasant,
Speaker 1: but Catherine's career at least was protected. We were all
Speaker 1: senior government scientists that inn that we couldn't really be fired.
Speaker 1: We didn't depend on grants, and we didn't need to
Speaker 1: get tenure or anything like that. We couldn't be promoted
Speaker 1: any higher. She says, it would have been a whole
Speaker 1: different story if she was an associate professor somewhere. I
Speaker 1: would never want any grants. That would have ruined my career.
Speaker 1: It was only later that Catherine started thinking of this
Speaker 1: whole dust up a little differently. It felt like her
Speaker 1: fellow scientists had taken a side on the issue all,
Speaker 1: almost as if it were a political campaign. I actually
Speaker 1: was surprised the first of my thoughts I heard someone
Speaker 1: mentioned the idea of sides, like I don't have a side.
Speaker 1: This is the data we use, these are the methods
Speaker 1: we use. It's not a side. It's not a statement
Speaker 1: of opinion. It's not like personal opinion. It was like
Speaker 1: Catherine's fellow scientists had decided being bigger was bad for you, period,
Speaker 1: no nuance, no questions about it. It's been fully established.
Speaker 1: Any data that contradicts it, that data can just shove
Speaker 1: right off. So to summarize, the idea that weighing more
Speaker 1: is bad for you is incredibly prevalent, but well, it's complicated.
Speaker 1: In fact, there's a group of researchers and advocates who
Speaker 1: argue that the dangers of being heavy have been exaggerated.
Speaker 1: They say we've scapegoaded weight for diseases when there could
Speaker 1: be other causes, like a lack of activity or not
Speaker 1: eating particularly healthily. And when scientists put out research that
Speaker 1: suggests being a little bigger isn't so bad, they face
Speaker 1: these vigorous attacks from really prominent people for years. All
Speaker 1: this brings us to the billion dollar questions can you
Speaker 1: be healthy at higher weights? The experts we spoke with say, yeah,
Speaker 1: you can be. Something that we actually can solve is
Speaker 1: how to make people healthier. Much easier to make people
Speaker 1: healthier than it is to make people thinner. I'd say
Speaker 1: this all the time, and I don't know why it's
Speaker 1: so radical a thing to say, but behaving in healthy
Speaker 1: ways will make you healthier. It just won't necessarily make
Speaker 1: you thinner. Healthy behaviors like exercising, eating our vegetables, getting
Speaker 1: lots of sleep, and reducing stress, even if those things
Speaker 1: don't make us lose weight, which they may not. Here's
Speaker 1: Glenn Geeser, the Arizona State University professor again, and at
Speaker 1: some point in our life we have to kind of
Speaker 1: just say, look, this is my weight. This is about
Speaker 1: it for me. I'm just gonna have to settle for this.
Speaker 1: But that is not the same as saying, look, I'm unhealthy.
Speaker 1: I'm just going to have to settle for this. Because anyone,
Speaker 1: regardless of their weight, can improve their health with lifestyle change,
Speaker 1: and as obvious as it sounds, people at all different
Speaker 1: weights do all different levels of these healthy things, which
Speaker 1: is part of the reason it's so wild we group
Speaker 1: people together in these broad, undifferentiated categories. It's like telling
Speaker 1: everyone who is at a so called normal weight, you
Speaker 1: get a free pass vegetables. Who needs them stay at
Speaker 1: that weight and it doesn't really matter what you do.
Speaker 1: B m I stigmatizes those who get classified as overweight
Speaker 1: or obese because of it, but so called normal weight
Speaker 1: people are also getting led astray by b m I
Speaker 1: because they might think they're fine and don't have to
Speaker 1: exercise or anything, even though their lifestyle might be putting
Speaker 1: them at risk. Everyone is getting screwed. Someone who is
Speaker 1: classified as overweight or obese by the body mass indexed criteria,
Speaker 1: but exercises a lot and has a modest, at least
Speaker 1: a modest level of fitness. They tend to be better
Speaker 1: in terms of overall health outcomes than thin people who
Speaker 1: are very sedentary. So fitness matters, fatness not so much.
Speaker 1: That's great news for jim rats around the world. But
Speaker 1: here's the thing. All those classic healthy things I just
Speaker 1: listed off earlier, lots of people aren't doing them. This
Speaker 1: isn't me being judgmental. All that stuff is really hard
Speaker 1: to do the way society is set up. It's hard
Speaker 1: to make time to work out. It's hard to eat
Speaker 1: better when healthier food is way more expensive and inconvenient.
Speaker 1: It's hard to sleep more and reduce our stress when
Speaker 1: we lead busy lives and have stressful jobs. The world
Speaker 1: we live in is not built to encourage or support
Speaker 1: healthy behaviors, but there are things we could do to
Speaker 1: change that. First, let's talk exercise. The US government recommends
Speaker 1: a few hours a week of moderate cardio plus at
Speaker 1: least two days of muscle strengthening. Most adults aren't doing that,
Speaker 1: and the government actually tracks what people eat. How it
Speaker 1: compares with dietary guidelines. That score has gotten a little
Speaker 1: better over time, but it's still not great. In Americans,
Speaker 1: eating habits rated a fifty ninety nine out of hundred
Speaker 1: at some schools, that's a failing grade. What it means
Speaker 1: is that we're definitely not eating enough vegetables, fruit, or
Speaker 1: dairy each day, and getting the right kinds of grains
Speaker 1: and protein like whole grains and nuts can be a
Speaker 1: problem too. So people aren't moving enough and they aren't
Speaker 1: eating so great. But then let's say they go on
Speaker 1: a diet. They start exercising more and eating in more
Speaker 1: healthy ways. They're doing those quintessential healthy behaviors, and the
Speaker 1: most common ways to lose weight are through exercise and diet.
Speaker 1: And remember are that laundry list from earlier, of all
Speaker 1: the health risks tied to heavier weights. Doctors and scientists
Speaker 1: will tell you that the way you reduce those risks
Speaker 1: is to lose weight. But also, the funny thing about
Speaker 1: diets is that sometimes when people go on diets, they
Speaker 1: actually lean into a lot of those healthy things. So
Speaker 1: now you have to ask the question, will wait a minute,
Speaker 1: if people are exercising and dieting, when they lose weight.
Speaker 1: How do we know that it's the weight loss that
Speaker 1: improves the health and not the exercise and the healthier eating.
Speaker 1: Glenn says that there are studies where people with b
Speaker 1: m I is considered overweight and obese change their diet
Speaker 1: and exercise, but don't lose much or any weight. And
Speaker 1: why do you know these folks start looking healthier by
Speaker 1: measures like lower cholesterol. And in study of what's known
Speaker 1: as the Dash diet, which helps people reduce high blood pressure,
Speaker 1: researchers actually prevented participants from losing weight. They did that
Speaker 1: by weighing people and adding in calories when needed, and
Speaker 1: people's blood pressure declined. Anyway, long story short, people can
Speaker 1: improve their health without losing weight. Tracy Man from the
Speaker 1: University of Minnesota says it's actually easier. It's really really
Speaker 1: hard to lose weight and keep it off, but eating
Speaker 1: your vegetables and getting your steps in that's within reach. Still,
Speaker 1: it's kind of a tough sell, right You're telling me
Speaker 1: to get on a treadmill or whatever, and I'm not
Speaker 1: even going to drop a pant size. We need to
Speaker 1: find a way to help people stick to those health behaviors,
Speaker 1: especially physical activity thing. Two, we've got to get rid
Speaker 1: of weight stigma, because as long as there's weight stigma,
Speaker 1: people are going to keep trying to diet, and people
Speaker 1: are going to continue to make obese people uh feel
Speaker 1: bad and suffer in various ways that are unfair and unjust.
Speaker 1: Um And three, we need to find a way to
Speaker 1: help people feel satisfied with whatever body they have once
Speaker 1: they are behaving in healthy ways consistently. That body won't
Speaker 1: necessarily be thinner at then as you want, but that's
Speaker 1: your healthy body, and we've got to find a way
Speaker 1: to be satisfied with that. Freecy's Lab at the University
Speaker 1: of Minnesota is working on those right now. Adding vegetables
Speaker 1: to your diet um and especially doing the recommended amount
Speaker 1: of physical activity each week. Those are lifestyle changes and
Speaker 1: people should do them. Again, doing them doesn't mean you're
Speaker 1: gonna lose weight, Doing them doesn't mean you're going to
Speaker 1: be thin, and but doing them does mean you will
Speaker 1: improve your health. You have to measure health in a
Speaker 1: different way now at the scale, approaching health in a
Speaker 1: way that's way inclusive. There's actually a movement behind it
Speaker 1: called you Guessed It Health at every size. What we're
Speaker 1: trying to do currently, and the current mainstream approach to
Speaker 1: health and weight isn't working. This is Annie again from
Speaker 1: asda as that advocates for health at every size. What
Speaker 1: we see in the research is that efforts to make
Speaker 1: that people thin are failing. They fail over and over
Speaker 1: and over again. We have decades, literal decades of research
Speaker 1: and so those are not things that people can just
Speaker 1: choose to do, like they could choose to eat more vegetables.
Speaker 1: And so what what happens when we shift the focus
Speaker 1: to things that people actually have control over, like what
Speaker 1: they eat, or how they move their bodies or web
Speaker 1: or not they smoke any Veronica and their fellow activists
Speaker 1: are fighting for exactly that, for people to stop treating
Speaker 1: weight as the equivalent of health. They say that we've
Speaker 1: been telling people to lose weight for their health and
Speaker 1: that's not only wrong, but it's actually causing a lot
Speaker 1: of harm. The vast majority of doctors today are still
Speaker 1: very fat phobic. Ultimately, we need healthcare practitioners to understand
Speaker 1: what the science really does say and and right now,
Speaker 1: the science is contrary to what the mainstream beliefs about
Speaker 1: fatness are. And if a fat person is going to
Speaker 1: get good care in the hands of a doctor. We
Speaker 1: need people to also understand what the science and research
Speaker 1: says about weight and weight loss. This is again contrary
Speaker 1: to how society still thinks about things. Any points out
Speaker 1: that just having a certain b m I, a b
Speaker 1: m I that's considered in the obese range, is now
Speaker 1: itself being called a disease. But the activists at ASDA
Speaker 1: are fighting for more than that too. Veronica and Annie
Speaker 1: argue that even the idea of health itself is broken.
Speaker 1: After all, how did scientists come up with standards for health.
Speaker 1: They did it by mostly studying white heterosexual men. We
Speaker 1: are trying to shift the way that we talk about
Speaker 1: health in health at every size so that we don't
Speaker 1: continue to uphold those white centric, erocentric um standards within
Speaker 1: our own movement. One way to think about this is
Speaker 1: in terms of how much we value health as a
Speaker 1: society and what that really means. Health is often defined
Speaker 1: as the absence of disease right off the bat. That
Speaker 1: leaves a lot of people out, and on top of that,
Speaker 1: some of the sickest people in society are also the
Speaker 1: most marginalized people like people of color, LGBTQ people, more people,
Speaker 1: A fat person, uh could live this healthy, long, happy
Speaker 1: life according to these Western Eurocentric standards of health. Right,
Speaker 1: this is Veronica again. But let's say they don't. Let's
Speaker 1: say a fat person does develop diabetes, then what do
Speaker 1: we do? Do we not care for this person? Are
Speaker 1: they just disposable? Um? And like a lot of times
Speaker 1: it plays out in our medical industrial complex, like fat people, uh,
Speaker 1: disabled people, aging and chronically ill people are just seen
Speaker 1: as disposable. And like if we look at the pandemic
Speaker 1: that we're living in, some people were just left to
Speaker 1: die or people like, oh, well, it's only this COVID
Speaker 1: is only affecting certain people, so like I don't have
Speaker 1: to worry about it, and those people could just get
Speaker 1: sick and die. But is that the type of world
Speaker 1: we want to live in? Is that the type of
Speaker 1: health care system like we want to uphold? Veronica says
Speaker 1: that ASDA wants to change these things to people, no
Speaker 1: matter what size they are or what health can soon
Speaker 1: as they have or don't have, or whatever deserved care,
Speaker 1: they deserve equitable, barrier free access to the care and
Speaker 1: resources they need to support their well being. I wonder
Speaker 1: like what our health care system would look like if
Speaker 1: we actually just all acknowledge that being sick, being like,
Speaker 1: becoming disabled, being disabled, getting old and dying is a
Speaker 1: normal part of the human experience. That means getting the
Speaker 1: message across about health and we isn't enough. Historically, the
Speaker 1: movement has really promoted this idea that we just need
Speaker 1: to get healthcare professionals to stop prescribing weight loss and
Speaker 1: to stop using BMI as a measure of health and
Speaker 1: kind of like we'd be good, like we'd be done.
Speaker 1: And honestly, this promotes a very white centric view of it,
Speaker 1: because for a fat white person, if you can eliminate
Speaker 1: that barrier, all of the sudden, you have health care
Speaker 1: that affirms you. But and he says that isn't the
Speaker 1: case for lots of other people, including black people, trans people,
Speaker 1: and disabled people. That's changing what their organization fights for,
Speaker 1: things like who gets a seat at the table when
Speaker 1: people are doing research. The way health insurance is structured
Speaker 1: use of b M I to access health care services
Speaker 1: like surgery. And now I think what we're shifting to
Speaker 1: is really this understanding that the way that we define
Speaker 1: health as a society, the way that we define it
Speaker 1: when we study it in our research studies, and the
Speaker 1: way that the health care systems engaged with people are
Speaker 1: barriers on so many levels that we need to start
Speaker 1: dismantling and reconstructing the whole thing because they were based
Speaker 1: on one kind of person. It's not just our ideas
Speaker 1: about weight and health are wrong, it's that they are damaging.
Speaker 1: We can all be doing a lot more to shift
Speaker 1: how we think about these things and to make the
Speaker 1: world a better place for people in bigger bodies. As
Speaker 1: we do that, though, we've still gotta eat. And the
Speaker 1: thing about eating is that we've gotten pretty messed up
Speaker 1: about it. All. This talk about what's good for you
Speaker 1: and what's bad for you really does a number on people.
Speaker 1: Diets put so so many rules and food, and they
Speaker 1: can be incredibly hard to unlearn. If we put the
Speaker 1: diet to rest, stop making weight loss the goal, then
Speaker 1: what is there a way to be satisfied and healthy
Speaker 1: in whatever body we've got With self care, self compassion,
Speaker 1: tuning into hunger, fullness and enjoyment satisfaction, our bodies are
Speaker 1: going to be what they're going to be, and it's
Speaker 1: about learning how to be liberated from a belief that
Speaker 1: you have to change your body in order to be acceptable.
Speaker 1: Next week, on the final episode of Losing It, we
Speaker 1: dive into the world of intuitive eating. The scale is
Speaker 1: just a false idle and what we lose when we
Speaker 1: try to lose weight? What would you spend those on?
Speaker 1: What passions do you have of? What creativity would you
Speaker 1: spend it on? What hobbies? What you know? Spending time
Speaker 1: of loved ones? Like what would you do if you
Speaker 1: got that time back? Getting rid of diets? Eating without
Speaker 1: thinking about weight? Is that even possible? Losing It is
Speaker 1: written and reported by me I'm a Court and edited
Speaker 1: by Kristin B. Brown. Magnus Hendrickson is our senior producer,
Speaker 1: Stacy Wong our associate producer, and Blake Maples is our
Speaker 1: audio engineer. Our theme was composed and performed by Hannis
Speaker 1: Brown thanks to Francis A. Leavi and Tim and Nette.
Speaker 1: Be sure to subscribe to Prognosis if you haven't already,
Speaker 1: and if you like our show, please leave us a
Speaker 1: review that helps others find out about it. Thanks for listening,
Speaker 1: See you next time.