00:00:00.000hi everybody and welcome to maintenance phase the podcast that's just concerned about your health
00:00:15.460oh my god we're in your mentions on instagram you're glorifying it
00:00:22.140that one really lived or died by the line reading and i feel pleased with how it turned out if i'm
00:00:27.680honest. I'm Aubrey Gordon. I'm Michael Hobbs. This month, by astonishingly popular request,
00:00:35.740our bonus episode for Patreon patrons at every level is the HBO Max documentary miniseries,
00:00:43.100The Way Down. Yes, I have been told that I have very disappointing opinions on this matter.
00:00:47.260So enjoy those. And today we are talking about is being fat bad for you?
00:00:56.800I'm both very excited for this to get the Michael Hobbs, like terrier digging through a million facts kind of treatment. I am also nervous about it because this is the kind of thing that people with profound anti-fat bias use against fat people all the time.
00:01:18.120Anytime you open up this conversation, it's like opening up Pandora's fucking box for fat people.0.98
00:01:24.940This like this little intro is so telling, I think, because the way that fat people and thin people experience this conversation is worlds apart.0.99
00:01:34.680Thin people experience this conversation as like, well, you know, I read in Newsweek the other day that because everybody's fat, we're all going to live, you know, 13 years less than we thought we would.
00:01:43.080And fat people experience this as like, you are going to die.0.94
00:01:46.600Yes. And I would say fat people experience it as you are going to die because often thin people who read those Newsweek articles then turn around and tell fat people you are going to die.0.86
00:01:56.660When a thin person decides to tell a fat person we're going to live 13 years less or whatever because of you, because you're fat, whether or not that thin person intends to do so, the idea that that introduces is I'm superior to you.
00:02:11.380Yes. Because I have figured out how not to do this thing and you are failing because you have
00:02:16.080not figured out how to do this thing. Right. Anti-fat bias has, I would argue, a more decisive
00:02:21.280impact on fat people's health than actual just physical body weight.
00:03:52.760So this has always been associated with like this is a group that I do not like and I'm going to assign to them like some sort of health status.
00:04:00.360I mean, if we think back to the BMI episode, right, the earliest codification of the BMI was the fattest 15% of people would be considered overweight, right?
00:04:11.280It didn't have anything to do with health risks.
00:04:14.000It didn't have anything to do with anything but the fattest among us need to be defined in this way, right?
00:04:21.080Then you create a bunch of funding streams to find out why it's so unhealthy and so terrible to be what we already think of as terrible.
00:04:55.460Right. This is the 40s, 50s kind of era. Yeah. Yes. So, like, think about who had excess income in the 40s and 50s. Yeah. To spend on life insurance. It's going to be disproportionately white, overwhelmingly male. Yeah. Middle class, upper middle class and straight up wealthy. Right. Like there's like a whole wide, wide range of people that you're missing.
00:05:18.900Exactly. So basically, the big innovation at this time and the closest thing we get to reliable information on fat people and health is the rise of the cohort study. So are you familiar with this?
00:05:31.960Uh, no. I mean, like, I know cohort studies like exist, but I don't know about the rise of them.
00:06:26.500After a couple of years, after longer periods, I mean, some of these cohort studies have
00:06:30.460been going for like decades at this point.
00:06:32.280So once you wait long enough, people start dying.
00:06:35.480And then you can get into all of this risk relative, you know, mortality rates rising kind of thing of like, okay, so why if we would expect 25 deaths, why are there 50 deaths among fat people?
00:06:47.840Like that is how you can start doing these gradations and figuring out like what is killing Americans.
00:06:53.020And so the sort of the central issue with calculating these mortality rates is you can't just look at the raw numbers, right?
00:07:00.680So if you say, like, okay, if we look at normal people, 500 of them died.
00:07:05.200But then if we look at smokers, 1,000 of them died, right?
00:07:08.580So it's like, oh, okay, so smokers are twice as likely to die.
00:07:25.860So you have to sort of adjust so that you're comparing like poor, uneducated smokers to poor, uneducated nonsmokers.
00:07:35.200And then you can say, ah, OK, so this is what accounts for the smoking.
00:07:39.700Right. And if you don't do some level of statistical control, then you do what your brain is sort of wired to do, which is fill in the blanks with what you think you know, which are often not rooted in data or science or anything.
00:07:55.040Exactly. So what you just said is basically the Rosetta Stone for this entire episode. Because if you look at the raw numbers, it's true that very fat people have shorter lifespans than thin people. It's complicated for the lower weights and there's a lot of scientific debate about sort of when that association kicks in and we'll get into it. But that correlation, that statement that very fat people are more likely to get heart disease and diabetes and everything you've read about in a million Newsweek articles, that's never really been debated.
00:08:23.500The debate is about what the association means because obesity is not the only thing
00:08:30.340that's associated with having a shorter lifespan. Catholics live two years longer than evangelicals
00:08:37.320and Jewish people live two years longer than Catholics. People who live in West Virginia0.74
00:08:42.560die six years younger than people who live in California. One of the weirdest statistics I
00:08:47.960came across is that people with master's degrees have 10% higher mortality rates than people with
00:08:54.740PhDs. What? So next time you see somebody posting about like, hey, I got my master's degree on
00:08:59.620Instagram, go into their mentions like, you're glorifying having a master's degree. I'm just
00:09:04.840concerned about your health. I know. Quit your master's program. Another really consistent one
00:09:10.040is that unmarried people have between two and two and a half times the mortality rate of married
00:09:16.640people. What I love about the unmarried statistic is that when you tell people, okay, unmarried0.84
00:09:22.700people are more likely to die, you can like see the gears in their brain start working. People0.99
00:09:27.800are like, oh, it's probably something to do with like if you fall down the stairs, if you're a
00:09:31.980married person, like someone is there to call 911 or maybe somebody's going to hassle you about
00:09:36.960getting a doctor's appointment for like the lump in your chest if you're married, whereas if you're
00:09:41.140not, you might just like leave it for another year. Like people will start speculating about
00:09:45.260what the sort of the real reason is for this association because we all on a gut level
00:09:50.060understand that like having a piece of paper the marriage license is not extending your lifespan0.99
00:09:56.300this is also how you get that fucking garbage shit that's like it'll show up in like people1.00
00:10:01.160magazine it's like a pullout box that's like dog owners live five years longer than people who don't1.00
00:10:06.560own dogs people who own subcompacts have longer happier lives than people who drive suvs like
00:10:14.460all of that utter garbage comes from either findings that are not great or people not
00:10:23.040digging far enough into the findings before translating them into popular media and then0.99
00:10:27.840popular media running with that shit exactly no one looks at all these other associations0.94
00:10:33.340and immediately leaps to oh this is how we have to fix it like nobody is saying that like no matter0.99
00:10:39.900what you go into the doctor for, they should be like, uh, have you considered converting to
00:10:44.960Judaism? Yeah. This isn't actually a difficult concept for people. What's difficult is that we
00:10:51.460have been told this extremely simple story about obesity for so long that it's really hard to look
00:10:58.120at it any other way. And the thing you have to constantly remind people of is that obesity is
00:11:03.260not a behavior. Obesity is a characteristic. People become fat for all kinds of reasons,
00:11:09.040and people live their lives as fat people with all kinds of habits. There are fat people who
00:11:14.780don't get any exercise. There's fat people who get tons of exercise. There's skinny people who
00:11:18.840get no exercise. There's skinny people who get tons of exercise. These are all overlapping circles.
00:11:24.120And so the entire debate over obesity is where on the spectrum does it fall? So is obesity more
00:11:30.900like smoking in that it's a behavior that we can very clearly link to causing all of these health
00:11:36.100problems and shortening your life? Or is it more like having a master's degree? Where it's like,
00:11:41.120okay, it's basically a cluster of other correlations. Yeah. I mean, first of all,
00:11:46.260this is about to be maybe our methodology queeniest episode. I'm getting the sense.
00:11:54.860This is the project of creating and reinforcing an outgroup status. Yeah.
00:11:59.740And making people believe that it is objective, that it is scientific,0.97
00:12:03.060that it is beyond reproach and that it is natural for you to feel like fat people are lazy and gross
00:12:08.600because that's what they are because science tells you they are right like it's just bizarre that we
00:12:13.400try and take this stuff in a vacuum and just parrot it out as gospel this is this is the
00:12:18.820hardest thing about this is because you have to keep in mind issues outside of the data yeah so
00:12:23.880one of the most famous findings from these is in the 1990s the journal of the american medical
00:12:29.120association published a study that said that left-handed people die nine years younger than
00:12:35.620right-handed people what this was actually something that i was told growing up because
00:12:39.840i'm left-handed and like my whole adult life i've been thinking about like why like why why am i
00:12:45.940gonna die so young there's these like crackpot theories about like driving what because like
00:12:50.720the stick shift is with your right hand or something but also who drives stick anymore
00:12:55.180i know like it makes no sense i don't know man but so what it actually turns out is essentially
00:13:00.000the researchers looked at the population of 70 year olds and they said okay well there's you
00:13:05.380know roughly 12 of the population is left-handed and then they look at 70 year olds and they're0.81
00:13:10.000like oh my fucking god only three percent of these people are left-handed so all of the left-handed0.97
00:13:16.140people must have died it's like they're dropping like flies and we're only left with this much0.99
00:13:21.000smaller population. But of course, these are like some of the most scathing letters to the editor
00:13:25.960of a medical journal that I've ever read. All of these people write in and say, if you're looking
00:13:30.840at a population who's in their 70s in the 1990s, these are people who grew up in the 20s and 30s.
00:13:36.960And in the 20s and 30s, if you wrote with your left hand, they would make you write with your
00:13:41.200right hand. So the reason why there are only 3% left handers in that age cohort isn't because
00:13:47.560there's like a genocide of left-handed people it's because due to other social forces the rate of
00:13:53.520left-handed people is like artificially low among old people i will tell you this my grandfather who0.99
00:13:59.040passed away 15 years ago ish was like an extreme left-handed pride oh yeah the level of vindication0.64
00:14:09.500that this guy is getting posthumously is through the roof well look aubrey all hands matter i don't
00:14:15.180know why he was being so weird about it all hands matter all hands so i mean the left-handed thing
00:14:21.960i mean first of all i just have kind of a chip on my shoulder as a left-handed person about this
00:14:25.200but also it's just important that like you can't only look at the data that data about left-handed
00:14:31.400people you can slice and dice it you can control for smoking status and like you can do all kinds
00:14:36.620of statistical mumbo jumbo on that data but it's only going to drive you to like a slightly less
00:14:42.960boneheaded conclusion so this leads us to meet our protagonist for this episode oh we have a
00:14:49.980protagonist yes a woman named katherine flegal oh sure you know this oh my god mike i'm so excited
00:14:56.960i forgot about this all right put put us in space and time who is katherine flegal and like what is
00:15:01.880going on in the late 1990s so katherine flegal is a statistician who works at the cdc and i know
00:15:08.800that she waited to tell this story until after she was retired yes so katherine fliegel is at
00:15:14.660this time a statistical researcher for the cdc she got her bachelor's from uc berkeley she did
00:15:21.960a phd in nutrition at cornell her work has always focused on obesity and she's one of the first
00:15:28.880people to notice like hey americans are getting fatter like she's one of the first people to
00:15:34.300start publishing on this. And she was actually in, I believe it was Geneva at that WHO meeting where
00:15:39.680they changed the BMI categories. Oh, whoa. Holy shit. She is like deep in this field and like
00:15:45.660one of the earliest people, like just trying to get the message out that like something is changing
00:15:51.320in the American population and like people are getting fatter. So in the year 2000, she starts
00:15:56.540working on a paper about obesity and health. She's been to the CDC for a while. There's this kind of
00:16:02.560long-standing debate about like what does it actually mean for your health to be fat
00:16:06.420and she decides to start looking into this in like a very concerted way like i'm gonna find
00:16:11.080the best data i'm gonna like try to really answer this question once and for all what she does not
00:16:15.560know is elsewhere at the cdc another team is also working on this so in 2004 we get the infamous
00:16:24.260paper that is called years of life lost to obesity we've talked about we've debunked this like four
00:16:30.640times on the show already it's basically this big cdc study that makes huge headlines everywhere
00:16:35.120for saying that obesity causes 365 000 deaths per year yeah it also says that obesity is poised
00:16:43.780to overtake smoking as the number one cause of death in america this is like a level of deaths
00:16:50.440that like you would know someone who died just of fat that is a very large number of people to
00:16:57.220just keel over because of their fatness, which is sort of the impression that certainly that
00:17:02.380the general public is left with after the reporting on this, right?
00:17:06.800So this paper comes out, gets a ton of media coverage.
00:17:09.880Less than a year later, Catherine Flegel puts out her paper.
00:17:14.120And in her paper, instead of showing that obesity causes 365,000 deaths a year, her
00:17:19.900paper shows that obesity causes 112,000 deaths, but it also reduces deaths by 86,000 because
00:17:29.280slightly overweight people are actually less likely to die.
00:17:33.460Right. This is what they call the obesity paradox, which is my favorite thing to yell about
00:17:38.640because it's only a fucking paradox if you can't imagine fat people living healthy lives.0.92
00:17:44.660Catherine Flegel has some like very salty papers about the obesity paradox.0.97
00:17:47.700really she's like it's not really a paradox it's just like maybe it's just not universally bad for
00:17:53.580you like maybe it's complicated totally it's not really a paradox it's just you assumed this wasn't
00:17:59.700possible then researchers actually looked into it and it is possible exactly like calm down and
00:18:05.940sometimes you'll see scientists just kind of rejecting this out of hand they're like oh
00:18:10.160there's no biological mechanism that would make fat people live a bit longer and it's like really
00:18:15.340you don't see any reason why people who carry around extra energy on their bodies would live
00:18:22.340longer from certain conditions? Like, I actually don't find this difficult to believe at all,
00:18:27.320considering how many diseases cause you to sort of waste away as you get older. It makes sense
00:18:31.720they would live longer from some of these conditions, and that gives them more time to
00:18:34.860recover. Yeah. There's also actual studies on this. 80% of deaths in America are of people 70
00:18:41.220the end above, right? So one of the most common causes of death and disability in old age is
00:18:46.980falling down and breaking a bone, especially breaking a hip. One third of people who break
00:18:51.520a hip die within a year. And so this sounds really facile, but fat people just have more
00:18:55.840padding on themselves. So there's actual studies that find that the skinniest people are the most
00:19:01.980likely to die after suffering a hip fracture. So once you get into the actual causes of death,
00:19:08.160And you're actually curious about this phenomenon rather than simply rejecting it.
00:19:13.460It's like, oh, yeah, it actually makes a lot of sense that under certain circumstances for certain people, being a little bit fatter is actually better for mortality.
00:19:21.920So basically, I mean, the number one finding of her paper is that, like, people in the BMI overweight category are slightly less likely to die.
00:19:29.960So a little bit of fat has, like, some protective effect on mortality rates.
00:19:34.360the other big finding is that skinny people are more likely to die so in the fattest category
00:19:41.500like the obese category she logs 26 000 deaths in the skinniest category she logs 33 000 deaths
00:19:49.640yep so one of the quotes that goes around about this this is sort of how it ends up in the
00:19:54.000mainstream media coverage of it is given current government guidelines it appears that the average
00:19:59.240person is better off being 50 or even 75 pounds overweight than five pounds underweight this is a
00:20:06.280thing that also gets sort of thorny right it's worth noting very thin people are more likely to
00:20:12.820die than very fat people and there is no cause for you as a lay person to then start talking to0.98
00:20:21.380very fat people or very thin people about how they're gonna fucking die i like it when you0.99
00:20:26.180stand up for thin people like it won't someone think of the thin i like it when you say thin0.97
00:20:32.660rights there's all kinds of actually cohort studies that show this same pattern of like
00:20:38.320this weird spike for thin people a little bit reduced mortality for people that are like a
00:20:42.760little bit overweight and then a higher curve for people that are like fat they call it the u-shaped
00:20:47.940curve even though it's like more like a nike swoosh but it's an extremely consistent finding
00:20:53.500in this kind of research. So we now find ourselves in 2005. There's this 2004 paper that finds that
00:21:00.100like obesity is like really bad for you. Overweight people are going to die. Fat people are like
00:21:04.360totally going to die. It's just like really, really, really obvious deep line. And we've got0.95
00:21:08.740365,000 deaths caused by obesity every year. And we've also got Catherine Flegel's 2005 paper that
00:21:15.380says that like, eh, it's really not that many people. Like once you subtract the lives that it
00:21:20.420saves from the lives that it takes it's like 25 000 deaths a year due to obesity and there's this
00:21:26.080weird thing with like skinny people being less healthy and like it seems actually to be like
00:21:31.000good to be like five to ten percent overweight like there's now these two papers both of which
00:21:37.120are from the cdc saying completely different things right and one estimate is 90 lower yes
00:21:44.720So to this day, this is still framed as like a scientific debate and like two different ways to look at obesity data and like who can say.
00:21:53.800But the important thing to know about these two estimates is that one of them is wrong.
00:34:52.320One of the things she mentions in this paper is that like she was invited to attend this0.78
00:34:57.960symposium, but was not invited to speak. That is such an aggressive move.0.86
00:35:02.400It's such an aggressive move. I also think on some level, like holding a symposium to
00:35:07.260criticize a piece of work that you don't like, like, I honestly think like some of this is fine.
00:35:12.220There are elements of this that is okay.
00:35:14.920But what she finds over and over again is the actual rhetoric that they are putting out and that Walter Willett is putting out is this idea that the data is fundamentally flawed and the methods are fundamentally flawed.
00:35:26.880So it's not like, well, she made these choices and we would make other choices and these are why we would make these other choices.
00:35:35.220It also feels like, I'm not talking about this guy in particular, but like, often in the minds of like people with deep seated anti fat bias, any acknowledgement that fatness might not be as horrifically unhealthy as we have been led to believe, translates to, then people will think it's okay to be fat, then people will intentionally get fat or let themselves get fatter.
00:36:03.380He constantly compares her work to the previous paper that found 365,000 deaths, but he doesn't mention the previous study had been corrected and that it has, like, errors in it.
00:36:15.920He seems to talk about it as, like, this weird Kathy-Flegel joint where, like, she went out of her way to publish this, like, strangely ideological research when she's like, I work at the CDC.
00:36:27.660After she got her data, she spent four months with the higher-ups checking her data and, like, stress testing it.
00:36:33.540It feels very much like some interloper just shows up and like figures out that it's like
00:36:39.080probably not going to play great for him to take aim at the CDC, which is where this research
00:36:45.300originates. So he instead switches to like an ad hominem approach and is like, it's about this
00:36:52.360woman. It's also so funny that to people outside of this world, he starts telling them random
00:36:59.080reporters for like national publications he's like you know the real problem with katherine0.96
00:37:03.760fliegel's work is that the bmi is problematic oh fuck off like of course katherine fliegel is like0.79
00:37:11.780the other study also used bmi right you have shown no interest in your entire career in like0.84
00:37:18.740the ways in which the bmi is problematic like this is not work you have done you've not written about0.93
00:37:23.040this you haven't rejected other studies that use bmi because the entire fucking field uses bmi
00:37:27.300But then I like, I'm the problem for using BMI. And you think we should use this other estimate
00:37:33.340that also use the BMI, right? It feels like a little bit like the research equivalent of
00:37:38.940Stockholm syndrome with the BMI, which is like, it's terrible. And it's sort of an open secret
00:37:44.560that it's terrible for like a bunch of reasons. But also now in order to make research that you
00:37:51.260get that can be in conversation with other research, it is the way that researchers talk
00:37:56.780about size and health. It's like the measure that people use. So you can decide to opt out of BMI,
00:38:04.060but then you're also kind of deciding to opt out of your research being like, considered in concert
00:38:09.460with other more damaging research, right? Exactly. And like, this goes on for years.
00:38:15.500Yeah. Blog posts start showing up on like the Harvard website that say that she's been demoted
00:38:22.120from the cdc and her paper was retracted and she's like what like i won an award like i got
00:38:27.660everything's fine i go to work here every day and people still like me and work with me what0.78
00:38:35.720are you talking about exactly and like fucking i mean there's no evidence whatsoever that walter0.97
00:38:40.420had anything to do with this but like someone updates the fucking wikipedia article for obesity0.98
00:38:44.820jesus christ it included her article and then someone said that it had been like discredited0.88
00:38:49.760what are you talking about there's just like this weird shadow campaign to make it seem as if she's0.98
00:38:54.880some like rogue statistician she's like looking around and she's like no everyone thinks this is0.97
00:38:59.720fine i get so exhausted by this as a fat person as a woman definitely and as a person who cares0.99
00:39:06.980about like having conversations in good faith totally exactly like it's such a fucking soap1.00
00:39:12.700opera it's weird hey you know how all you have all this like garbage shit to deal with at your0.99
00:39:17.420job and you've got like a co-worker who's like totally unreasonable and weird and like you can't0.98
00:39:21.940stand to be around them like so do people at the cdc yeah you're like oh got it the thing that i
00:39:28.440have been taught to trust uncritically is from like deeply deeply deeply human sources and that
00:39:35.260feels like yeah the headline of this story to me i mean yeah my headline for this is that academia0.96
00:39:40.720is basically the big brother house this little fight's going on it just sucks in there
00:39:46.500it's the big brother house but like people are constantly running campaigns to get people
00:39:53.580kicked out of the house but no one ever actually gets kicked out of the house
00:39:57.580so fast forward to 2013 partly in response to the criticisms of her 2005 article
00:40:08.900fliegel starts working on a much bigger meta-analysis so originally she just had these
00:40:14.080like two data sets from american data but what she does is she looks for all other data sets like
00:40:19.880you know there's there's hundreds of studies going on about like obesity and health at any
00:40:23.720given time like it's it's kind of absurd you find these like random like norwegian cohort studies
00:40:28.300and like the south korean nurse collaboration or whatever right india australia all around exactly
00:40:33.820like this is a question that like the entire field of science wants to answer so katherine
00:40:38.560fliegel does like a pretty normal meta-analysis where she looks at every single study that's been0.51
00:40:42.280published on this. And she publishes a meta-analysis that includes 97 studies and 2.9
00:40:49.260million people. And she finds the same thing. Again, we have this spike of mortality for the
00:40:55.960thinnest people. And then you have a reduction in mortality for the overweight people. And then it's
00:41:01.620higher for fat people. So I interviewed Catherine Flegel for this. And one of the things that she0.98
00:41:06.820noticed is that oftentimes in these studies, they'll categorize people as like normal,
00:41:11.480overweight obese but as we've talked about on the show many times there's actually a huge gradation
00:41:16.800within fat people like you're talking about people that are like 210 pounds and you're talking about
00:41:21.220people that are like 600 pounds that's a huge category right and so oftentimes what you find
00:41:25.900in these studies is they'll say overweight people are fine but like obese people that's where all
00:41:30.340the risk is but then what catherine notices once you start digging into their data if you break up
00:41:35.020the fat people into like they call it again these names they call it class one class two and class
00:41:40.340three obesity, the lowest class of obesity, like the thinnest fat people, oftentimes also don't
00:41:47.800really have any health risks. So for her previous study, she found that if you're five foot eight,
00:41:52.240up to 185 pounds, you don't really have any health risk. In this study, which is even bigger and has
00:41:57.700more data, you can go up to 210 pounds and still not really have any elevated health risk.
00:42:02.680Right. I mean, this is where it feels worthwhile to insert that until the late 90s, people who are now in class one obesity category were previously in overweight categories and people who were who are now in overweight categories used to be in quote unquote normal weight categories.
00:42:26.120also one of the things that's amazing in because i've read a bunch of these like random ass studies0.99
00:42:29.340for this too one of the things that's incredible is they'll mention like almost like offhand they'll
00:42:34.300be like oh yeah uh bmi for black people just like doesn't work like some of them will be like up to
00:42:38.040like bmi of 35 so you can weigh like 280 pounds if you're black and like not have any of these0.99
00:42:42.920mortality statistics but some of them have also found that like it just doesn't fucking matter0.97
00:42:46.400for black people at all and it's again treated as this like weird footnote oh it's a paradox0.95
00:42:50.500no reason to dwell on it no reason to put it in the abstract no reason to like write an open letter0.98
00:42:55.680anything anyway back to the main anyway white people like jesus fucking christ this is the0.99
00:43:03.220fucking chickens coming home to roost when you made a like body measurement slash eventually0.99
00:43:08.780like moral assessment tool i know that was only built for white people so basically this massive1.00
00:43:15.960meta-analysis finds the same thing that her previous study found and that lots of other
00:43:21.460studies around the world have found this like basic mechanism. And again, Walter Willett goes
00:43:27.420on the attack. He shows up on NPR and says, this study is a pile of rubbish and no one should waste0.98
00:43:33.880their time reading it. Wait, is that a quote? Oh, yeah. Oh, Jesus Christ. He also tells, I believe0.95
00:43:39.980the Atlantic. He's like, Kathy Fleel just doesn't get it. And then Catherine's like, I go by
00:43:45.240katherine i don't don't let's just keep it katherine walter that's as close as you'll get
00:43:51.820in like academic research world to like get my name out of your mouth it's fully like smackdown
00:43:59.520language it's great so speaking of unfair criticism i'm going to be very unfair to
00:44:05.580walter right now so he gave because he calls all these journalists and like inserts himself in all
00:44:11.780of these publications about this controversy, there's quotes from him everywhere. And so I made
00:44:16.700like this little medley of like all of the inappropriate shit that he says about Catherine0.99
00:44:21.360during this period. And so I'm going to send it to you to read. Okay, quote, when Willett sees the0.96
00:44:27.740CDC study on obesity, his mind flashes to the picture of what he is sure this confusion will
00:44:31.840lead to. Patients packing on more weight while their doctors become less willing to broach the
00:44:36.840subject. People will get fatter, die sooner, and all the medical bills could cripple the
00:44:41.460healthcare system. Willett feels he has no choice but to go on the attack. No choice. It's important
00:44:47.460to push back strongly against the promotion of ideas and analyses that are based on faulty data,
00:44:52.620he says. Willett claims that Flegel clearly has a point of view on this issue. After all,
00:44:58.640she published a paper in 2005 that reached the same conclusion about the protective powers of
00:45:03.340a few extra pounds. Quote, the Flegel paper was so flawed, so misleading, and so confusing to so
00:45:09.800many people, we thought it really would be important to dig down more deeply, Willett says.
00:45:15.620Studies such as Flegals are dangerous, Willett says, because they could confuse the public and0.77
00:45:20.940doctors and undermine public policies to curb rising obesity rates. According to Willett,0.97
00:45:27.580the papers Flegal published were woefully misleading and undermined dietary guidelines
00:45:32.740that had been in place for several decades. Worse, he says, these findings can be hijacked
00:45:37.740by powerful special interest groups such as the soft drink and food lobbies to influence
00:45:42.840policymakers quote it's basically giving a green light to gaining weight and becoming overweight
00:45:48.120we're talking about millions of lives lost every year due to obesity it's a death spiral as this
00:45:54.960gets normalized as we look around and everyone's overweight end quote so other than agreeing
00:46:00.380wholeheartedly what do you think um i mean this is so like here's what i think about this this is1.00
00:46:06.100genuinely the shit that trolls say online all the fucking time it's wild right this is the shit0.99
00:46:11.220right yeah and actually like i like i genuinely don't even know where to fucking start with this0.99
00:46:16.800like oh no this would undermine public policies to curb rising obesity rates which don't fucking
00:46:22.800work i know exactly we've been doing for 20 years and have produced nothing but continually rising0.84
00:46:29.100obesity rates like oh no they go against dietary guidelines which change every five to ten0.82
00:46:36.200fucking years because we know very little about nutrition all told won't someone think of the
00:46:41.860dietary guidelines everyone the beloved dietary guidelines that all americans know and love and0.98
00:46:48.680never change yes i can't jump inside his head i don't know what he's thinking what this communicates
00:46:53.560to me as a fat person and what i hear with this stuff is like the ultimate terrible thing that
00:46:58.380will happen as a result of this is that there will be slightly more people who look a little
00:47:02.320bit more like me. I know. I also think an important thing that he says here is that he says, you know,
00:47:07.200all this is going to undermine public health. And also it's going to be taken up by powerful
00:47:11.640lobbies of like the soft drink makers and like the fast food companies. And on some level,
00:47:16.620he's actually right. There are like really gross corporate lobbying firms, like these fake
00:47:22.480grassroots companies like that pretend to be grassroots NGOs that like say the same shit0.97
00:47:26.840that we do yeah i sort of get that like yeah there's some really gross forces aligned with0.96
00:47:31.620like what we are saying on the show like that is worth acknowledging but also his argument is
00:47:35.780aligned with pharmaceutical companies and the weight loss industry right you're not like the
00:47:40.720lone david standing up to like the goliath of mcdonald's it's like you're sitting there with
00:47:45.880novo nordisk dude yeah totally well and also just like listen corporations are going to use0.96
00:47:52.180whatever the fuck is in their reach to prove their point. And that can't and shouldn't drive
00:47:58.860what research tells us, right? So like, his argument, I would say is like, even more dystopian,
00:48:05.200which is like, we shouldn't research anything that corporations could then turn around and use to
00:48:10.520defend their own self interest in their own bottom line. That's also not good. That's also
00:48:16.000corporations exactly an undue influence on science and research that we shouldn't be encouraging
00:48:22.360dude exactly it just feels like deeply not only half-baked but it's like leading him in like
00:48:27.560unintentionally a more sinister direction and also i mean when i talked to katherine like i think this
00:48:32.960was what really bothered her is that he's basically accusing her of like having ideological motives
00:48:38.500with no evidence right there's one report of someone who was in a class of his and he said
00:48:44.920that she holds these views she published these studies because she's a little bit plump herself
00:48:49.900oh get fucked exactly so look this is a person on twitter like this this has not been confirmed0.94
00:48:55.360like i i want to be clear about like the source of this information right but what what bothers0.98
00:49:00.700me is like even if that isn't true what he's accusing her of is basically being an ideologue0.99
00:49:05.660right that like she wants a policy outcome she wants doctors to not talk to their patients and
00:49:11.700And, like, he is skipping straight from the data to the implications of the data and accusing her of trying to bring about some sort of policy outcome.
00:49:20.840And Catherine Flegel, like, I don't know much about her.
00:49:23.260She's actually kept her personal life completely out of the public sphere, which seems totally fine to me.
00:49:28.300But, like, even in our phone call, she would, like, correct me if I was like, yeah, I feel uncomfortable with, like, doctors talking to patients about their weight.
00:49:35.160She'd be like, well, I don't know about that.
00:50:04.880And he thinks that it is irresponsible to publish scientific research that even hints at the idea that it might not be as bad to be fat as he thinks.
00:50:17.560This is also such like every bad faith dude who I've ever worked with, who just sort of throws his weight around. Both this is a totally extraordinary story of science getting hijacked by like weird personal interactions and personal motives.
00:50:36.240and also it feels totally unremarkable and common i know and like all of us especially
00:50:43.680any of us who are not white dudes like know this fucking dude dude i know i love that it's like0.85
00:50:49.300this is an outrage and also wednesday and also and also staff meeting it's so remarkable and0.97
00:50:59.020it's so not all at once exactly and for like all of my close friends and family i can name you
00:51:05.500three of these dudes in their lives yeah i have known those dudes and i've also been that dude
00:51:09.920sometimes oh michael i know the bravery i know congratulate me congratulate me for admitting it
00:51:16.700that's what i want i'm gonna mail you one cookie thank you that's all i want i don't have to
00:51:23.060actually fix my behavior as long as i acknowledge it it's very good okay are you ready for the
00:51:30.740methodology queen section of this episode i've never been readier mike so i've been saving this
00:51:36.900because a lot of the arguments that walter makes against katherine are like technical
00:51:42.100methodological things about how she has designed this study and i want to take them seriously so
00:51:47.720what he says in his article that he eventually publishes like responding to her study
00:51:52.200is he says we believe her study is flawed their normal weight group contains persons who are lean
00:51:59.080and active heavy smokers frail and elderly and seriously ill with weight loss due to their
00:52:04.940disease so he's making a specific point about her sampling he also says he also says as well0.99
00:52:12.240as asian populations historically undernourished and burdened by infectious diseases what the fuck0.53
00:52:18.800because i think she included some data sets from like south korea or japan what are you doing sir0.56
00:52:23.820Walter, we're talking about human biology, Walter.
00:52:27.800And like, it's a normal thing to include studies from other countries when you're doing that.
00:52:32.440I also like that he was like, my take doesn't seem garbage enough.
00:54:36.620It's disproportionately removing like a bunch of marginalized communities.0.71
00:54:40.460And again, feel like a likely return to centering the bodies of like middle class white people, right?0.65
00:54:48.060Like if we're like getting down to it.0.90
00:54:50.260Well, this is the problem is that what you end up doing with removing all the smokers is you say that you're removing the effect of smoking, right?
00:57:02.420That's what I was going to say is like, couldn't you say the same thing about like someone my size wasting away, quote unquote, could mean a loss of 100 pounds for me, right?
00:57:11.860Like that would be like dramatic weight loss.
00:57:13.780I would still be in the quote unquote obese category.
00:57:17.080Well, this is this is the whole problem, right?
00:57:19.480I think it's it's so interesting once you start talking to people about the higher rates of mortality among thin people.
00:57:27.080then people are like very likely to die according to these studies and then you watch people's minds
00:57:32.880go to like well that's not because they're thin right it's probably because like they have an
00:57:36.540illness maybe they have like a really severe eating disorder or something like that you know
00:57:40.140there's all these conditions that make you thin and then kill you and it's like wait until i tell
00:57:43.960you about fat people yeah like there's also medical conditions that make you fat what do
00:57:50.720you know how many like medications cause people to gain weight i think birth control pills it's
00:57:55.160like typically like 15 pounds there's mental illness medications that cause you to gain like
00:57:59.74050 pounds and like oftentimes those people have higher mortality rates too so it's like the same
00:58:04.420thing is happening on the other end of the scale right there are also health conditions like
00:58:08.340lipedema which is like swelling and like accumulation of fat in specific parts of bodies
00:58:15.020if we're cutting people out and going okay it doesn't apply to this person it doesn't apply0.86
00:58:19.360to this kind of person it doesn't apply to this health condition it seems fully fucking bananas
00:58:24.280to do research on fat mortality and not account for things like polycystic ovarian syndrome,0.71
00:58:30.040not account for things like eating disorders at any level.
01:11:19.580If we go to those people, when you look at those statistics, it's dire.
01:11:23.820It's like they're half as likely to be college graduates.
01:11:27.320One quarter of them are earning less than $20,000 per year.
01:11:31.300They're twice as likely to be on Medicaid.
01:11:33.120the group with the highest prevalence of grade three obesity is black women who didn't complete
01:11:39.860high school? Yeah, there it is. Is this a group that like we're confident in saying it's the1.00
01:11:45.960weight that's doing this and that like what they need is to lose weight? Yeah. Is that the biggest
01:11:51.900need that we've identified here? Also, have we listened to poor fat black women about what they1.00
01:11:57.300want and need exactly instead we're focused on chiding fat people for what we assume their0.99
01:12:04.280behaviors are there's all kinds of studies on like fat people do not get pap smears fat people
01:12:09.320do not get like prostate cancer checks if you want to say that it's like the adipose tissue
01:12:13.900that is causing those health consequences you know what fine i'm probably not going to talk
01:12:18.960you out of that opinion but it's like what can we do like what are the steps that we can take
01:12:24.260for that group that will actually make a difference. Because telling them to lose weight,
01:12:28.500we know that it doesn't work. Medical institutions define successful weight loss as losing 10% of
01:12:33.840your body weight. So if you're 300 pounds, you're going to be a 270 pound person. That's the best
01:12:39.840we can deliver. And not even like very reliably, but like, there are some programs that have been
01:12:45.020shown to deliver that for like some number of people. Great. We now have a 270 pound person.
01:12:50.460what does that person need right the idea that any of this data doesn't account for medical bias
01:12:57.400and the ways in which doctors will like diagnose illnesses differently the ways in which doctors
01:13:02.060will like and health care providers of all stripes will have like shorter visits with fat people
01:13:06.820they'll order fewer tests they'll consider fewer options and then fat people understandably will
01:13:14.220postpone health care as long as they possibly can. I have a family friend who was like put on
01:13:20.700prednisone by her doctor and put on weight because that's what happens when you go on prednisone,
01:13:25.340right? This is one of many medications where this happens and is now having significant,
01:13:30.200significant cardiovascular issues. And her doctor is saying, well, it's because you didn't lose
01:13:34.340weight and you need to lose weight. And she's like, I need to go into the hospital. These are
01:13:39.600like very clear cut cases of fat people clearly not getting the care that thin people are getting
01:13:46.260it just feels utterly bananas that we have a cultural conversation that is dominated by thin
01:13:52.340people and thin people's imagining of fat people's health and not the like extremely overwhelming
01:13:59.800very clear experiences of fat people on this front one things i found in one of the older papers
01:14:05.140one of the few papers actually that actually investigated the causes of death among fat
01:14:10.380people like cancer deaths are much higher among fat people this is like a pretty well established
01:14:14.420thing but they noticed that one of the reasons for that was that fat people couldn't fit into
01:14:19.900the machines that they needed yeah they also a really interesting one was they mentioned that
01:14:24.300like fat people were much more likely to get gallstones right it's some sort of side effect
01:14:28.580of like what you're eating but when you look into gallstones it's also a side effect of dieting
01:14:33.400If you stop, especially fat consumption, but like calorie consumption, your liver just like goes nuts. So like 30% of people who get gastric bypass surgery and stop eating very quickly, they get gallstones, 30%. So it's like another one of those things that is like, it's seen as like, well, fat people are at higher risk of gallstones. And like, okay, but is it the fat doing that? Is it their diet? Or is it dieting? And those are actually like very different phenomena as a society that we would need to look into.
01:15:01.300Quite a bit of the things that we think of as being like the cost of being fat are actually the costs of weight cycling, right?0.94
01:15:09.060Guess who's under the greatest pressure to diet all the fucking time?0.99
01:15:27.160okay so i do think that like the effect of dieting and people basically being in like a starvation
01:15:33.400state for potentially years is like vastly under covered yes but the studies are trash oh really0.98
01:15:41.260oh my god a lot of them are on fucking rats and they do show that like raising and lowering their0.99
01:15:45.420rats weight is like really bad for them which like fine but also rat studies yeah yeah a lot of them0.99
01:15:49.720are just slicing and dicing the same data and like people aren't gathering weight cycling data so
01:15:54.900So, like, these big cohort studies, one of the huge weaknesses of them is you're relying on, like, what were they asking people in, like, the 1990s?
01:16:02.440You can't go back and ask people the same questions.
01:16:04.920So, they're using the data that they have.
01:16:07.180So, I found a study on weight cycling, like, a study that shows that weight cycling is bad.0.98
01:16:11.920But look at this fucking methodology.0.99
01:16:13.680So, they're looking only at men, of course, because these cohorts are terrible.1.00