00:08:27.220Yes. That is the Latin translation is like you ate so much, you got so fucking fat.1.00
00:08:32.660Someone's researching her new book. Reading the Latin.0.99
00:08:36.140Hmm. So it's just worth knowing that that is like the stigma is built into that term. Yeah. Yeah. Fat people who are most of us are being made to listen to all of these sort of like public health declarations about like, if only we could get to a world where fat people didn't exist, where most of you weren't here. Right. And that is a wildly heartless thing to say.
00:08:59.540But, Aubrey, what if I'm making that argument to say that it would be cheaper than a group of people around?0.99
00:09:25.360But then, okay, so this is, I mean, this is just like conceptually gross and shouldn't exist. But of course, as part of my like rabbit hole tumbling, I started looking at the other numbers, right? Because as we noticed with this number itself in Michael Pollan's book, there's no consistency, right? These numbers bounce all over the place.
00:09:44.400So I started looking at the sort of canonical, quote-unquote, costs of obesity throughout time.
00:09:50.160So the earliest I could find was 1990, a study estimated the cost of obesity at $46 billion.
00:09:56.700There's a 1994 paper that says $70 billion.
00:10:00.140There's a 1998 paper that says $78 billion.
00:10:03.720There's this 1999 paper that Paulin references that says $99 billion.
00:10:07.540So from 1990 to 1999, the costs of obesity have somehow doubled.
00:10:13.300They've gone from $45 billion to $99 billion.
00:10:16.220Can I take a swing at one of the factors?
00:31:53.260It's like this receptor on the HB2 tendril or whatever, these are scientists having debates about the nomenclature of something within their field.
00:32:03.900Like at no point in any of these papers does like there's too many fat kids so we have to rename diabetes comes up.
00:32:11.460So basically in 1979, the American Diabetes Association officially recognizes this type 1, type 2 thing and is like, yeah, this is the way forward.
00:32:20.140And then the WHO recognizes it in 1980.
00:32:22.100that's how all that happened so this whole thing of like oh they had to rename it not only is it
00:32:27.740not true this is in the wikipedia entry for the history of diabetes so like this is not some like
00:32:35.560secret hidden figures untold history of the of diabetes it's like this is extremely mainstream
00:32:42.220stuff and yet this claim shows up everywhere it's the same thing with the 90 billion number it's
00:32:49.200just like i just need a sentence in this man i just we all know obesity is really bad and all
00:32:53.600like the kids are dying so like i just need to throw in something and you don't even do the most
00:32:58.000basic fact checking of any of the claims that end up in your article and that's how these zombie0.97
00:33:03.100statistics run around yeah anyway annoyed annoyed as fuck next paragraph okay hang on a recent study0.89
00:33:10.960in the journal of the american medical association predicts that a child born in 2000 has a one in0.91
00:33:16.080three chance of developing diabetes. An African American child's chances are two in five.
00:33:22.200This was actually the one that got me interested in doing the research,0.94
00:33:25.660because I was like, that doesn't pass the smell test for me. Yeah. First of all,
00:33:29.960that's like kind of a weird roundabout way of just saying like how many people in America have
00:33:35.740diabetes. It's weird. Yeah. The prevalence rate of diabetes in the US, I've seen various estimates,
00:33:41.440it's somewhere between 7% and 12% of Americans have diabetes.
00:33:46.680People born now have a one in three chance of getting a disease that only at most 12%
00:35:25.900This study is a lifetime risk. And one of the findings that stuck out to me in this study
00:35:32.260is that the mean age of diagnosis of diabetes is 57 years. So in the study, it says in the cohort
00:35:41.660of individuals born in 2000, we estimate that 0.88% of males and 1.1% of females will develop
00:35:50.200diabetes by age 20. So your chances of getting diabetes by age 20 are around 1%.
00:35:56.020Significantly less than the estimated prevalence of eating disorders at those ages.
00:36:00.080Exactly. By age 40, your chances are somewhere between 4% and 7%. And by age 60, your chances are somewhere between 18 and 20%. So almost all of the risk is coming from people older than 60.
00:36:15.460Well, and again, like, these are sort of framed in a way that's like pretty misleading. And again, relies on weight stigma and like sort of panic about fat kids in order to carry the message forward. And the message is like a deeply stigmatizing one here, right?
00:36:32.640Well, that's the thing. If what we're talking about is childhood diabetes, why wouldn't you just list the prevalence of childhood diabetes?
00:36:46.740You know, and also there's also the thing that like if what we're really talking about is people over 60 being diagnosed with diabetes, if you're born in 2000, by definition, by the time you're 60, it's 2060.
00:36:58.440And there's also presumably some like new treatments and technologies available.
00:37:02.020So it's also this weird fear-mongering about people being diagnosed in 60 years with diabetes.
00:37:08.740Well, I mean, if you look at the advances in the last 60 years of the treatment and diagnosis of diabetes, it's like things are totally different now than they were in 1960.
00:37:29.820That is a ghoulish fucking thing to do is to say you're going to die and it's going to be your fault.1.00
00:37:36.900Right. But then also, I mean, what's so striking to me about this research is that, you know, with all of the scare stories we've read about, like, childhood diabetes and stuff, how much coverage have we actually gotten that engages with those actual kids and their parents and their needs?0.99
00:37:58.460So there's like this huge paradigm shift happening. One of the things I read was talking about how most adults who get type 2 diabetes, there's like a 10-year period where you have elevated A1C levels, but it hasn't become full-blown diabetes yet. And it takes a really long time for that to get to where you cross the threshold for diabetes. But then in children, that process takes roughly two years.
00:38:25.380The fact that it has doubled in the last 15 years, I think, is genuinely, like, it's a thing, but it has increased almost exclusively with non-white kids.
00:38:35.48075% of the kids who are diagnosed with type 2 diabetes have a close family member who has it.
00:38:42.880This is an excerpt from a really interesting article about the paradigm shift around childhood diabetes.
00:38:47.700it says support for the role of epigenetic factors comes from studies in children born
00:38:53.140to mothers who had undergone bariatric surgery children who were born before their mothers had
00:38:58.700weight loss surgery had a higher rate of obesity and insulin resistance than their siblings born
00:39:04.160to the same mothers after they had lost weight similarly offspring of mothers with gestational
00:39:09.720diabetes have a higher risk of developing obesity and type 2 diabetes compared to offspring of the
00:39:15.420same mothers born after an earlier pregnancy, not yet complicated by gestational diabetes.
00:39:21.160The other side of the coin, represented by studies in offspring of mothers exposed to famine,
00:39:26.460also clearly shows the increased incidence of insulin resistance and type 2 diabetes later in
00:39:31.580life. So it's like, there's something more complicated going on.
00:39:36.220Well, this is also like, we talked about this a little bit in our eating disorders episode with
00:39:40.940Aaron Harrop that there is this sort of like burgeoning field of epigenetic research into
00:39:47.640sort of like what's the relationship between family or community traumas and food security
00:39:55.420and your body weight or your disordered eating or whatever, right? And this is like this huge
00:40:01.480field that is sort of like opening up and there is more and more research coming out that actually
00:40:07.100things that happen to previous generations of your ancestors can directly impact your own
00:40:14.340health outcomes. So like, again, this is one of those places where it just feels like people are
00:40:19.220like walking around with this completely unearned certainty that we just reach for it and we go,
00:40:24.120great, you did it to yourself. You're going to die. That's all I need. All I need to know is1.00
00:40:28.280that you're doing the wrong thing and I'm doing the right thing. Reading the actual literature on
00:40:32.320this, which to my great discredit was the first time I had actually engaged with it, was just
00:40:36.920like, oh, this is so much more complex than it seems. And it's, it has never been presented to
00:40:42.960me in any of these magazine articles or whatever, as like an actual complex problem that needs
00:40:49.000complex solutions. Like you can see the way that it's just used as this cudgel. It's like,
00:40:53.180if kids don't do this, they're going to be diabetic or like America spends this much on
00:40:56.940diabetic people yeah it's not fair to just treat this as like one dashed off sentence in your
00:41:02.800article about obesity and then be like oh those kids need to be smaller or whatever it's like
00:41:07.120no they probably just need us to help them in like much more tangible ways well there's also
00:41:11.640just like way more going on here right i think there are these times when yeah in our sort of
00:41:17.280public discourse people who are not disabled people who are not fat will talk about being
00:41:23.100I'm just concerned. I just want to solve this problem. Right. But then their actions sort of
00:41:27.440tell on them because their actions are not geared towards solving a problem. Their actions are
00:41:32.000geared toward freaking people the fuck out. If you are concerned about something, if you want to
00:41:38.260solve a problem, we all kind of know what that looks like, right? You approach it with a great
00:41:43.300deal of tenderness. You approach it with a great deal of curiosity. You try and figure out what
00:41:48.520are the, you know, like you test your own assumptions, the ways that we talk about fat
00:41:53.620people's perceived health risks, the ways that we talk about diabetes and hypertension and heart
00:41:58.760disease are not those ways, right? These kids are all going to get diabetes and it's going to cost
00:42:04.780us $90 billion. That's not solutions oriented. That's not loving. It's not caring. Fat people
00:42:11.920deserve better than that. Diabetic people deserve better than that. It is such shitty like lip1.00
00:42:17.140service that does the opposite of what it says it's doing those uh those people deserve a farmer's0.95
00:42:22.680market that's what we're prepared to offer according according to the rest of this book
00:42:29.720i don't know how many times i can fire you but once again michael you are
00:42:33.620okay uh want to do the last one last sentence of this weird terrible paragraph
00:42:43.160quote because of diabetes and all the other health problems that accompany obesity today's
00:42:49.220children may turn out to be the first generation of americans whose life expectancy will actually
00:42:53.980be shorter than that of their parents i hate this phrase i have heard it so many times this is king0.99
00:43:01.100of the zombies this is the zombie lord this is one of those things where there is so much fucking1.00
00:43:08.880stigma placed on parents of fat kids. We have this like really intense cultural lens that is0.99
00:43:15.280like, if a kid is fat, that is the result of a failing of a parent. Right. And this feels like
00:43:20.300the gnarliest and most ghoulish way to address a parent is like, you're killing your kid.0.92
00:43:27.340Yeah, it's absurd. So do you know who Dr. William Klisch is?
00:46:40.600And so they do all of this. The whole thing, again, is just like empty statistical mumbo jumbo. The whole thing is like, what would happen if everyone in the country who had an overweight or obese BMI instantly magically attained a BMI of 24? Like, that's what they're that's what they're basing this whole thing on.
00:46:58.960Oh, my God. So we're now just fully in fantasy land. Yes.
00:47:03.400Yeah, we've never – these conditions where every single American is under a BMI of 24 have literally never existed in the country.
00:47:10.800As it turns out, fat people are around, have been around, will continue to be around.0.57
00:47:15.980Fat people have existed and also exist.0.87
00:47:18.740This is a side note, but it also does this thing where it just like mentions that like the BMI doesn't work for black people.
00:47:25.420It's doing all this like mortality rates, BMI, and then it's like, oh, yeah, anyway, like BMI isn't connected to mortality rates for black people.
00:47:33.400Like, any black person, like, above 60, like, it just doesn't really work for them.1.00
00:47:37.360Anyway, they just, like, keep going.1.00
00:47:51.740Assuming the current rates of death associated with obesity remain constant in this century,
00:47:56.080the overall effect of obesity in the united states is a reduction in life expectancy of
00:48:01.580one-third to three-fourths of a year good good that's a tiny effect and also they're not saying
00:48:08.620that life expectancy will shorten by that much right in 2005 the life expectancy is around 77
00:48:14.500they're basically saying if it wasn't for all the fat people american life expectancy would be like
00:48:20.70077.5. That's what we're talking about. God damn it. In a hypothetical scenario that has never
00:48:28.280existed in the United States, our life expectancy would be around half a year longer.
00:48:34.840It's just so irritating. This isn't even the original claim that was made. The original
00:48:40.680claim that was made was that this generation of children, people born now, are going to have
00:48:45.920shorter life expectancies than their parents. That's not what this is showing. It's showing
00:48:49.760that rates are going to continue to increase but they would have increased more if it wasn't for
00:48:55.060obesity my god the first part of that sentence is also important where it says assuming that
00:49:01.500current rates of death associated with obesity remain constant in this century it's going to
00:49:06.240affect life expectancy yeah but why would we assume that current rates of death associated
00:49:11.200with obesity would remain constant yeah deaths associated with obesity have fallen precipitously
00:49:17.760you are significantly less likely to die of a heart attack now than you were in 1950.
00:49:23.380Even cancer, I found a really interesting analysis of this, of like changing mortality
00:49:27.840statistics in America. Since 2011, since very recently, cancer death rates are down 20%.
00:49:35.200Heart disease death rates are down 10%. Yeah. And also, again, like these are all presumed to be
00:49:41.560causes of death that are related to being fat. And that also hasn't been fucking established.0.96
00:49:47.760Right. It has never been established. Right. So we're like going so far down the road without the most basic thing confirmed. It's just like a house built on a foundation of sand.0.95
00:50:01.500Right, right. So what drives me nuts is the same researcher who wrote this paper being like, oh, we're all going to die, life expectancy getting shorter, writes another paper in 2009 that is like completely unrelated to this, right? It's like Social Security Administration projections, like a million institutions project U.S. life expectancy for various things, where he predicts that the Social Security Administration and the CDC's life expectancy predictions are not optimistic enough.
00:50:29.760but he says life expectancy for americans is going to keep increasing and it's probably going
00:50:34.920to be like 87 years by 2050 whoa so it's like oh so when you're not writing about obesity you're
00:50:41.860going to be like oh well actually this is what the data indicates but you know i also i had to
00:50:46.200write an article that like was kind of scaring people about obesity so i like did some weird
00:50:49.840statistical shit with that you find this all over the place you find this with some of the economic
00:50:54.560analyses too that it's like when they're writing for like an obesity audience or for a public health0.99
00:50:59.380journal, they'll be like, obesity is the biggest killer. And then you'll find the same author with
00:51:04.300a paper that has like something to do with something completely else. And they're like,
00:51:07.800oh, yeah, obesity is really not that big of a deal. It's a social imperative, not a fucking0.99
00:51:11.460scientific or medical one. Exactly. It's like they want to raise the alarm about obesity,0.98
00:51:15.900right? It's like, oh, it's a public health problem. We have to do something about it.
00:51:18.660But it's like, you're not really being transparent about the fact that that's what you're doing.
00:51:22.720The same author, he admits in this paper, he's like, oh, yeah, I wrote another paper a couple
00:51:27.160of years ago saying that like obesity might shorten lifespan but that was only if we do
00:51:31.900nothing my actual projections for life expectancy in 2050 like i'm just assuming that like the
00:51:37.680the reductions in the death rates are going to continue i didn't do that in that previous paper
00:51:40.960good god it's like this totally counterfeit statistic that like even the people putting
00:51:46.300out like don't really believe in it i'm so frustrated by all of us michael it's also i
00:51:53.080mean also there's this thing of like american life expectancy is actually decreasing now
00:51:57.860but the decreases are almost all in like middle-aged white people and it's almost all because
00:52:03.540of drug overdoses it's like 70 000 overdoses a year opioids jesus christmas there's also like
00:52:09.420a lot of like liver cirrhosis and stuff and even in these papers about like white people are dying
00:52:15.260younger they're like yeah we looked into obesity and like yeah we just don't see it it's just wild
00:52:20.220how often you sort of read stuff and just on the face of it as a lay person it just doesn't hold
00:52:25.460water you know this is what really bugs me about this is that like you sort of expect the michael
00:52:30.400pollens of the world journalists to do this kind of thing like whatever i'm trying to raise
00:52:34.960awareness i need this paragraph in my story being like here's a bunch of scare statistics about
00:52:38.460obesity whatever we kind of expect that from journalists right but what we see here is like
00:52:43.540there's a pipeline of academic institutions that are producing numbers for exactly this purpose
00:52:49.500They are producing numbers so that it can show up in the Surgeon General's report, it can show up in media reports, it can go on the CDC website, whatever, to raise awareness of this, what they perceive to be a public health problem.
00:53:01.440And I think on some level, I get it, right?
00:53:04.180If you're a smoking tobacco researcher, if you're a climate change researcher, I get that you want to get science out there in a way that is going to inspire people to take action.
00:53:13.260But the problem is I think that this has like gotten away from people.
00:53:16.560but like they've kind of forgotten how many assumptions they're making they've forgotten
00:53:21.240how thin this correlation stuff is and they've forgotten that the purpose of all of this right
00:53:26.100if all of this raising awareness all of this is supposed to be for public health it's supposed
00:53:31.820to make people healthier right and what we see again and again in these studies and the way that
00:53:36.520these studies are covered in the media is that it's like we're giving up on public health so we
00:53:41.840can warn people about obesity we're giving up on public health so that we can call people fat0.94
00:53:46.540right and be like it's your own fault you're gross i think you're gross and it's your own fault and0.89
00:53:52.460you're gonna die and that's also your own fault right we are giving all of this up for what is0.98
00:53:57.540essentially like emotional satisfaction yeah it is a project that is designed to make thin people0.96
00:54:03.900feel better about their health right by using fat people as a morality tale right right i also think
00:54:10.020it allows public health institutions to find like one of the few things for which there is
00:54:16.060a case for personal responsibility or something that they see as an individual change,
00:54:21.500something that they can do something about. What I found in a lot of the research that I read for
00:54:27.440this was public health having like kind of an existential crisis over the last 40 years.
00:54:33.140A lot of our public health institutions are set up for communicable diseases, right? They're set
00:54:38.480up for things like, okay, there's like a Legionnaire's disease outbreak at some hotel in
00:54:42.920michigan and we got to fly a bunch of people out there we got to isolate we got to do contact
00:54:46.960tracing we got to figure this out tamp it down right like something acute whereas public health
00:54:52.520institutions when it comes to non-communicable diseases a lot of these institutions are really
00:54:57.480flailing because there isn't a lot that they have in their power to do like a lot of this stuff
00:55:02.820comes down to like weird esoteric shit like urban policy and housing policy and welfare tax policy0.73
00:55:09.900and all kinds of other stuff because a lot of these diseases are actually diseases of inequality.0.75
00:55:15.720As you said last episode, this gets very political very fast. And I don't think that
00:55:20.220institutions of public health and institutions of science and medicine, they're not set up to do
00:55:26.200these more holistic analyses of problems. And so I think that they have seized on obesity because
00:55:33.620it's one of the few things that they feel like they can control, even though they can't because
00:55:39.740none of these interventions work. But it's one of these things where they feel like,
00:55:43.060ah, okay, so we like we as a hospital can do a weight loss program, or we as an institution can
00:55:48.600give people like weight loss tips, or we can give out nutritional guidelines, dietary tips for
00:55:53.260Americans. It allows them not to deal with these like much thornier and much more difficult issues.
00:55:59.940Yeah, I mean, it's so frustrating, because we get so attached to having these cultural
00:56:07.140conversations about health in a vacuum as as if they are somehow uninfluenced by social
00:56:12.260or political or institutional dynamics. And actually, what the research shows and what the
00:56:18.620lived experience of marginalized people shows is that our sort of understandings of health are a
00:56:25.240direct result of those institutional and cultural and political factors, right? Right. That it is
00:56:30.520like a pretty straight line between what our institutions decide to do and the health outcomes
00:56:36.540of any given population, right? And it's so frustrating to have so many sort of conversations
00:56:43.320about this kind of stuff that are like, no, no, no, no, I just want to talk about the science.
00:56:46.780And it's like, buddy, you can't talk about the science without talking about the bias that is
00:56:50.900baked into the science. Sorry. Also, what, quote unquote, the science is showing you
00:56:56.080is that social issues play like a really significant role in who has access to what
00:57:02.500kind of care and when right like it's such a stubborn approach that we take another way to
00:57:07.680put it is that institutions of public health need to disinvest from weight stigma and reinvest in0.51
00:57:14.680brains god damn it michael we're going for a landmark two firings in one episode0.91
00:57:21.920i've been saving that for like 45 minutes0.98