The problem, as Goebelbecker highlights in the comment below, is that we socialize the risk and individualize the responsibility. Big corporations have an incentive to sell cheap, appealing food, and they have lobbying power and research dollars to get their products normalized. Dannon Almond Milk is listed as the #1 choice in the current Food Compass for dairy. That is sacrilege. The food supply is corrupted with sugar, vegetable oils, artificial flavorants, and refined grains. 92% of Americans have Metabolic Disorder. But if you go into the doctor, he -- who went to school for a decade and sees the product of unhealthy living and dysfunction go past him every day, people who place an onus on him for solutions - will lecture you on your lifestyle and responsibility, and blame you.
People don't feel like that blame is warranted. They're just eating food, like their neighbors. Their parents taught them that three square meals was important. But today, the system is structured to capture the lowest common denominator and give them a dopamine hit. Because food is comforting and represents safety, and because we internalize our past habits as being functional and keeping us alive, it's not easy to overhaul your diet. Trash food is normalized. So is being on multiple pharmaceutical interventions. Most things in the middle aisles of the store contain the same ingredients as I listed above, along with hydrolyzed soy protein, hydrogenated oils, and other things that the human animal has only been adapted to in the last few decades. Try stopping vegetable oil.
A weight loss pill is fine. It may work for some people, who also undertake to change their lifestyle. But this isn't a new solution. Weight loss drugs, from amphetamines to caffeine, have existed for decades and centuries. This is simply the newest one patented. The issue is a tragically unhealthy diet and mode of living that has become socially normalized and instantiated across the nation, and is spreading abroad.
All this talk of what is good for you, what is bad, cases that succeed with treatment and those that don't, obscures the issue. Generally what happens is we conflate smoke for fire. You go into the doc with some complaint. He discovers obesity, high blood pressure, or some risk factor. He places you on a medication, like a beta blocker, statin, or obesity drug. This is a warning sign that the stress being placed on your body is out of whack, that your lifestyle needs some intervention. That's the signal. The actual risk factor is diet, sedentary lifestyle, stress in unremitting doses, lack of love and meaning.
But doctors have limited ability to intervene in lifestyle. Moreover, adherence is a huge issue, with prescriptions as well as diet, so much so that Pharma is pushing monthly injections for many medications these days. People generally go back to their internal image. In the diet world, this is known as Set Point Theory. A vanishingly small number of people are successful, long-term, with large weight loss goals, according to the data. As humans, we generally approach a problem by trying to solve it and then returning to our normal realm of experience. So it's much easier, on so many levels, to take a pill, and look for a one-off solution, than to undergo the painful, slow process of discovery and transformation of our lives. So we treat the signal, the symptom, rather than the problem, the causes of disease.
With the markers of chronic illness, like insulin resistance and obesity, the warning sign being pointed to is our very activity itself, what we're trying to return to after we solve the problem. This makes treating lifestyle extraordinarily difficult, and it's something people must captain in their own lives. At the end of the day, we have adapted, well or poorly, to circumstances as they currently are. But it is necessary. A pharmaceutical intervention will never be a miracle pill, and the reason is simple: it treats the signal, not the reality.
What happens when you treat the signal instead of the reality? The problem runs unchecked. There are cases in which people use these drugs and also intervene successfully in lifestyle. There may be some short-term use for them. But expecting them to solve some societal level issue about quality of life is shockingly confused.
Your body is a finely tuned engine for survival and healing. It takes a lot of stressors, or a shocking paucity of needs (like food, shelter, engaged attention, love), to do us in. Because your body has all these self-regulating mechanisms that play off one another, a series of switches like a computer, sticking any of these switches to the "On" position is not going to long-term boost your capacity for healing. The great Human power of adaptation means that your body will just try to work around it. You'll acclimatize to it, as you did to your own insulin, and you'll fight to return to baseline.
Meanwhile, you're not getting any closer to eating a rich and healthful diet. Or getting stronger and more efficient on the weights or on the pavement. Or enjoying life more, facing bigger challenges, loving what you do and who you do it with.
Not only are these drugs a poor excuse for a solution from our technocratic priestly elite, that allows them to line their pockets while Americans get fatter, sicker, and more self-loathing, but they are actively evil, in the sense that to proffer a solution that hides the problem is to confuse the issue and create complicity in the problem itself, which kills more Americans and causes vastly more social ills than any school shooting or pandemic. Big Agra makes record profits, as does Pharma and biotech. They spend a ton on lobbying. There's a reason that the word "government" as become "governance" in many instances - because the ultra-powerful civilian elite, that makes up a huge portion of our GDP, donates to and owns NGOs, and has tight connections to academia, media, and regulatory bodies, wants an increasing share of power, power that they will use, as they have used it in the past, to enrich themselves at our expense.
Meanwile, I pray every day, I weigh 185 pounds and look great, I eat whole foods, and I've gotten pretty good at boxing. This has cost me precisely zero, except for opting for whole grain pasta instead of regular, or raisin bran instead of froot loops. I have a punching bag in the basement, a weighted backpack, and a pullup bar. A pinch of salt and ACV in the morning. My insulin is sensitive, my mind is clear, and my blood pressure is low normal. I simply do intermittent fasting and eat whole foods whenever possible. I save my sugar for dessert or sauces. Each of us that does this, that lives as an example, changes the basic reality of social normalization. I know guys who work tough jobs post triple-bypass, or with terminal prostate cancer. Guys in their 70s still working every day on metformin, eating ridiculously clean, except for sugar binges, and still with high fasted glucose.
Instead of confusing the issue, and fighting these battles for billion-dollar companies, if we come together in love, or simply take our own path and stick to it, it will show the possibility to others.
Then we can start to grapple with the question of internal self-image, eating for comfort, and self-punishment. This is why so many people return to their baseline levels, whether it's with drugs, with diet, with bad relationships: they learned to cope in these ways for reasons, and they're comfortable in those reasons. Learning new ways can be done, or else we simply resign ourselves to death. But it takes a willingness to try, and faith in the process. It takes freedom from past shame. It works best with a social environment of others keeping us honest, as the early Christians confessed their sins to one another, or as a gang-infested neighborhood tracks the reputation of its denizens. Finally, it takes concerned citizens lobbying to clearly label and communicate about ingredients like vegetable oil and sugar content.
I started Mounjaro in March for Type 2 diabetes. I couldn't deal with the side effects of Metformin, the more traditional medication (if that's the right term?) and needed something to help with my blood sugar.
I've lost 60 pounds, and my blood sugar numbers have never looked better. I've been able to ramp up my exercise (I was already cycling ~100 miles a week before I started,) and haven't dealt with any side effects.
I don't find the resistance to these medications difficult to understand at all. If they work, it means obesity is a medical issue, not a result of laziness or lack of self-control. That means you can't blame the person for being fat. It's not different from how people looked at psychiatry in the past.
This drug was intended to treat diabetes. During the clinical trials, it was observed that weight loss was an unintended side effect.
That finding does NOT turn obesity into a medical condition and being obese can be a precursor to other health issues.
People overeat for different reasons, they dont have the knowledge of healthy eating, they overeat to fill an emotional void, etc.
There are some medical issues that can make it harder to kee the weight off. Thyroid, PCOS but there are people that will totally blame their weight on these conditions, and it does not play that huge of a role, but ppl will be ppl.
There is one way to lose weight consistently and keep it off. How you work it is the personal journey.
You have to expend more calories than you take in.
I am enjoying the podcast overall, but I was frustrated by this first episode. Your presentation did not, in my view, do a great job at answering the question in the title. To me it seemed to present the Ozempic controversy as being between commonsense scientific consensus and angry fat activists who are against the existence of any weight loss drug for anyone. The latter, it seems to me, is a bit of a strawman. I feel like this was a missed opportunity to offer listeners a grounded and nuanced conversation about the complexities of the controversy. But what we got instead was an uncritical acceptance of what Paul Campos calls The Obesity Myth.
First off, your discussion framed the controversy as a simple debate about whether the existence of Ozempic as a weight-loss drug is good or bad. I’m not saying you invented this frame, but there are way more interesting dimensions to the controversy. For starters, there is a feeling of unpleasant déjà vu. The history of new wonder drugs promising to finally “fix” people’s bodies is not glorious. We’d all like to forget about Fen-Phen, especially those who foisted it on the world, but we must not forget the lesson: that our collective and irrational eagerness to eradicate fatness can put fat people at greater risk than the worst risks attributed to their weight.
Regarding the alleged risks of being in a larger body, the matter is not nearly so settled as is generally believed. To be clear, I’m not here to deny the risks of, say, having a BMI over 40. No serious people deny this. However, I think it would have been valuable to inform listeners about the factors that complicate the correlation between “obesity” and poor health outcomes, such as the evidence that people in larger bodies often receive crappy treatment from doctors. We need more reporting on weight bias in medical settings and how often this bias results in people having much needed treatment withheld or delayed. Plus, it is likely that a non-trivial portion of morbidity and mortality among “obese” people is due to them avoiding doctors because they know they’ll be fat-shamed and/or have their symptoms dismissed or misattributed to their weight.
The medical mistreatment of fat folks is not the only reason to be suspicious about the causal link between “obesity” and poor health. Anti-fat bias is obviously not limited doctors’ offices. People in larger bodies suffer overt discrimination in all areas of society. And we know that weight stigma can have real health impacts . Plus, people in larger bodies are routinely told to diet, despite the fact that dieting is known to not work over the long run. This leads to patterns of disordered eating and weight cycling, which very likely contribute to poor health outcomes.
I don’t see any conflict in acknowledging the risks of a very high BMI and recognizing that the “obesity epidemic” may be a moral panic. This seems like the most plausible way to understand the treatment of obesity researcher and epidemiologist Katherine Flegal.
In 2005, as a senior scientist for the CDC, Flegal published an article in JAMA, which, to no one’s surprise, reported excess all-cause mortality for individuals with BMI >= 35. However, the mortality rates for “obese” people overall were far lower than another CDC study from a year. Furthermore, the 2005 article reported mortality rates for those with BMI between 30 & 35 that were similar to “normal” BMI individuals. And, for those with BMI between 25 & 30 (so called “overweight”), the mortality rate was lower than for those with BMI under 18.5 (so-called “underweight”). This finding was surprising to some, but it was in line with existing literature.
The reaction, however, was swift and bizarrely reactionary. According to Flegal, her team’s research “became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer.” This campaign, which ConscieHealth characterized as “academic bullying,” was led by Harvard professor Walter Willett.
The fact that Willett chose to use his social power and media connections to attack Flegal, rather than engage with her research through scientific channels, suggests that his motivations were more ideological than scientific. Indeed, he was open about the fact that his real concern was to ensure that the public not get the “dangerous” message that being even a little bit fat is OK. His actions earned him a rebuke from the journal Nature (see Nature article here). Meanwhile, Flegal’s 2005 article and her follow-up review and meta-analysis published in 2013 have been thoroughly vindicated and highly cited by the obesity research community.
I suspect that the Flegal debacle would have been exceedingly unlikely without the deeply entrenched fat antagonism that prevails at all levels of our society. This worldview makes it easy to believe, without good evidence, that, since being extremely fat is unhealthy, being a little fat has to be a little unhealthy. But that’s not science. That is the logic of stigma. This sort of moral panicky thinking can lead to treatments that are worse than the disease. This is precisely why it makes sense to be suspect about claims made for weight loss remedies.
Clearly the Ozempic controversy goes way beyond “is it good or bad.” I welcome the arrival of drugs like Ozempic to the extent they can reduce, not weight, but actual risk factors for disease. I also welcome them to the extent that they can facilitate, not sideline, conversations about fat antagonism, weight discrimination, disordered eating, and diet culture in general.
Hahaha -- Sounds like preliminary assumptions may have been correct. Don't know if you saw my comment, but this is what I mentioned:
"Disclaimer: I haven't listened to the episode yet, but was the loss of muscle mass touched on? This is a side effect that, yes you lose weight, but you also lose muscle mass as well. Unsure if many are aware of that. Yahoo also reported on the effects on the stomach seen here as well: https://www.yahoo.com/lifestyle/ozempic-users-report-stomach-paralysis-215028573.html
Another aspect that I don't know if discussed on the was the rise in tumors shown in rodents.
Again, these drugs are effective, but are they worth it due to the side effect profile? This is something that needs to be discussed. "
Thanks for the episode! If you are looking for related topic suggestions I would enjoy a dive into intermittent (sometimes called time-restricted eating) and extended/multi-day fasting for weight loss. I think the general public has a very negative view of this method of weight loss so could be interesting to see if there is actually any good evidence for or against it. Anecdotally I have used several week-long water fasts (no caloric intake, only electrolytes and flavors/caffeine) to aggressively lose body fat without a noticeable loss in muscle mass or strength. I have read that this is due to hormonal changes (HGH, adrenaline, cortisol, insulin, etc) during the fast but haven't looked deeply into the evidence behind this.
"Stating the problem with obesity is that society doesn't appreciate obesity is nuts."
Also:
"The problem with managing the climate is that society won't appreciate limiting growth and, potentially, accepting degrowth."
Quite a peculiar position to hold. One might say tenable. I know I would appreciate someone pointing out my own hypocrises, so here's mine to you two: that's hypocrisy.
Stuart, I loved the audiobook of Science Fictions. Thank you for reading it for the version that I have.
So in 2014, i finally hir a point where i was able to be physical and started being more active.
I evntually got down to 215. That may sound like i still weigh a lot, to whover reads this. I dint care what rhe hell other people think, never have, i dont get my validation from others.
Hell they may go home and kick the dog or idk.
My upper arms have loose skin AND IT DOES BOTHER me. It keeps me from wearing some shirts, bc the arms dont fit. And i guarantee both of you, that each arms loose skin weighs about 5lbs
Do either one of you know what the chub rub is? Its that area on the inside of a thigh. The struggle with the chub rub is real.
I adked my doctor to figure out a way to write it so that insurance would cover something. She had zilch.
I had lost weight when i was in the hospital in 07. And because of stepids and my inability to feed that hole i out weight back on. I didnt ger snywhere near where ii was.
I tell this fir background.
You men had some audacity to sir and critique bring over weight, then voicing how nasty the extra skin looks when fat people lose weight.
Now i had lost weight slowly and things were fine. But after being on high doses of steriods, that weight did not come on in a normal wau nor did it come off as smooth as before.
Ive been told that i should not write such long cimmrnte or messages. So long story short, i was asking everyone in white, whether it was a sweater, jacket, shirt, i would wave them over and ask thrm very seriously, "why are yall trying to murder me?" The staff (remember this was my 3rd time) thought i was being funny. .
This is for the scietific writers, voices on the podcasts..
I gained weight in my 20's, 30's as i went from dr to dr, bc something was wrong with me, however, these doctors kepr telling me that could not find anything. (as is often the case with women. Long story short i got where i couldnt be as active bc i was in pain, the weight started coming on and my top weight was 319.
In 08, i was disgnosed with Lupus, this after spending 2 months in a local hospital (52 days of that in ICU)
So after that, it was decided that my hop needed replacing. It was worn out. They blamed Lupus for that also.smh.
I did that to go to nursing school and be physically able to keep up.1st wentnbad, they blsned Lupus, i dmsaid someone didnt wash their hands. 2nd surgery, 6 weeks of antibiotics. Went to appointment, dr pulled off a small circular bandaid. I almost bles out in the office. Crazy.
So they come 200 yards w ambulance and they transport me to hospital. I spent 2 monrhs there that visit, kidneys quit, u had MRSA & VRSA.
Disclaimer: I haven't listened to the episode yet, but was the loss of muscle mass touched on? This is a side effect that, yes you lose weight, but you also lose muscle mass as well. Unsure if many are aware of that. Yahoo also reported on the effects on the stomach seen here as well: https://www.yahoo.com/lifestyle/ozempic-users-report-stomach-paralysis-215028573.html
Another aspect that I don't know if discussed on the was the rise in tumors shown in rodents.
Again, these drugs are effective, but are they worth it due to the side effect profile? This is something that needs to be discussed.
So, AS I UNDERSTAND IT, Google Podcasts takes a few days to scrape from Apple and we only put the RSS feed on Apple last night, so it should be there soon. But we'll keep an eye on it. In the meantime I know it's on Spotify and Overcast and Apple itself. Sorry about the delay!
wait, that might not work: I got it because I put the RSS feed into Google Podcasts so maybe it only works for me. So here's the RSS link and you can probably do it yourself: https://api.substack.com/feed/podcast/1757214.rss
Since you mentioned it, yes please do an episode on the classist voodoo that is "ultra-processed food".
On Ozempic and Obesity Drugs:
The problem, as Goebelbecker highlights in the comment below, is that we socialize the risk and individualize the responsibility. Big corporations have an incentive to sell cheap, appealing food, and they have lobbying power and research dollars to get their products normalized. Dannon Almond Milk is listed as the #1 choice in the current Food Compass for dairy. That is sacrilege. The food supply is corrupted with sugar, vegetable oils, artificial flavorants, and refined grains. 92% of Americans have Metabolic Disorder. But if you go into the doctor, he -- who went to school for a decade and sees the product of unhealthy living and dysfunction go past him every day, people who place an onus on him for solutions - will lecture you on your lifestyle and responsibility, and blame you.
People don't feel like that blame is warranted. They're just eating food, like their neighbors. Their parents taught them that three square meals was important. But today, the system is structured to capture the lowest common denominator and give them a dopamine hit. Because food is comforting and represents safety, and because we internalize our past habits as being functional and keeping us alive, it's not easy to overhaul your diet. Trash food is normalized. So is being on multiple pharmaceutical interventions. Most things in the middle aisles of the store contain the same ingredients as I listed above, along with hydrolyzed soy protein, hydrogenated oils, and other things that the human animal has only been adapted to in the last few decades. Try stopping vegetable oil.
A weight loss pill is fine. It may work for some people, who also undertake to change their lifestyle. But this isn't a new solution. Weight loss drugs, from amphetamines to caffeine, have existed for decades and centuries. This is simply the newest one patented. The issue is a tragically unhealthy diet and mode of living that has become socially normalized and instantiated across the nation, and is spreading abroad.
All this talk of what is good for you, what is bad, cases that succeed with treatment and those that don't, obscures the issue. Generally what happens is we conflate smoke for fire. You go into the doc with some complaint. He discovers obesity, high blood pressure, or some risk factor. He places you on a medication, like a beta blocker, statin, or obesity drug. This is a warning sign that the stress being placed on your body is out of whack, that your lifestyle needs some intervention. That's the signal. The actual risk factor is diet, sedentary lifestyle, stress in unremitting doses, lack of love and meaning.
But doctors have limited ability to intervene in lifestyle. Moreover, adherence is a huge issue, with prescriptions as well as diet, so much so that Pharma is pushing monthly injections for many medications these days. People generally go back to their internal image. In the diet world, this is known as Set Point Theory. A vanishingly small number of people are successful, long-term, with large weight loss goals, according to the data. As humans, we generally approach a problem by trying to solve it and then returning to our normal realm of experience. So it's much easier, on so many levels, to take a pill, and look for a one-off solution, than to undergo the painful, slow process of discovery and transformation of our lives. So we treat the signal, the symptom, rather than the problem, the causes of disease.
With the markers of chronic illness, like insulin resistance and obesity, the warning sign being pointed to is our very activity itself, what we're trying to return to after we solve the problem. This makes treating lifestyle extraordinarily difficult, and it's something people must captain in their own lives. At the end of the day, we have adapted, well or poorly, to circumstances as they currently are. But it is necessary. A pharmaceutical intervention will never be a miracle pill, and the reason is simple: it treats the signal, not the reality.
What happens when you treat the signal instead of the reality? The problem runs unchecked. There are cases in which people use these drugs and also intervene successfully in lifestyle. There may be some short-term use for them. But expecting them to solve some societal level issue about quality of life is shockingly confused.
Your body is a finely tuned engine for survival and healing. It takes a lot of stressors, or a shocking paucity of needs (like food, shelter, engaged attention, love), to do us in. Because your body has all these self-regulating mechanisms that play off one another, a series of switches like a computer, sticking any of these switches to the "On" position is not going to long-term boost your capacity for healing. The great Human power of adaptation means that your body will just try to work around it. You'll acclimatize to it, as you did to your own insulin, and you'll fight to return to baseline.
Meanwhile, you're not getting any closer to eating a rich and healthful diet. Or getting stronger and more efficient on the weights or on the pavement. Or enjoying life more, facing bigger challenges, loving what you do and who you do it with.
Not only are these drugs a poor excuse for a solution from our technocratic priestly elite, that allows them to line their pockets while Americans get fatter, sicker, and more self-loathing, but they are actively evil, in the sense that to proffer a solution that hides the problem is to confuse the issue and create complicity in the problem itself, which kills more Americans and causes vastly more social ills than any school shooting or pandemic. Big Agra makes record profits, as does Pharma and biotech. They spend a ton on lobbying. There's a reason that the word "government" as become "governance" in many instances - because the ultra-powerful civilian elite, that makes up a huge portion of our GDP, donates to and owns NGOs, and has tight connections to academia, media, and regulatory bodies, wants an increasing share of power, power that they will use, as they have used it in the past, to enrich themselves at our expense.
Meanwile, I pray every day, I weigh 185 pounds and look great, I eat whole foods, and I've gotten pretty good at boxing. This has cost me precisely zero, except for opting for whole grain pasta instead of regular, or raisin bran instead of froot loops. I have a punching bag in the basement, a weighted backpack, and a pullup bar. A pinch of salt and ACV in the morning. My insulin is sensitive, my mind is clear, and my blood pressure is low normal. I simply do intermittent fasting and eat whole foods whenever possible. I save my sugar for dessert or sauces. Each of us that does this, that lives as an example, changes the basic reality of social normalization. I know guys who work tough jobs post triple-bypass, or with terminal prostate cancer. Guys in their 70s still working every day on metformin, eating ridiculously clean, except for sugar binges, and still with high fasted glucose.
Instead of confusing the issue, and fighting these battles for billion-dollar companies, if we come together in love, or simply take our own path and stick to it, it will show the possibility to others.
Then we can start to grapple with the question of internal self-image, eating for comfort, and self-punishment. This is why so many people return to their baseline levels, whether it's with drugs, with diet, with bad relationships: they learned to cope in these ways for reasons, and they're comfortable in those reasons. Learning new ways can be done, or else we simply resign ourselves to death. But it takes a willingness to try, and faith in the process. It takes freedom from past shame. It works best with a social environment of others keeping us honest, as the early Christians confessed their sins to one another, or as a gang-infested neighborhood tracks the reputation of its denizens. Finally, it takes concerned citizens lobbying to clearly label and communicate about ingredients like vegetable oil and sugar content.
God bless, my friends.
I started Mounjaro in March for Type 2 diabetes. I couldn't deal with the side effects of Metformin, the more traditional medication (if that's the right term?) and needed something to help with my blood sugar.
I've lost 60 pounds, and my blood sugar numbers have never looked better. I've been able to ramp up my exercise (I was already cycling ~100 miles a week before I started,) and haven't dealt with any side effects.
I don't find the resistance to these medications difficult to understand at all. If they work, it means obesity is a medical issue, not a result of laziness or lack of self-control. That means you can't blame the person for being fat. It's not different from how people looked at psychiatry in the past.
This drug was intended to treat diabetes. During the clinical trials, it was observed that weight loss was an unintended side effect.
That finding does NOT turn obesity into a medical condition and being obese can be a precursor to other health issues.
People overeat for different reasons, they dont have the knowledge of healthy eating, they overeat to fill an emotional void, etc.
There are some medical issues that can make it harder to kee the weight off. Thyroid, PCOS but there are people that will totally blame their weight on these conditions, and it does not play that huge of a role, but ppl will be ppl.
There is one way to lose weight consistently and keep it off. How you work it is the personal journey.
You have to expend more calories than you take in.
Thanks for illustrating my point so well.
Any chance we could get a transcript? I'm interested in the topic but hearing impaired.
Thank you for your consideration.
I am enjoying the podcast overall, but I was frustrated by this first episode. Your presentation did not, in my view, do a great job at answering the question in the title. To me it seemed to present the Ozempic controversy as being between commonsense scientific consensus and angry fat activists who are against the existence of any weight loss drug for anyone. The latter, it seems to me, is a bit of a strawman. I feel like this was a missed opportunity to offer listeners a grounded and nuanced conversation about the complexities of the controversy. But what we got instead was an uncritical acceptance of what Paul Campos calls The Obesity Myth.
First off, your discussion framed the controversy as a simple debate about whether the existence of Ozempic as a weight-loss drug is good or bad. I’m not saying you invented this frame, but there are way more interesting dimensions to the controversy. For starters, there is a feeling of unpleasant déjà vu. The history of new wonder drugs promising to finally “fix” people’s bodies is not glorious. We’d all like to forget about Fen-Phen, especially those who foisted it on the world, but we must not forget the lesson: that our collective and irrational eagerness to eradicate fatness can put fat people at greater risk than the worst risks attributed to their weight.
Regarding the alleged risks of being in a larger body, the matter is not nearly so settled as is generally believed. To be clear, I’m not here to deny the risks of, say, having a BMI over 40. No serious people deny this. However, I think it would have been valuable to inform listeners about the factors that complicate the correlation between “obesity” and poor health outcomes, such as the evidence that people in larger bodies often receive crappy treatment from doctors. We need more reporting on weight bias in medical settings and how often this bias results in people having much needed treatment withheld or delayed. Plus, it is likely that a non-trivial portion of morbidity and mortality among “obese” people is due to them avoiding doctors because they know they’ll be fat-shamed and/or have their symptoms dismissed or misattributed to their weight.
The medical mistreatment of fat folks is not the only reason to be suspicious about the causal link between “obesity” and poor health. Anti-fat bias is obviously not limited doctors’ offices. People in larger bodies suffer overt discrimination in all areas of society. And we know that weight stigma can have real health impacts . Plus, people in larger bodies are routinely told to diet, despite the fact that dieting is known to not work over the long run. This leads to patterns of disordered eating and weight cycling, which very likely contribute to poor health outcomes.
I don’t see any conflict in acknowledging the risks of a very high BMI and recognizing that the “obesity epidemic” may be a moral panic. This seems like the most plausible way to understand the treatment of obesity researcher and epidemiologist Katherine Flegal.
In 2005, as a senior scientist for the CDC, Flegal published an article in JAMA, which, to no one’s surprise, reported excess all-cause mortality for individuals with BMI >= 35. However, the mortality rates for “obese” people overall were far lower than another CDC study from a year. Furthermore, the 2005 article reported mortality rates for those with BMI between 30 & 35 that were similar to “normal” BMI individuals. And, for those with BMI between 25 & 30 (so called “overweight”), the mortality rate was lower than for those with BMI under 18.5 (so-called “underweight”). This finding was surprising to some, but it was in line with existing literature.
The reaction, however, was swift and bizarrely reactionary. According to Flegal, her team’s research “became the target of an aggressive campaign that included insults, errors, misinformation, social media posts, behind-the-scenes gossip and maneuvers, and complaints to her employer.” This campaign, which ConscieHealth characterized as “academic bullying,” was led by Harvard professor Walter Willett.
The fact that Willett chose to use his social power and media connections to attack Flegal, rather than engage with her research through scientific channels, suggests that his motivations were more ideological than scientific. Indeed, he was open about the fact that his real concern was to ensure that the public not get the “dangerous” message that being even a little bit fat is OK. His actions earned him a rebuke from the journal Nature (see Nature article here). Meanwhile, Flegal’s 2005 article and her follow-up review and meta-analysis published in 2013 have been thoroughly vindicated and highly cited by the obesity research community.
I suspect that the Flegal debacle would have been exceedingly unlikely without the deeply entrenched fat antagonism that prevails at all levels of our society. This worldview makes it easy to believe, without good evidence, that, since being extremely fat is unhealthy, being a little fat has to be a little unhealthy. But that’s not science. That is the logic of stigma. This sort of moral panicky thinking can lead to treatments that are worse than the disease. This is precisely why it makes sense to be suspect about claims made for weight loss remedies.
Clearly the Ozempic controversy goes way beyond “is it good or bad.” I welcome the arrival of drugs like Ozempic to the extent they can reduce, not weight, but actual risk factors for disease. I also welcome them to the extent that they can facilitate, not sideline, conversations about fat antagonism, weight discrimination, disordered eating, and diet culture in general.
Lots of generalizations in this podcast. You sound like pimps for the pharma industry. I don’t consider this solid journalism.
Hahaha -- Sounds like preliminary assumptions may have been correct. Don't know if you saw my comment, but this is what I mentioned:
"Disclaimer: I haven't listened to the episode yet, but was the loss of muscle mass touched on? This is a side effect that, yes you lose weight, but you also lose muscle mass as well. Unsure if many are aware of that. Yahoo also reported on the effects on the stomach seen here as well: https://www.yahoo.com/lifestyle/ozempic-users-report-stomach-paralysis-215028573.html
Another aspect that I don't know if discussed on the was the rise in tumors shown in rodents.
Again, these drugs are effective, but are they worth it due to the side effect profile? This is something that needs to be discussed. "
Thanks for the episode! If you are looking for related topic suggestions I would enjoy a dive into intermittent (sometimes called time-restricted eating) and extended/multi-day fasting for weight loss. I think the general public has a very negative view of this method of weight loss so could be interesting to see if there is actually any good evidence for or against it. Anecdotally I have used several week-long water fasts (no caloric intake, only electrolytes and flavors/caffeine) to aggressively lose body fat without a noticeable loss in muscle mass or strength. I have read that this is due to hormonal changes (HGH, adrenaline, cortisol, insulin, etc) during the fast but haven't looked deeply into the evidence behind this.
So you do without water for how long?!
Really good episode, and absolutely right too.
No idea what the guardian are on with their anti-semaglutide campaign but they are being twats.
thank you!
"Stating the problem with obesity is that society doesn't appreciate obesity is nuts."
Also:
"The problem with managing the climate is that society won't appreciate limiting growth and, potentially, accepting degrowth."
Quite a peculiar position to hold. One might say tenable. I know I would appreciate someone pointing out my own hypocrises, so here's mine to you two: that's hypocrisy.
Stuart, I loved the audiobook of Science Fictions. Thank you for reading it for the version that I have.
So in 2014, i finally hir a point where i was able to be physical and started being more active.
I evntually got down to 215. That may sound like i still weigh a lot, to whover reads this. I dint care what rhe hell other people think, never have, i dont get my validation from others.
Hell they may go home and kick the dog or idk.
My upper arms have loose skin AND IT DOES BOTHER me. It keeps me from wearing some shirts, bc the arms dont fit. And i guarantee both of you, that each arms loose skin weighs about 5lbs
Do either one of you know what the chub rub is? Its that area on the inside of a thigh. The struggle with the chub rub is real.
I adked my doctor to figure out a way to write it so that insurance would cover something. She had zilch.
I had lost weight when i was in the hospital in 07. And because of stepids and my inability to feed that hole i out weight back on. I didnt ger snywhere near where ii was.
I tell this fir background.
You men had some audacity to sir and critique bring over weight, then voicing how nasty the extra skin looks when fat people lose weight.
Now i had lost weight slowly and things were fine. But after being on high doses of steriods, that weight did not come on in a normal wau nor did it come off as smooth as before.
Ive been told that i should not write such long cimmrnte or messages. So long story short, i was asking everyone in white, whether it was a sweater, jacket, shirt, i would wave them over and ask thrm very seriously, "why are yall trying to murder me?" The staff (remember this was my 3rd time) thought i was being funny. .
This is for the scietific writers, voices on the podcasts..
I gained weight in my 20's, 30's as i went from dr to dr, bc something was wrong with me, however, these doctors kepr telling me that could not find anything. (as is often the case with women. Long story short i got where i couldnt be as active bc i was in pain, the weight started coming on and my top weight was 319.
In 08, i was disgnosed with Lupus, this after spending 2 months in a local hospital (52 days of that in ICU)
So after that, it was decided that my hop needed replacing. It was worn out. They blamed Lupus for that also.smh.
I did that to go to nursing school and be physically able to keep up.1st wentnbad, they blsned Lupus, i dmsaid someone didnt wash their hands. 2nd surgery, 6 weeks of antibiotics. Went to appointment, dr pulled off a small circular bandaid. I almost bles out in the office. Crazy.
So they come 200 yards w ambulance and they transport me to hospital. I spent 2 monrhs there that visit, kidneys quit, u had MRSA & VRSA.
Disclaimer: I haven't listened to the episode yet, but was the loss of muscle mass touched on? This is a side effect that, yes you lose weight, but you also lose muscle mass as well. Unsure if many are aware of that. Yahoo also reported on the effects on the stomach seen here as well: https://www.yahoo.com/lifestyle/ozempic-users-report-stomach-paralysis-215028573.html
Another aspect that I don't know if discussed on the was the rise in tumors shown in rodents.
Again, these drugs are effective, but are they worth it due to the side effect profile? This is something that needs to be discussed.
Hi Franklin. Cancer risk and muscle loss are indeed discussed in the episode, as are several anecdotally reported side effects.
Thanks for this and the response as well :) !
Can’t see it on Google Podcasts. Is there a link?
So, AS I UNDERSTAND IT, Google Podcasts takes a few days to scrape from Apple and we only put the RSS feed on Apple last night, so it should be there soon. But we'll keep an eye on it. In the meantime I know it's on Spotify and Overcast and Apple itself. Sorry about the delay!
Thank you!
Found it! You can't fault the service around here, at least https://podcasts.google.com/feed/aHR0cHM6Ly9hcGkuc3Vic3RhY2suY29tL2ZlZWQvcG9kY2FzdC8xNzU3MjE0LnJzcw/episode/c3Vic3RhY2s6cG9zdDoxMzQ3ODY4NTE?sa=X&ved=0CAUQkfYCahcKEwjA2PyH56mAAxUAAAAAHQAAAAAQQg
wait, that might not work: I got it because I put the RSS feed into Google Podcasts so maybe it only works for me. So here's the RSS link and you can probably do it yourself: https://api.substack.com/feed/podcast/1757214.rss
Thank you Tom that worked.
all part of the service, sir