Maintenance Phase - The Body Mass Index

Episode Date: August 3, 2021

The BMI is EVERYWHERE. But is it scientific or scientif-ish? While many Americans think of the body mass index as an objective measure of health, its history reveals a more complicated story. This week, Mike and Aubrey tackle the first in a two-part series about the BMI and the “Obesity Epidemic.” Along the way they visit 18th century Belgium, learn a gross new acronym and dissect Dracula's facial features. LINKS!:The Bizarre and Racist History of the BMI (Elemental) Adolphe Quetelet, Social Physics, and the Average Men of Science, 1796-1874 (University of Pittsburgh Press)Mindful of eugenics’ dark history, researchers are reexamining the genetics of social mobility (Quartz) Adolphe Quetelet (1796–1874)—the average man and indices of obesity (Nephrology Dialysis Transplantation)For Researchers on Obesity: Historical Review of Extra Body Weight Definitions (Obesity)Quetelet, Adolphe (Canada’s Eugenics Archives)Top 10 Reasons Why The BMI Is Bogus (NPR)The False Science Linking Body Shape to Personality (The Atlantic)Obesity task force linked to WHO takes “millions” from drug firms (The BMJ)Impact of weight bias and stigma on quality of care and outcomes for patients with obesity (Obesity Reviews) Support the show

We're ready. I think you're up on intro, yeah? This one might be kind of offensive. Sorry, in advance. Welcome to Maintenance Phase. The podcast that is just right between 20 and 25 too long, between 25 and 30 and morbidly too long, between 30 to 35. Oh God, I just wanna make the tagline of our podcast just permanently like the podcast that is morbidly too long. When you apply morbidly to anything else, you see how shitty it is.

Yeah, describe another person as morbidly anything and see how that goes. It's not going to be great. I am Michael Hobbs. I am Aubrey Gordon. And if you want to support the show, we are on Patreon at patreon.com slash maintenance phase, where you can listen to our adorable bonus episodes about things like Megan and Harry and the bachelor, or you can buy t-shirts or just give us money for no reason or do none of that and just continue listening quietly. That's right. So today, Mike, we are gonna talk about the body mass index,

better known as the BMI. Dude, I'm so excited. I am really excited too. We did a whole episode on Bommos stuff and now we're doing one on Beamy stuff. Beamy. You know? So I am curious, Mike, what kind of role would you say the BMI has played in your life?

How does it show up for you? Oh, man. I mean, as a guy who sort of presents as quote unquote normal on the BMI, I think it doesn't play much of a role at all. I actually went to the doctor's office a couple of months ago and they asked to weigh me and I was like, oh, I prefer not to be weighed. And I was ready to have a big fight about it,

be like, this is ridiculous, it's not related to health, blah, blah, blah. And they were like, okay. Yeah, hopefully that means that doctors' offices are becoming more chill about this. But I think it also means that he's a thin guy and we don't need to weigh him. I think that's obviously playing into it too.

Right, it only applies to bodies that we sort of deem deviant in their size, absolutely. And then we start to care. Yep, and then we start to care. And that applies to underweight people, and it applies really, really prominently to people who are, quote unquote, overweight. I hope we mostly focus on skinny shaming in this episode.

I think somebody has to. You know, it's my wheelhouse, Mike. I know, you love it. It's your number one issue. So the BMI is a simple calculation. It is your weight in kilograms divided by your height in meters squared. It doesn't measure muscle mass or body fat or build or age

or anything else. It is truly just like your weight divided by your height, the end. And in many sort of medical systems around the country and around the world, it has become central to accessing medical care. And as we will learn today, its history is absolutely not as a tried and true medical tool. Shocking twist.

I've spent the last couple weeks actually reading about your books about race and IQ and this whole nightmare of an academic field. And I don't know much about the history of the BMI, but I do think that basically any scientific effort to boil a complex phenomenon such as health or intelligence down to one number is just like pre-doomed. Like it's just always a bad idea.

Well, and it's always a bad idea to try and boil all that stuff down into one measure. And it's an extra fucking bad idea when we only ever put white people in charge. Right? Because what happens with the BMI, what happens with IQ tests, all of that stuff that sort of came to be in the 1800s and early 1900s, is that whether or not they said that that was what they were doing, what white people were functionally doing,

is looking for reasons to prove that we were, like, quote unquote, genetically superior. Yes, I do think that if you come up with a system of ranking humans on like their inherent worth and you end up on the top of it, we just need to have a little bit more skepticism of any system that has that output. Like, it's like me coming up with some sort of system of ranking, like how good all the names are in America. Like people named Jeff Suck and people named David are just trash and like, people named Mike are just great.

I came up with this objective system and everybody named David are just trash and like, whoops, people named Mike are just great. I came up with this objective system and everybody named Mike is cool. You'd be like, mm, Mike, I don't know. Right, sorry guys, I don't make the rules. I just absolutely make the rules. All we're doing is science here, guys. Oops, see, Daisy, yeah, that's right, that's right. So I actually wrote about the history of the BMI

a couple years ago, you were talking about this piece. Yeah, I love the base. Part of what's happened with that piece is that it's gotten very popular, which is wonderful, but it's also gone through the giant game of telephone that is the internet. Oh no. So when people talk about that piece now,

they're like the inventor of the BMI was the head of the eugenics movement. And I'm like, no, he for sure wasn't. Right, that like people are sort of like so insensed at the history, which totally makes sense, that they start to ascribe intent to the history, that as we'll talk about just isn't really documented. That doesn't know it wasn't there,

but it isn't really documented anywhere. And I actually think it's much more interesting and telling that what we have is a history full of people who didn't think they were doing anything discriminatory and created like one of the wildest worst and most ubiquitous pieces of science that we all hear about all the time. And also that can sound like a defense,

like they were doing their best, but it's like if you want to prevent this from happening in the future, you do have to actually understand like how it happened and like getting into the nuances of it. Totally. And you and I are both white people, right, who sort of like think and talk about race in the course of our work. And I think it's a really meaningful and instructive thing to look at this history where again, all of these white people thought they were helping. I think it feels much more instructive to me as a white person to go,

you know what, even when I think I'm helping, I might be hurting. Yeah, exactly. Well, should we dive on in? Let's do it. Okay, so our story begins in Gent in 1796, or in Belgium before it was Belgium. Oh, yeah. In 1796 in Gent, this guy was born who was named Adolf Kutley.

Not a lot of Adolf to run around these days. He was not a healthcare provider of any kind, not a medical researcher of any kind. His work otherwise did not revolve around the human body at all. It revolved way more around astronomy and around statistics and around analyzing state data. And he's a guy who's very interested in describing the world as it is.

He wants to figure out why the world works the way that it is and articulate that. This is like Chekhov's scientist. He's like, is that looking at this guy? Is he not trying to do any harm? He's interested in like describing the world and like maybe coming up with some like measurement systems. Of Mike, I just really appreciate that anytime I try to like structure a twist into a story,

you're like, no, I can tell what you're doing. The good guy, scientist, doing his best. I wonder what will happen. I mean, I think more than anything, he's described as a bureaucrat and a sort of population analysis kind of guy. It is worth noting that his work happens against the backdrop of a major civil war

that becomes the Belgian Revolution. All right. And what he wants to do while Belgium is sort of working toward its independence, is to put Belgium on the intellectual map. There is this sense amongst Belgian academics that the Enlightenment happened and sort of passed them by. And so Kudley kind of decides that he's going to be the guy.

Never underestimate the importance of like, dude insecurities. Maybe going a little too fast and like cutting some corners. So he starts working on these really big swings kind of academically. His biggest project is something that he calls social physics. Is this something that you've heard about at all, Mike? Social physics, no. He's essentially looking at data sets

and analyzing data sets about people and is trying to look for sort of social quote unquote laws that kind of mimic the laws of physics. So something like if you eat off of smaller plates you'll eat 30% less water type. His findings are actually better than Brian Watzings. Okay, not saying much, but you know. So he writes quite a bit at this time about he wants to figure out how to measure acts of like courage and heroism. He wants to measure acts of cowardice and malice and all of these different things. But he's like one dude and how the fuck do you measure courage at a population level, right? So he doesn't have the infrastructure to pull all that off.

So he starts analyzing state gathered data sets. And those are things that are way more boring, frankly, like birth rates and death rates and marriages and height and weight as a term. Or without. This was all part for him of finding his idealized kind of average man. That average man was defined mathematically

absolutely as sort of like the center of a bell curve, no question, but it was also an ideal. In his mind, the average was what everyone should aspire to and we should have more sort of homogeneity, we should have more sort of like aspiring to normalcy. He actually says at one point, quote, if the average man were completely determined, we might consider him as the type of perfection

and everything differing from his proportion or condition would constitute deformity or disease or monstrosity. So what's like the output of this? So you find stuff like death rates are highest in February It's looking at birth rates and figuring out when those are highest and lowest and stuff like that So what he's looking for again is some kind of pattern that's like, aha Here's a secret, you know key to understanding the human condition weird and that is what leads him to creation of what we later come to know as the BMI.

He's trying to build the case for this idea of social physics, the sort of like laws of human behavior kind of stuff. And he's using whatever state gathered data he can get his hands on. And one of those data sets is height and weight data from France and Scotland. Okay. and weight data from France and Scotland. Those data sets are made up exclusively of men, exclusively of white people. He analyzes this data, he plots it out, he finds a bell curve, and this whole process

and sort of the output of it is called Kutlé's index. He envisions the index being used by the state to help predict the size and shape of the population as a whole. And he's actually very clear at the time that the BMI is not to be used for individual diagnosis or treatment or assessment. He's like, this is a population level tool.

Do not try to use it on individuals. It's not gonna work, it doesn't make sense. Right. So he basically has this index of like, the average French and Scottish person has like, this ratio between their height and their weight. Yeah. It's like plotting out like, the average length of people's arms to like their average shoe size.

It's like, there's a ratio and like, it differs between people, whatever. Totally, and this was sort of like a footnote in his work around social physics at the time. It was not the main event, and it was, his work did generate controversy and did generate interest and debate, but it was not about the BMI.

It was about social physics. A bunch of his contemporaries were like, I don't like this because we have free will. Right. So why would there be laws that govern human behavior? We govern human behavior. How dare you? I mean, in their defense, it is a very dumb idea.

Social physics. It seems totally assin' on you. Yeah, it's not great. It's not a worthwhile endeavor. The trick here, this is where it gets like a little sticky, after he dies, his work gets picked up by some pretty unsavory characters. So Mike, I'm gonna I'm gonna ask if you're familiar with a movement called Eugenics. Oh

A little bit familiar, especially after all my reading last couple weeks. Yeah, totally. I mean, this is the idea that basically humans are like livestock in that there are some humans that are superior to others, and we can basically make the human population more superior over time by encouraging breeding among the good ones and discouraging breeding among the bad ones. So eugenics refers to the bettering of the human population over time, and then dysgenics is the opposite, is this idea that human societies are declining

because like the stupid people and like the racial minorities are procreating more than like their social betters is basically the theory, right? Right, it's a idiocracy. I feel compelled to point out that like this is total fucking nonsense. Evolution does not happen on these timescales. Like it's a complete fallacy to think that like,

you know, since the 1950s, higher birth rates among poor people like mean anything. So just like as a scientific endeavor, it's just complete trash. I mean, I think it also, it feels worth mentioning that it wasn't just the discouragement of procreation amongst quote unquote undesirable groups of people. There were many many state apparatuses focused on forced sterilization of people of color, of immigrants, of autistic people, of people with developmental disabilities, of sex workers.

This is actually where we get the term moron. It was an official range of IQ scores. And if someone was declared legally to be a moron, they would be forcibly sterilized. Yeah, it's really bad. I think the thing to know about sort of what happens with Kutley's work is that it gets picked up by this guy, Francis Gaulten, is that someone you've come across in your research?

No, no, no. Gaulten was sort of a leader in scientific racism. He was a major, major vocal proponent of Eugenics. He was knighted for his contributions to the Eugenics movement. Sir Eugenics. That's right. He's also a big believer in social Darwinism,

which is perhaps unsurprising because do you want to know who his cousin was? Was it Charles Darwin? Yes, it was. So Darwin has a problematic cousin just like everybody else. Totally. So there is a quote from Canada's Eugenics Archive, where they sort of point out Cutlet and Galton

as key figures in this. And they essentially say that Kutlay was looking for the average and labeled the average ideal, but Gaulten really took it to the next level. So here's what they say about that quote, it was Gaulten who, while building upon Kutlay's notion of the quote unquote average man, a product of measurements and statistics, affected an important twist. Instead of positing the normal as healthy and desirable, Galton equated the normal with the mediocre. Within this tradition, the normal state

is to be transcended, improved upon, and overcome. Sure, right. They're all just making stuff up without realizing that they're making stuff up. Yeah, it's all totally fucking made up. Because it's not clear that the average should be the ideal either. That's right, but it's also not clear that the average making stuff up. Yeah, it's all totally fucking made up. Because it's not clear that the average should be the ideal either. That's right.

But it's also not clear that the average should be bad. They're just putting value judgments into this and calling it science. I mean, they do this again. So, like, Kutley is also credited with founding what's been, what's later sort of called the positivist school of criminology. That's where we get shit, like,

homo-criminalis. Is this something you're familiar with, Mike? Dude, this comes up a lot in the race and IQ literature. Tell me. This is the idea that there are actual physical features of criminals, like inborn criminals. And so what I found out reading Stephen J. Gould's The Mismeasure of Man is that count Dracula in that book was specifically written to have the facial features of the born criminal. What?

Yes. So like the high widows peak, the long nose, like the sharp cheekbones, all of that was at the time considered to be the sort of the criminological features. And there was also this weird science about how born criminals don't blush. This is complete junk science, but this is one of the things of like, oh, he doesn't blush, he must be a criminal. And like, part of that might be wrapped up

in Dracula like being sort of, you know, cold, blooded or whatever. Well, also part of that is like such a measure of white people. Yes, exactly, yes. Like, I'm constitutionally incapable of committing a crime because all I do is blush, try again, and jokers, like it's not great.

It's not great. I mean, this is like one branch off of Kutle's work is sort of being sort of used as a justification for eugenics. So how is the BMI related to all of this? These forced legalizations are they being done on a BMI basis? Not that I found.

But is this idea that is sort of like a wave that is started by Kutley, which is the idea of like, what does a normal person look like? Gets immediately transferred over within like a couple of decades of his death into, if we can know what normal looks like, we can know what exceptional looks like, and we can only be exceptional people,

and that means white and wealthy, and not disabled disabled and all of these sorts of things, right? This project of social physics sort of starts to inform all kinds of systems, in a way that is disconnected from what he thought it was going to do, right? So, BMI isn't like officially a justification for eugenics, but eugenics is like the context in which the BMI is gaining more notice. Absolutely. The other context in which it's gaining more notice is through insurance companies. Oh right. So in 1842, Kutley creates Kutley's index later called the BMI by 1867. So still within his lifetime, the first American life insurance company

creates height and weight tables for the purposes of charging fat policy holders more. Interesting. Again, this is like 25 years after Kutley creates the BMI. This idea of like a quote unquote normalized body starts to be used for corporate profit, which will be a through line in this story. A bunch of different insurance companies create a bunch of different tables, and then the

sort of industry as a whole realizes that they should probably standardize them. The first sort of newly aligned insurance table that's used by multiple companies is the MetLife table, which was introduced in 1942. So it really does take them quite a bit of time to get there. So this whole time, they're using cutlays data on French and Scottish people. Like, that's still the measurement that they're using. No, no, no.

They are making up their own measurements. Oh. They have taken the idea that there is a correct weight for people to be. And they're like, we think it's this. Right. So each different insurance company is fully making up what they think the correct weight is. Sometimes they are broken out by age. Sometimes they're broken up by gender. Sometimes they're broken up by something called frame size. So small frame or a large frame, they don't account for age,

they don't account for race or ethnicity or disability or health conditions or any of that kind of stuff. So I might be overweight on the MetLife version, but I might be like normal on the cutlay version. Yeah, there are some, I looked at some of these charts and there's genuinely like a 40-pound difference in some of my hits. Oh wow. It's really significant differences. Okay. The data that they're using here is super duper all over the place. Like they're drawing their examples from their own pools of policyholders. So they're basing all of these charts on the height

and weight of people with the wealth and inclination to buy life insurance policies, which, once again, means, at this point in 1942, that is white men, everybody. A bunch of their data is also self-reported. Some of the weigh-ins that they use for these charts include people like wearing their clothes and shoes, and some of them don't.. Like it's a total mess, right? Right. That's in the 40s. These insurance charts sort of keep kind of floating around. Some doctors actually start to use the insurance charts as guidelines for their individual patients, which is truly fucking wild to me. Because again, insurance companies are staffed by actuaries.

They're not staffed by doctors. They're not staffed by doctors. They're not staffed by anyone with sort of healthcare, individual care provision experience. And it makes its way into doctors offices enough that there becomes this sort of like desire for a unified system across doctors in the same way that insurance companies have developed a unified system for insurance companies.

The person who decides to take on this challenge of finding the standardized system is our old pal, Ansel Keys. Ah! Here we go. He really was as close as they had at the time to like a celebrity researcher. Yes.

He's on the cover of Time Magazine. He's responsible for military K-rations. He's responsible for the Minnesota Starvation Study. He's also a big part of like, if you would like to know about the history of the low fat diet craze, go back and listen to our episode on snack. Well, he is like all over that business. He has called fatness and fat people disgusting, He has called fatness and fat people disgusting, a hazard to health, and quote, ethically repugnant. Yeah.

So sorry for my unethical body, everybody. In his infamous newsweek cover story, he talks about people like eating themselves to death. I spared myself reading that piece for this, and now I'm very glad that I did. Yeah. So, Ansel Keyes starts looking for ways to effectively measure body fat. He's not looking for the best way to measure and most accurate way to measure body fat.

He's looking for the most cost effective way for doctors to do this in their offices and health care providers to do this in their offices, which is a different question. And he's also somebody we've established is not a neutral arbiter of this. He's clearly somebody who thinks that fatness is a crisis and that fat in the diet is a crisis. Yes, absolutely. Like those are the two beliefs

that he's coming into this project with. So he conducts a study of 7,500 men from five different countries. So he tests three methods for measuring body fat. These are the three most common at the time. One is water displacement, where they fully just submerge you in a tank of water and see how much water you've displaced. And that's how much body fat you have, great.

Another one is skin-fold tests, which are where they get out those big calipers and measure the skin folds. It's better to reserve those for children in front of all of their peers. That's not, let's not do that in Dr. Thomas's. Yeah, that's right. So like Kudley, he draws his subjects

from predominantly white nations. He's drawing subjects from predominantly white nations. He's drawing subjects from the US, from Finland, from Italy, and he's also drawing them from Japan and South Africa. And he does note this in the study that while he had participation in South Africa from Bantu men, so men for the Bantu tribe, it was not a representative sample. So it's like, he's like technically including black people in this study, but not using

any of the data in his analysis or recommendations. But it's basically like, it's there, but ignore it. Yeah, exactly. So once again, he's like centering white people, he's centering wealth, and it's only men, only men. He is sort of pretty circumspect about his findings in this actual study. He says, quote, again, the body mass index

proves to be, if not fully satisfactory, at least as good as any other relative weight index as an indicator of relative obesity. Still, if density is truly and closely inversely proportional to body fatness, not more than half of the total variance of body fatness is accounted for by the regression of fatness on the body mass index.

So basically what he's saying is the BMI is the strongest of three week and imperfect measures and it's right about half of the time. Because like the other methods, if you're putting somebody into a bathtub and figuring out how much water they just place, that's just measuring like how big they are. Yeah, so like they might be like a super duper buff person.

Right, the rock. So like they're all pretty bad. Totally. I mean, I think again, as we're looking at sort of like this understanding of the BMI as some kind of like hard and fast medical truth, this is happening in the 70s. We are in the last 50 years, right?

When this really gets sort of introduced as an individual medical diagnostic tool, right? It just is fascinating to me that like, it's right about half of the time, so it's the best we've got, so let's run with it. It's also worth noting that those numbers hold fast. Like, there was a study in 2011 that found the same thing. It predicts obesity about half the time.

There's also this thing where I feel like a lot of these kind of methodologies, people will write papers documenting them and like proposing these as methodologies to me. Like, well, obviously, there's weaknesses and obviously, like, no one's going to run with this. Yeah, totally. And then it's like surprise. Yeah It's like No one's gonna use this for individuals clearly and then people see it and they're like a number. Yeah, let's use that Totally I like this one. There's a chart. Yes, and like all of these caveats get completely erased totally

So within a few years of this finding from keys, the National Institutes of Health in the US has a conference on the quote unquote, health implications of obesity, right? We've now got the BMI. It's been sort of anointed in like the least dramatic way. Right. As like the least worst measure of fatness, and the NIH goes, great, we actually have to have a conversation about this at a population level, right? And they hold this conference that's designed

to set medical categories for fatness. So this is where we actually get categories that are sort of being refined around who is quote unquote overweight, who is quote unquote severe overweight, who is quote unquote obese, and who is quote unquote severe obese. Oh, so right now we don't have cutoffs.

We don't have the 20 to 25 thing yet. Not yet. Okay. Basically, like what we're about to talk about is a solid three years of those categories being redefined and renegotiated every five or 10 years by the US government. Oh wow.

The way that we talk about, quote unquote, being overweight or obese now, is we assume that that is tied to some level of like the onset of health complications or the increased risk of contracting certain diseases or whatever, the way that they defined the NIH to find them was by a percentile of the population. Oh wow.

So it's just like you're fatter than 90% of Americans, but there's no connection with like you your 18% more likely to have cardiovascular disease or like none of that stuff is included yet. None of that stuff is included. This NIH definition from the 70s says that overweight people are anyone in the 85th percentile or above in terms of their weight in the late 70s. So that's a BMI of 27.8 for men and 27.3 for women. Wait, reverse BMI look up.

Here's a BMI calculator. All right, let's say five foot 10. Let's pretend I'm as tall as I am on my Tinder profile. And it was 27.5. For men it's 27.8. 27.8. Okay, so if I'm a 5.10 dude, if I weigh more than 194 pounds, I'm, I guess, overweight, like what's the, what's the category?

Yeah, that's overweight. That's the start of being too fat. Okay. Okay. Severe overweight is the 95th percentile. It's the BMI of the 95th percentile. Okay. And then they have a separate scale of measures for obesity and severe obesity. Both of those are tested by skinfold thickness instead of BMI. Okay. So once you get to a certain size, then they switch to skinfold. Not even once you get, like, someone could be overweight, but not obese, or obese, but not overweight. Oh.

Because they're using totally different measures. Oh, weird. So, like, calipers, it's so fucking weird, dude. Yeah. I think it's also worth noting that, like, the cutoff for overweight in the 70s is 27.8 for men. The cutoff for overweight today is 25 for people of all genders.

Wait, 20, all right, here we go, 25. I'm a five foot 10 dude. So I used to be able to weigh 194 pounds before I'm overweight. Now I can only weigh 174 pounds before I'm overweight. Right, so it's a 20 pound difference. Just by the definitions that we use, right? These are really significant changes.

We're in this moment where ideal weights, quote unquote, are fully being invented. And there are people in a room going, I think this is too fat. No, I think this is too fat. And again, they're being defined not relative to health risks, but relative to other people. Right. So it's basically like the biggest Americans, like must be at higher health risk. It's not, there's no diversity within that group.

That's right. It is the largest Americans must be at the greatest health risk and they are because I don't like that they're so good. Right. What happens is that in 1985, the National Institutes of Health revised their definitions of obesity to also be tied to the BMI. So they pull out the skin calipers thing and they're like, okay, it's all BMI now.

At least it's consistently trash. Yeah, it's even inconsistent. And that's when we really get like BMI becomes the measure. Because by 1990, we're fully in the obesity panic mode. That's when we've already had this wave of articles coming out about the future of our children and our national defense and all this, the population is pretty well briefed by the early 90s.

Yes, but we're not yet in obesity epidemic mode. Oh, is that later? That happens in 1995. And this is the thing I am constitutionally incapable of shutting up about at this point Oh, oh in 1995 the World Health Organization Decides that the BMI is going to be their new global standard for measuring Overweight and obesity that's bad as part of that decision

They do a couple of things that are very, very, very controversial amongst researchers and medical care providers. One, they decide to use, start using the BMI in children. Oh, what? Yeah. So prior to this, the BMI has been a measure for adults. There is quite a bit of back and forth at this time amongst pediatricians

and pediatric researchers going, it really does not make sense to try and tie weight to height for children, because essentially what happens in children's growth processes is that they grow out and then they grow up and they grow out and then they grow up, right? Childhood and adolescence are a wild time to try and standardize bodies.

We also don't have data on, you know, kids with a BMI of 26.4 at age 10 are 2.1 times more likely to have cardiovascular disease at age 50. It's so fucking noisy to even try to get that kind of data because when we're talking about things like lifestyle diseases, right? Of like diabetes and cardiovascular disease, that stuff takes decades to happen.

Yes. And like people's weights fluctuate wildly throughout the course of their life. So a kid who's like fat at, you know, seven, you would need some like pretty robust data to show that that puts him at a higher risk of being unhealthy later Like you really have to prove that Mike. I'm about to blow your mind They did not have any of that data. They did not have the data

Wow So Basically what they decide to do they sort of track growth studies from Brazil from Great Britain, from Hong Kong, from the Netherlands, Singapore, and the US. And they sort of decide that what they're gonna do is just extend the curve of the BMI for adults. Oh, just like draw the line,

like just keep drawing the line down with it. Yes! That's all they're doing. And they're like, this is for kids now, moot. Oh, I always love whenever I hear the phrase, like if current trends continue, yeah, it's always like, if current trends continue, like 60% of the population will be obese in like 2024

or whatever, and it's like, okay, but if current trends continue, 112% of the population will be obese by like 2030. Yes. If we're drawing trend lines, then they're gonna exceed 100% at some point. Yes. If we're drawing trend lines, then they're going to exceed 100% at some point. So we can't draw the trend lines in straight lines

because that's not how trends work. That's right. The other thing that they do is that they get recommendations from WHO staff saying actually our evidence shows that people can be healthy at higher weights. So you should probably actually raise the floor for who's considered overweight and who's considered obese. So people are already sounding the alarm about this.

They're already saying, I don't think this measure is right. And actually if we're going to adopt this as an international standard, we should probably say that overweight starts at a BMI of like 30 or 28 or something. Like quite a bit higher than it is now. In both cases, they do the opposite of what is recommended to them by healthcare practitioners. And a bunch more people are now going to be considered medically overweight and medically obese.

So in 1995, the WHO changes their definitions of who is and who is not, quote unquote, overweight or obese. And in 1998, the US follows suit and comes into alignment with those international measures. And that's how it's reported. It's like, uh, America was out of step with international guidelines. Now we're in step with international guidelines

and whoa, we got a lot of fat people. Oh, CNN at the time has one of my favorite leads ever. Which is, quote, millions of Americans became fat Wednesday, even if they didn't gain a pound. Nice. So that sentence goes on to say, quote, as the federal government adopted a controversial method for determining who is considered overweight. So like, how was your week?

I became fat. Yes, that's right. And what happens is because we've now changed the standards, because it looks like there is an epidemic happening now that wasn't there before, it opens the flood gates for all of this research to be like, why is it terrible to be fat? So we were talking earlier about like the research question

of a bunch of these white dudes in the 1800s was like, I know I'm superior to black people, but why? And essentially the research that we get here is, we know it's terrible and unhealthy to be fat, but why? Not like, how do health measures play out for fat people? There's no neutrality in these questions, right? They are just like, how do we prove what we all already know,

which is that fat people are hideous and they're gonna die? Right, like, oh no. And what's frustrating about this is that there is very consistent data all already know, which is the fat people are hideous and they're gonna die, right? Like, oh no. And what's frustrating about this is that there is very consistent data that at a population level, people with higher BMI's have worse health outcomes. So like that's a real correlation, but there are things that correlate much better

with health outcomes that like we haven't put as much focus on. That's right. The correlation between like does this person get 30 minutes of exercise five days a week is, like, a better predictor of bad health, regardless of somebody's weight? So it's frustrating that, like, we had this panic

over, like, what people look like and how we can extrapolate that as a proxy indicator. When, like, we could have been framing all of these, like, diet-related disease issues in, like, a much more accurate way. The thing that I got stuck on, this is a perfect segue. Why the fuck was this the thing? Yes. I get that we're biased against fat people. I get that people have been grossed out by fat people or whatever for a long time. But why did this in particular become not just a national but an international health policy priority. And I found an answer that makes me feel like I need to wear a fucking tinfoil hat.

Ooh, smoking gun, I want it, I want it so bad. I fully, like I have the bulletin board full of like news clippings with like red string and pins and the whole thing. Wait, is it gonna be like Hillary Clinton, like traffic to a bunch of children? And like I'm nervous now, Aubrey. It all starts at Cosmic Ping Pong. Yeah, no.

That's where we're going now. No, we're not getting into peace of gate territory. Okay, thank you. Christ. No, we're getting into something that is like the answer is hiding in plain sight. Okay. And it also makes me feel like I am losing my grip on reality because it feels so conspiratorial.

I'm gonna send you this quote. This is what the British Medical Journal has to say about the International Obesity Task Force, which is the sort of body in the WHO that has set these international standards. This quote that you just sent me, it just says, killere stole the election from Donald Trump,

Aubrey, lock her up, lock her up. Well, we don't believe this. No, okay. The most recent annual report of the newly merged group highlights, close ties with WHO, but also shows that two drug companies, Roche and Abbott, are primary sponsors.

Supplying around two-thirds of its total funding. Roche makes the anti-obesity drug orlest stat, and Abbott makes subutermine hydrochloride, known as reductil, the Sunfake. A senior member of the merged group who has seen funding documents but did not want to be identified, told the BMJ that over recent years, sponsorship from drug companies is likely to have amounted to millions. I see where you're going with this. Do you see where I'm going with this? It was Pfizer all along.

Like, it was these drug companies that want to sell us anti-obesity drugs. So, what this quote leaves out is that reductol, which was sold in the US as meridia, was in the approval process. Both of these drug companies have weight loss drugs that are in the approval process, in the mid to late 90s. But first, they need to establish that weight loss is a going concern for medicine. Right. And that a fuck ton of people need medical intervention to lose weight. So what they are doing is they are establishing this as a medical concern at sort of a new level and they are lowering these thresholds for what it means to be overweight and obese so you can

weigh the same amount and previously be at a quote unquote normal weight and now be overweight or obese. And that is so that Roche and Abbott have customers to buy meridia and ally was orlistat in the US. Is that because there were BMI cutoffs for doctors being able to prescribe these? Being able to prescribe them and for insurance to cover them.

Right, yeah. So it's only over BMI 27.5. Can you get this reimbursed? Right, only the overweight and obese categories qualify for these medical interventions. And if you can lower the threshold of who's considered, if you can make more people, quote unquote, medically overweight or medically obese, then you have a fuck ton more customers,

not only on an individual level, but you've got state contracts to handle the obesity epidemic. You've got large-scale insurance, like sweetheart deals with insurance companies, who will pay you untold amounts for untold numbers of people who now believe that they are overweight or obese, because their doctors are telling them that, so why would they not believe it, right? I mean, this is a little 10-poil hat, Aubrey. It is a little fucking 10-poil hat.

I kept looking for alternative narratives of how this happened. I was like, I wonder what Roch and Abbott have to say about how this happened. I wonder what, you know what I mean, like a different sort of entities involved in this have to say about how this happened. I wonder what, you know what I mean? Like a different sort of end of the use involved in this have to say, there is no alternate narrative. This is the story of how this happened.

There's also just the fundamental fact that any other solution to the quote unquote obesity epidemic, you know, bike lanes to school are like subsidies for healthy food or like higher food stamps or all of these sort of real solutions to diet-related disease require like political trade-offs, and like they cost money. There's no sort of free lunch, the way that there is with fucking throwing pharmaceuticals

at something, like whether or not this is like a deliberate kind of like conspiracy by the drug companies and like the government officials or whatever, it's just a lot fucking easier. That's right. And I also think like, look, it's possible that the WHO is like, we gotta get to this overweight, no B-city thing. At some point, we don't know how we're gonna fund it. And the drug companies sort of swoop in and go,

what if we funded it? Right, like there are a bunch of different ways that this could happen, but the fucking fact of the matter is most of the budget of this international Task Force that's focused on defining who is and who is not overweight and obese is funded by drug companies that absolutely have a stake in this outcome. It doesn't it doesn't look good. It doesn't look good. That's exactly right. It doesn't look good. Whether or not you believe that that is like they're like ringing their hands and their conspiratorially like hatching a plan behind, you know, and smoke-filled rooms or whatever, or whether you think the WHO wanted and needed to do a thing and drug

companies altruistically agreed to fund it. Which like no. Which no. Which probably not. Let's get back to just like documented facts that we can for sure prove regardless of intent, right? 1995 the WHO changes their definitions of overweight and obese 1998 the National Institute of Health in the US falls in line those changes are funded by

Abbott and Roche and In 1998 and 1999 both of those companies have weight loss drugs approved by the FBI. Like it's like the next two fucking years. And what we know from our FENFEN episode is, this is after eight decades long drought of approving weight loss drugs, right? So it is absolutely in their financial best interest to establish that there are more customers

who need their product. Right. There's also a way that I think journalistic bias operates. Like, if I'm writing an article about a school shooting, I can find experts that will say like it's mental health. Like America doesn't have mental health treatment. And I can find experts that say it's guns. We have too many guns. And like the bias in that article isn't necessarily in what the experts say, or even in what I write in the actual text of the article, the bias comes in which experts am I consulting?

Yeah, that's right. And that's a very invisible form of bias, because there's an infinite number of experts who I could consult on something as broad as that issue. And I think as a guy who worked in international development for 11 years, and I worked on corporate human rights violations, that was the bulk of my human rights career. And I have seen the ways that corporations warp the kinds of human rights issues

that get talked about, and it is a lot of which expert is going to be on the panel. And who is going to be appointed to this thing? Yeah. And I can absolutely see that happen here. Another way that that's sort of like bias in the populace is promulgated through media, even without intent, is that when we see reporting about the quote-unquote obesity epidemic, this entire history is nowhere. Yeah, yeah, yeah. There is no discussion of like,

actually we spent like a really long time defining and redefining and sort of moving the goal posts. Right, there's no discussion of like, you could have been at a quote unquote healthy weight in the 70s, stayed the same size and now be overweight. That's not an indictment of reporters doing that reporting necessarily, but it does, you can see how when you make that history invisible to people, it really seems like there is a very real threat out there.

It feels a little bit, you know what it feels like to me is, we've got all these movies about shark attacks and then you talk to shark experts and they're like, they pretty much never happen. Yeah. But everyone's freaked out about them all the time. Like, we are being trained to see this as a function of the natural world, not something that is a function

of humans' interpretations of other humans. Right. And this completely arbitrary scale that was essentially arbitrary for like more than 100 years. And then we kind of backfilled the science because we had already agreed on this one number as the thing that had to be the center of our understanding of hell. That's right. So even when we're talking about these definition changes in the late 90s, which is so fucking

recent, there is also continuing research that's coming out in the last 10 or 15 years that are adding even more complexity and nuance to our understanding about sort of the relationship between weight and health, right? So in 2015 researchers that Harvard and the University of Sheffield released a study where they say they found six different types of obesity Each of which have their own sort of etiology. Just a couple years later, researchers at Massachusetts general hospitals say that they have observed

59 different types of obesity. Yeah. So we're trying to sort of cram all of these different potential threads rather than looking closer at, like, wait a minute, what's actually going on here? Right. Instead, we go, oh my god, what's actually going on here? Right. Instead we go, oh my god, it's even worse than we thought fat people are terrible. And also, for my sort of years ago research into BMI stuff, there also is like very different

data based on race. Yeah. The correlation between disease and BMI starts to show up at lower BMI's for Asian people, although there's huge diversity within Asia, obviously. But then for black people, like, black people can be larger before those correlations start to show up. And like, again, it's all like there's other things

that are more correlated, like there's no way to talk about this without sounding like kind of like a eugenicist and like shitty, but like humans are diverse on like every dimension, including like the size that they're kind of best suited to be. And so it's not like an academic issue that like this was only done on white people. It's like an actual epidemiological issue. We're getting shitty data by applying this to everybody.

And it's also been designed pretty much exclusively at this point still for cis men. Yeah, that's weird. It's also so dumb because women are supposed to have far more body fat than men. That's right, and there's no real research on the impacts of the BMI on trans people, but the BMI is used as a reason to deny trans people's surgical care. Yeah. That also plays out. Now that we're talking about like a global obesity epidemic,

quote unquote, there are all of these fucking rankings that come out that are like, what are the fatest countries in the world? Yeah, I hate those. Would you like to guess at some of the top 10 fatest countries in the world? Oh, isn't it always like, Tuvalu and these other like Pacific island nations that are like, have been large for like most of human history. Yeah, the top 10 is like the Cook Islands, the Marshall Islands, pull out, Tuvalu, Tonga, Samoa. So like in addition to all of the like garbage science stuff,

we also now have this like hand-ringing about sort of the health of populations that have kind of always been in this size range, right? Right. Not only that, but in the United States, the way that we categorize race and ethnicity lumps together Asian and Pacific Islander communities. And like East Asian and South Asian communities too.

And East Asian and South Asian, right, like Asia, all of it. It's like 40% of humanity. Like one catapult. Yeah, totally. And if you are sort of looking at race-based differences for how the BMI plays out, like the idea that Japanese people and Samoan people would be in the same category, as interpreted,

like it's just whack-a-do. Like it makes zero sense, right? And India and China, which are not in the top 10 of most quote unquote obese nations, have some of the highest levels of type 2 diabetes diagnoses. So because we're looking for fat people and the problem of fat people, we're also missing opportunities to intervene on other public health issues. This is also where we sort of like get into some of the pitfalls of sort of conversations

that critique the BMI, right? I think one of the ones that we talked about is like trying to find villains in history. Right. I'm calling myself out with this one. It's like, you can say the rock is obese by the BMI, so like that's how you know it's so wrong. The implication there is like,

if it really detected fat people, then it would be okay. Right, exactly, yeah. But the problem with the BMI is that people who are not fat get lumped in and that's not right. But if it's just fat people, it's fine to have a war on obesity. It's my dev like all of the shitty public policy.

It's very hard to say both the BMI is trash and it's bad that there aren't separate BMI's for like Samoans and Japanese people. That's basically kind of the argument that we're making, but not really. That's right. I think the underlying question here is, why is it critical to the state,

like capital S state, to define an ideal weight? Yeah, and the central issue with me is that the BMI and sort of fatness generally has always been presented to us as a proxy indicator. Fatness is bad because fatness is an indicator that you are more likely to get heart disease, that you have bad cholesterol, that you have all of these underlying health conditions that we can't see. And because we can't see cardiovascular risk, we use fatness because it's all we have,

right? But then what's fucking insane about using the BMI within the medical system, is that you can take people's cholesterol. You can actually ask them, what are your lifestyle factors? What is your genetic background that puts you at higher risk for heart disease?

We're still using a proxy indicator for underlying data when the underlying data is there. Like if we don't want people to be fat because like they might have a bad like resting heart rate, like we can take their fucking resting heart rate. If they're in a doctor's office. And there are interventions that we know work for those specific things.

Exactly. But instead we use this proxy as the measure for the health risks. And then we try to control the proxy as a way to control the health risks rather than just fucking controlling the health risks. Just controlling the health risks. Why do we need this intermediate thing?

And why if we put all of our effort into this intermediate thing, if it's supposed to be the tip of this health iceberg? Like let's just look at the iceberg. That's exactly right. I mean, this is one of those places where I'm like, if you want to talk about health, if that's a thing that you want to talk about,

and you really genuinely care about population level health markers and individual care of individual patients, then the BMI is leading us away from that. Yeah. That also traces back to the entire fucking history of the entire fucking thing, which was like a dude who thought he was doing a population level analysis,

and then a series of people who grabbed onto it, largely for profit motives, right? First insurance companies and then drug companies. Right. So like it does feel really challenging to figure out how to have this conversation. And I will say it feels challenging to me as a fat person because I think it's easy for me talking about this to read as a very self-serving set of conclusions. Yeah, I was just gonna accuse you of glorifying obesity.

Thank you. I'm trying my best. That's how all of our episodes end. You saw my eyeliner today. If that's not glorifying obesity, I don't know what is. Like, glory be. So I mean, like, I didn't really sleep particularly well last night.

I was like, all churned up about recording this episode, which usually happens a little bit, but not to this level. And I think a lot of that has to do with being a fat person, saying into a microphone. Like here's what I researched and found, right? About something that is seen as self-serving, right? Like, it made me think about like when we had our marriage equality court case in Oregon, the judge, the circuit court judge who was assigned was a gay man, and there was a big outburst

about like, he can't be impartial. For fuck's sake, yeah. I am genuinely nervous about how this conversation plays out from here. But what's so fascinating is that like, this accusation against you implies that thin people don't have any dog in this fight and that's not true. Yeah, that's right.

Whether you are fat or thin, like your body size affects the way that you see the world and the way that you interpret political and social issues. And so thin people also have a reason to think that like fatness is bad. Yeah. And to think that you are virtuous for being thin

as opposed to like you were born with like pretty good genetics or whatever. I also think, I mean, I hate to be the person who's like, well, what about the people with more power? But like the BMI is not working for skinny people either. That's right. Because you have people like Bob Harper, the demonic personal trainer who hosts the biggest loser,

who like does more exercise than anyone else on planet earth, who has a heart attack in his 40s. And then goes back to host the biggest loser, and it's like, and that's why all of you need to lose weight. Exactly. Like, there are people who have risks of like lifestyle diseases and like genetic diseases, and we're like, well, you're thin, so I don't need to run those tests for you. It's much worse for fat people, but it's not working for anybody. Well, and it's much worse for fat people. It is arguably the worst of all

for fat people who are chronically ill. Yeah, my God. Because then the response from thin people writ large, from fat people who don't have chronic illnesses and from institutions and like medical systems is, well, you brought this on yourself, you knew the risks, you could have controlled your weight and you didn't.

I do, I mean, this also, this is my tinfoil hat turn in the episode. Oh my God, tell me, join me. I actually think that we are vastly underestimating the effect of medical bias as a driver of the quote unquote, health effects of obesity. Yeah, I mean, this is anecdotal. It's really hard to get data.

Eventually, we will understand this phenomenon more. But like for our show, after I wrote my article about obesity in 2018, our inboxes are jam packed with people who are like, I had a fucking tumor for years that nobody diagnosed because they kept telling me to lose weight. Very severe health effects that nobody looks into because it's like, oh, you're fat,

so I'm not gonna run these tests on you, right? I'm not gonna give you an MRI, I'm not gonna listen to you, I'm not gonna believe you until you lose enough weight that you appear as a person to me. Like I said, there is a correlation between higher BMI and worse health, and like some percentage of that is also the fact that like life threatening illnesses, in fact, people do not get fucking diagnosed.

Well, and on top of that, so like 100% the number of horror stories from like individual fat people out in the world, people do not understand how common this is. People really, really, really don't understand. It is one of the great fears of my life that I will die of a totally treatable or preventable thing because my doctor can't conceive of me having any other health problem

than just being a fat person. Like, that is a fear that follows me every time I go into a doctor's office. It's terrible. Yes. And two other things that we know for sure, you're right that this is hard to get good data on, this specific misdiagnosis stuff.

But I will say, we do know for fucking sure that there is a lot of data that says that fat people generally and fat women in particular post-pone care because they know that they are going to be overtly, directly judged by their healthcare providers, and they know that they will get substandard care because of that judgment. I've written about this that I went for years

without seeing a doctor because I just knew that it was just gonna be another fucking weight loss lecture because I went in for an ear infection at one point and my after care instructions were to lose weight. The other thing that we know for fucking sure is that there's quite a bit of data on when and where fat people report experiencing weight stigma, right? Number one is friends, family, and intimate partners,

which is real shitty, so everybody, all of us do a little reflecting, that's real bad. And number two is healthcare providers. So it's really tricky to figure out how to talk about medical bias in a way that doesn't seem like anti-doctor two or anti-health care provider that is like, no, I really fucking need what you're offering. Right.

And right now, I can't actually get it from you. And I would say, when you look at sort of these consistent correlations between like fat people and like lower life expectancy, it strains credulity that a population that systematically does not seek medical care, that that would have nothing to do with their shorter life expectancy.

That is absurd to say that, oh yeah, by the way, fat people are delaying care for years, and we shouldn't be factoring that into our understanding of the relationship between weight and health. It is nuts to think that it would. So the other thing that we do have quite a bit of data on is there is a lot of data, and it is straight up self-reported data from many different kinds of healthcare providers

that show things like a majority of nurses and nursing students think that fat people who are admitted to the hospital should forcibly be put on very low calorie diets. Yeah, that's really bad. Every study that looks into this finds like, oh, this other group is also biased against fat people. Right, it's every time someone just asks,

it's not even like, let's measure their patient interactions. It's just like, you just go up to like a doctor or a nurse or a physician assistant or whoever and you go, hey, what do you think about fat people? And they're like, oh, that they're lazy and that they're not going to follow instructions and that they're probably going to die. And that I shouldn't have to treat them. There is also some data that shows that like any intervention starts to change that. There is one study that shows that like a 15 minute video clip shown to medical students decreases their levels of bias against fat individuals. Oh wow. It is truly like all we have to do here is anything, but right now we're using this system, which is the BMI, it treats it as if there's a

straight line from being fat to being in ill health, to being a patient that's not worth caring for. And because we also have this sort of like myth that we're really committed to, that your personal weight is 100% in your control, 100% of the time, then we can also infer intent from fat people, right? That like you're not just seeing someone whose body looks different than you, you're looking at someone who's deciding not to be thin all the time, so you can decide to do whatever you want, including deny them healthcare, including, like whatever the things are, right? So it's a really tricky, challenging conversation

to get into without sort of feeling like you're like assailing someone's intent. And it's really not about those things. It really is just like fat people are fucking desperate to without sort of feeling like you're like assailing someone's intent. Right. And it's really not about those things. It really is just like, fat people are fucking desperate for decent healthcare and we're not getting it. Yeah, exactly.

Just don't know how to get anybody's attention. Just be like, can you please just treat me like you would treat a thin patient? It is a weird move for doctors to be like, I had to be mean to this patient, she's unhealthy. Yeah, it's like, right. Yes. I think it's be like, I had to be mean to this patient. She's unhealthy. Yeah, it's like, yes. Right, yes. I think it's actually like,

you should probably listen closer to those patients. Right. Yes. Arguably, the patients who you are perceiving as being unhealthy are the people who need your help the fucking most. So can you not be a dick to them? So maybe like spend more time with those patients

if they're fat and they're telling you about like, they're migraine. Yeah, have I ever told you about Honda's? No. Honda is the acronym that is disproportionately used to describe fat patients, and it stands for hyper-tensive, obese, non-compliant, diabetic, alcoholic. Holy shit.

Sometimes the A stands for asshole. Nice, okay. Some healthcare providers somewhere think that that's actually an okay way to talk about fat patients and think that they can then provide care in an unbiased way to that person when they're starting from a place of like, I've already decided that you have high blood pressure

that you have diabetes, and that you're non-compliant, that you're all, I've already decided you're not gonna listen to me. I love the non-compliant part because it's like, he can't even lose weight, which fails for 98% of people. I'm like, he can't even do this thing that only like one out of 50 people can do.

He's feeling the thing that everyone fails at. Yeah. Fart noise, yeah. Like ridiculous. I mean, there's like the moral arguments, which I feel like don't really work when we're talking about like issues of bias. You're not gonna get people in their hearts, right?

But the last numbers that I've seen are that one third of quote unquote obese people like have normal health markers and around 25% of like average weight people don't have normal health markers. If you are relying on the BMI, you're basically calling a bunch of fat people unhealthy who arenMI, you're basically calling a bunch of fat people unhealthy who aren't, and you're basically calling a bunch

of thin people healthy when they aren't. Yeah. Even if you want to keep hating fat people, if your goal is to have a healthier country, you would not be using the BMI. Totally. There's a bunch of really good and interesting health data that I found.

We'll talk about this next time, the idea of the quote unquote obesity paradox. Oh yeah. Is this a phrase that you've heard before? Isn't this like some fat people are healthy? It is and not only that, but fat seems to protect some people from some health conditions. Right.

So like fat people are more likely to have heart attacks, but less likely to die of them. Oh well. It all gets labeled like the obesity paradox, quote unquote, which is just these fat people seem healthy, but that's not possible. You're like, oh, fuck. That's like some 18th century medicine shit where they're like, this black person is smart.

Right. Right. They're like the race paradox. It's like, no, it's just your whole understanding of this issue is fucking wrong. Right. This woman seems to be able to do things for herself. What? Right. Yeah. It's just to be able to do things for herself. What? Right.

Yeah, it's just like completely, it's like you are showing your whole ass. Yeah. And I mean, I think the other thing that these conversations all leave out is that like the jury is still fucking out on a lot of this stuff, but we are treating it like it is hard and fast medical knowledge. But if you talk to researchers who are working on this, right? Like evolutionary biologists who are researching this stuff, they're like, actually, we just found out that your body adjusts to burn the same number of calories regardless of the

amount of activity that you're doing. And we don't really know why that happens. Anyway, bye. Yeah. Like, if you actually talk to the sources of the research that we all seem really secure that we think we know, they will tell you that we are wrong. Right, right.

So that's the BMI. I feel like I am losing my grip on reality. Our next episode is gonna be about Benghazi, isn't it? Aubrey's going down the rabbit hole I've lost there. This is it. Totally. Look, I'm just saying, Q makes some good points. Oh, my God. This is it. Totally. Look, I'm just saying, Q makes some good points. Yeah.

Yeah. So our next episode actually will be about how these sort of shifts in the BMI paved the way for declaring an obesity epidemic and sort of the policy history behind the obesity epidemic, which also is termed the quote unquote war on obesity. So we'll talk about that next time because, boy, boy, there's a lot there. Yeah. There's a lot of meetings in Switzerland that we need to talk about. Can I end this with like a little parable? Yes, please do. I would love it.

One of the things that stuck out to me from all this race and IQ stuff that I've been reading is, you know, the most famous IQ test is called the Stanford Bene test. And Alfred Bene came up with these ways of measuring IQ through multiple choice questions. And he deliberately came up with this measure as a way to get more attention on kids who needed it the most. His goal with coming up with these IQ tests was to be like, there's probably kids that are falling behind in school and we don't know about them. Oh wow. And of course, like 10 minutes after he comes up with the scale,

people like, let's sterilize the children. Yeah, totally. Like, of course, it comes this runaway train. The minute there's like a measurement out there because there's always this drive to quantify things. Like, I think so much of it is like the fact that our country is dominated by men. And there's like something sort of that feels valid

about a number that doesn't feel valid about like any kind of qualitative measure. I really think something similar happened with the BMI where it's like this number never really meant very much. And there was always so much diversity, like two people who both have a BMI of like 26. One of them could be super buff, and one of them like might have had an eating disorder before

and like telling her to lose weight is not a fucking great idea. These numbers take on this implied scientific rigor that makes us take them far more seriously, and especially makes institutions adopt them much more than they should, and takes away all of the nuance. And because we all have pretty serious implicit biases on a bunch of different measures, we are also pretty incapable of internalizing those measures without using them to justify the people that we already think are superior being superior,

and the people that we already think are inferior being inferior, right? We don't do a really good job of taking in research results without turning them into individual inferior, right? Yes. We don't do a really good job of taking in research results without turning them into individual mandates, right? Like, there was that whole wave of stuff about visceral fat is the fat that's really bad for you. It's like belly fat is worse for your health. And that turned pretty quickly as a fat person

into people being like, you have a lot of belly fat. That means you're gonna die and you're gonna lose weight. And I'm like, I can't control where fat accumulates on my body. Right, like this is scientifically useful, I'm sure, and also on an individual level, there's not an instruction that follows from there. That's right.

Oh, you guys are right. I guess I should have a different body shape. Like, I don't know how to do that. You're up there and I need you to be an apple. Yeah. Like, I don't know how to do that. Yeah. You're up there and I need you to be an apple. Yeah, that's great. It's like not useful advice for people. Again, like, sort of talking about like the nuance of this story

and this history, the failings of the BMI are mostly failings of humans. Yeah. Which makes it really fucking challenging to talk about this stuff when it gets presented as like, it's just capital T capital S the science Yeah, yeah, although Aubrey people named Mike really are better You're like I created a system wherein short white man are at the top of the pier

You know what five foot six gay mics turns out looking at piece of paper, sorry, it says here, we're the best. Science. Yeah. Thank you.