The Fat Doctor Podcast

Challenging the Economics of Fat Bodies

• Dr Asher Larmie • Season 5 • Episode 19

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The obsession with calculating the "cost of ob*sity" to society reflects our troubling tendency to commodify human life and health. In this rather ragey and explosive episode, I expose how a widely-cited figure of £98 billion was manufactured by pharmaceutical interests to sell weight loss drugs. 

I challenge the notion that we "owe" society a debt of health and explore how weight stigma, not weight itself, drives depression and poor health outcomes. Through a rather provocative thought experiment, I reveal the absurdity of reducing human experience to economic calculations and argue that tackling stigma, not eradicating fatness, is the real path forward. 

Today's journal article was:  Stevens, Serena D et al. “Adult and childhood weight influence body image and depression through weight stigmatization.” Journal of health psychology vol. 22,8 (2017): 1084-1093. doi:10.1177/1359105315624749 

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Hello and welcome to season 5, episode 19 of the Fat Doctor Podcast. I am your host, Dr. Asher Larmie. I have been building up to this moment for some time. I've had this particular podcast in the books for some time, and I'm carrying around a lot of anger, rage, fury—righteous fury, I would argue—about this particular topic.

It sits there in my gut, and every so often I will read something in the papers or see something on social media that talks about the cost of being fat, the cost of being diabetic, the cost of being chronically ill, the cost of health, and it makes me mad. It makes me mad that we talk about health and wellness in the context of money. I think that in itself is so problematic and says so much about us as a society.

In particular, I get mad when we talk about the cost of—and I'm going to use a very stigmatizing word here, but for good reason—the cost of obesity. "It's costing us money, don't you know?"

So today I'm going to be asking the question: Do we owe society a debt of health? Are we in debt to society? Is it our responsibility to be healthy or to remain healthy? Remember, we've already talked about what is healthy and how we define healthy. That in itself is a problem. But assuming we know what healthy means, do we owe society a debt? Do we have a collective responsibility to remain healthy for as long as possible, to take whatever actions are necessary to remain healthy? Yes, of course, that might not work out, and we all accept that eventually we'll become unhealthy. But we need to postpone that for as long as possible because we're all in this together. Is that true? Is that false? Let's talk about it.

It's going to be difficult for me to talk about this without talking about the O-word, because when I think of health and the cost of health to society, there is always someone who's going to bring up the cost of being fat to society. It doesn't matter what we could be talking about—disability, arthritis, antidepressants, whatever—someone, I promise you, will bring up the cost of obesity.

Obesity costs the United Kingdom an estimated 98 billion pounds annually, according to Google. 98 billion. That's just short of 100 billion. Why not round up when we get to these figures? 98 billion is equivalent to nearly 4% of the country's GDP.

This is according to a study by the Tony Blair Institute. For those who don't know, Tony Blair is a former Prime Minister of the United Kingdom, responsible for, amongst other things, international war crimes. But anyway, he has an institute that commissioned a report, and that's where the 98 billion pounds annually comes from. According to Google, this figure includes cost to the NHS, to social care, to lost productivity, and reduced quality of life for individuals.

I think it's time to take a look at this number. 98 billion feels very steep. It feels like a lot. And 4% of the GDP? This is a lot. Let's take a look at this report.

Content warning: this is going to be offensive. You are going to be offended, but don't worry. Stick with me, because by the end of today you will be feeling a lot better about this number. In fact, you will be armed with the knowledge of how to deal with anybody who dares quote that number in your face, because knowledge is power.

First and foremost, I want to talk about this report. I live in the UK and I'm talking about a UK-based report. There will be similar ones for the United States of America and probably every other country. You'll understand why in a moment. The report was commissioned and paid for through the Tony Blair Institute by a company called Novo Nordisk, which, for those who don't know, is a global pharmaceutical company that specializes in diabetes medication and weight loss treatments, in particular Ozempic and Wegovy.

Novo Nordisk commissioned this report, apparently according to the report, to provide an updated independent estimation of the full economic cost of obesity in the UK. Why? Because the previously widely referenced figure of 27 billion was based on a 2007 report and likely outdated, given the increasing prevalence of obesity.

You see, Novo Nordisk came along and said 27 billion feels a bit low to us. We think there's probably more to it than that. So we'll commission a report. And it just happened to be in 2021, which just happened to be the same time as when the National Institute for Clinical Excellence, which is the equivalent of the FDA—they make decisions about whether or not to approve certain drugs—was reviewing Wegovy for weight loss, semaglutide for weight loss. They commissioned this report in time for that review so that when they were talking to our equivalent of the FDA, when they were talking to NICE, they could say it's cost effective.

We have a nationalized health service, so in order for a drug to be approved, it has to be cost effective. They commissioned a report so that they could prove it was cost effective, because if we know how much being fat is costing, then we can say, "But our drug will reduce that by this much," then we can talk about actual cost-effectiveness. Great, right?

And 27 billion was low. I'm not sure that the prevalence of obesity has gone up that much since 2007 to account for the difference between 27 and 98 billion. That's more than triple. There must be more to it than that.

Let's break down the report. Bearing in mind where it comes from. What's really interesting is this report came out in 2022, and in 2023, a different organization sort of updated it, but looking at the report, it hasn't really changed since 2022.

Looking at the report, they separated it into three tiers. There were the individual costs—that is basically a reduction in longevity and quality of life—how long you live and the quality of your life from being fat. They separated it into being "obese" (again, hate the word, but that's BMI of over 30) and being "overweight" (that's having a BMI between 25 and 30).

The individual cost was really high amongst the "obese." That was 54 billion pounds, but not from being overweight—that was only 9 billion. So you add those two together, and you get 63 billion for the individual costs. That's the cost to individuals, not actually a cost to society.

Then there's the NHS cost. As I said, the National Health Service is funded by the taxpayer. It's a nationalized service, funded by taxes. So one could argue that's a society-based cost. The cost from being "obese" was 11 billion, and from being "overweight" was 8 billion. Together, that's 19 billion, almost 20 billion on the NHS alone.

Once upon a time, it was 27 billion for all of society. Now, it's just 20 billion almost just for the NHS. And then there are the wider society costs. What are the wider society costs? Well, the cost of inactivity in work, social care, things like that. The cost of "obesity" is 9 billion, from being "overweight" 6 billion. You put those together, and somehow you end up with 16 billion. This is not making sense—the math is not mathing—but I imagine they were doing some rounding up and rounding down. Anyway, you do the math, it works out as 98 billion. Trust them.

It's a sort of 3-to-1 ratio, 3 in the "obesity" section versus 1 in the "overweight" section, thus proving that the fatter you are, the more you cost.

Let's break it down. I'm starting with the cost of the NHS. How did they work it out? Well, they had to use something called a population attributable factor. You might be asking what that is—that's what I was asking. I had to ask AI.

A PAF basically asks the question: what percentage of this disease in the population would be eliminated if we completely eliminated obesity? If we got rid of obesity, what percentage of the disease in the population would be eliminated? And you might be thinking, how can we work that out? That is a very good question. It assumes that obesity is causally related to the disease.

If we look at a disease like diabetes and say 33% of it would be completely eliminated if we got rid of obesity, then we're saying that obesity causes diabetes, which is not true. There's no evidence for that, absolutely none.

We're assuming in this calculation that obesity is causally related to any disease, which, of course, there is no evidence to prove. We have never been able to prove causality. In fact, there's a ton of evidence that suggests otherwise—that suggests there is no causality there. You're making that up. In fact, all of the diseases that we associate with being fat—instead of blaming the fat, we could just as equally blame the weight stigma or the weight cycling or any other number of causes.

So already here we have a problem. We've said 20 billion, and we've never actually been able to prove that obesity causes anything.

The diseases they included: type 2 diabetes, high blood pressure, myocardial infarction, colon cancer, angina, gallbladder disease (that really pisses me off because one of the biggest causes of gallstones is weight loss), ovarian cancer, musculoskeletal disorders, stroke, and sleep apnea. I have done podcast episodes and masterclasses on a number of these conditions. I'm going to have to do masterclasses on the rest of them now.

I'm about to do one on gallbladder disease, on gallstones. I have done deep dives into the research, looked at the guidelines, looked at every paper ever written that claims to prove that being fat causes these, and they fail every single time. No one has ever been able to prove causality for any of these conditions, and yet they also did a separate calculation for antidepressant use.

As a fat person on antidepressants, this is making me mad. Is it making you mad? Are you feeling rage right now? Don't worry. Stick with me. It's going to be okay.

So listen, if being fat does not cause any of these diseases but is merely correlated to them, then we have problem number one. We're attributing a cost to being fat when there isn't a cost that we can prove. So there's an overestimation of the cost.

There are also all of the other confounding variables that we forget about—socioeconomic factors, social deprivation, healthcare access, systemic oppression. All of those things might be factoring in, making it difficult to make a guess and estimation, and cold, hard figures don't take any of this stuff into consideration.

And then there is something called reverse causality. Please remember this term—reverse causality. Some conditions actually cause weight gain rather than the other way around. Diabetes is a classic example of that. Insulin resistance causes weight gain; weight gain does not cause insulin resistance. So that complicates the calculations.

And then there's the idea about antidepressant use. There's also a bit in this report about COVID-19, but I haven't gone there because it's too triggering. But the antidepressants analysis in the report makes me quite sick. It really makes me sick because they've done a calculation: this is the cost of antidepressants, this is the cost of antidepressants that we can link to obesity, and therefore this is how much money we'll be saving if we got rid of obesity.

Let me tell you why that is a problem. Number one, you're assuming that being fat causes depression rather than the fact that perhaps depression may cause weight gain, and/or there might be some other factors that influence both the rates of depression and the rates of fatness. There's no causal relationship.

And then you're making a really big assumption that if we got rid of fatness, we would no longer need to take antidepressants. If I was suddenly thin, I'd no longer need antidepressants? Has that been your reality when you've gone on a diet, when you've lost weight? Can't say that has been mine. In fact, I felt really bad, and my mood certainly wasn't doing great when I went on a diet. Depression is often the thing that is my limiting factor when I've tried weight loss in the past—I got to a point where the depression was so bad that I stopped.

And then there is an assumption—and I think this is the bit that makes me so mad—that depression in fat people is somehow different to depression in thin people. We can have a conversation about how it differs because of the way that society treats fat, depressed people versus thin, depressed people. But being fat doesn't fundamentally change how depression impacts us in our body. It's disgusting to assume that it does. There's levels of ableism there that I can't even begin to fathom.

So that's the cost to the NHS. Then there were the individual costs, and I'd like to remind you that the individual cost was 74 out of the 98 billion.

The individual cost—in other words, how it's impacting you and I, me, us.

So how do they measure the individual cost? How do you measure the cost of being fat? The Tony Blair Institute has done it for you. They measure that using something called a QALY—a quality-adjusted life year. Feel free to Google it.

Basically, what this does is it combines quantity and quality of life by assigning—get this—one year of perfect health with a value of one. Perfect health, folks—that's a value of one, and I think dead is a value of zero, and everything in between is a spectrum of health.

Perfect health—someone remind me what perfect health is again? I can't remember. We defined it, right? No, hang on. No, we didn't. That's because perfect health is kind of hard to define, because we can't define health in the first place.

Already there seems to be a problem. Even though we're dealing with ones and zeros, it's already a problem. So the idea is that we can come up with a number. And how do we then attribute a financial number? How do we go from a QALY, which is just a number—which in itself is flawed because it's based on the idea that such a thing as perfect health exists, and we can define that, and we can give it a number one, and everything else is less than one? That in itself is flawed. But then, how do we take the QALY and attribute an actual monetary value to one year of "perfect" health? What is the value of that? How do we work that out?

Well, there are lots of ways to do it. First of all, we could ask people, "What would you be willing to pay to gain an additional year of perfect health?" Which is really crazy, isn't it? The idea of just asking people—out of curiosity, how much would you be willing to pay? I'm curious what that number is. If you're watching this on YouTube, I'd love it if you stuck it in the comments. Just give me a number—the amount of money you'd be willing to pay to gain an additional year of perfect health, assuming you can define perfect health for yourself.

We could estimate a person's economic contribution—how much people put into society—and therefore, on average, how much an extra year of their perfect health would be worth. That would assume that's only for people who work, because people who don't work are not valued citizens. So we don't include those in our calculation, just in case you're wondering.

We could observe how much people are willing to accept as compensation for a risky job. That's one way of doing it—how much do I have to pay you to do a job that may threaten your life? How much extra do I have to pay you? It's a shockingly low number, by the way.

And we can also look at health risks—what people are willing to pay to do things that would actually put their life in danger. We can observe those choices.

We can do a number of things to basically put a number on it. And I want you to know that the NHS—and by the NHS, I mean the National Institute for Clinical Excellence—says a QALY is worth roughly between 20 and 30,000 pounds per year, roughly. And the Government—His Majesty's Government—says it's about 66,000. It was 2-3 years ago: 66,000 pounds. In case you were wondering, you can decide how much a year of perfect health is worth to you. But according to our government, it's worth 66,000 pounds. You're welcome.

So we calculate the QALY, then we just do a simple mathematical equation, and we come up with what was it? 54 billion if you're "obese." But if you're "overweight," it's only 9 billion.

It's a bit controversial, isn't it? How do we reduce human experience to a monetary figure? How do we live in a world where that is possible? That's what I want to know. Are we not just commodifying human life? Is that just not what we're doing? Health—we've given it a number.

And I really want to ask the question: are all lives valued equally under this system? If it's all about a person's economic contribution, how much someone is willing to pay—if you have less money, you are willing to pay less money because you have less money. I'm sure Elon Musk would pay a lot more for an extra year of health than I would. I don't think in those types of figures.

And when it comes down to being a bit objective about it, it's inevitable that people who are already oppressed by society are going to be excluded from these equations, are going to be penalized by these equations. It goes without saying, right?

Just the idea that people can put a number on the quality of life—who gets to do that? Who gets to decide? I really want to ask the government: How did you come up with this? How dare you? It's not "How did you?"—it's "How dare you come up with that number? Who do you think you are to tell me what my life, my health is worth?"

And then don't forget, I talked about the NHS cost, the healthcare cost, the healthcare services. There was the individual cost. And then there's the wider society cost. And this is what the Dude Bros just love to talk about, isn't it? "What about the number of sick days? You're just calling in sick all the time. You're just not productive." That's my Dude Bro accent impression. It's all about productivity, isn't it? Because that's how we define human worth nowadays in society. How productive are you? How many days are you taking off work sick?

God forbid you don't have a job, or worse still, you're too sick to work—disabled. What are you? You are lower than low, you are useless, you are nothing in society.

This is bringing back one of the reasons I'm very angry: my father. I try not to think about my father at all—sperm donor, useless, abusive, narcissistic that he is, but he has come up in conversation recently. My Daily Mail, Reform-voting father. I don't know that he votes for the Reform party—I'm assuming he does. I'm assuming that he worships the Elon Musks and Donald Trumps of this world because that's the kind of person he is.

I know that he hates immigrants, which is funny because he's an immigrant. He immigrated here in 1978. English isn't his first language, but he hates immigrants, and he hates sick people, and he hates anybody on benefits because they're "the scum of the earth," and he thinks his life has been really hard. He's had it so hard—Boomer.

Anyway, this is bringing up a lot of anger and aggression towards my father as well. I just thought I'd put that in there. Why should I not share that with all of you? He's a terrible person. There's a reason I haven't spoken to him in many, many years and will never, ever speak to him again.

People—I can imagine what my father has to say about people who take days off work. He never took a day off work. He never did anything for his family and treated his wife like a slave, but he never took a day off work.

And then, of course, social care—the idea of social care upsets some people. "Why should we have to look after people, members of society that are struggling to look after themselves? Why is that our responsibility?" That's what they say.

And then the Dude Bros will tell you things that are absolutely untrue, like being fat and the cost of obesity is increasing our health insurance premiums. The hell it is. I'll tell you who's affecting your health insurance premiums: the CEOs of health insurance companies. That's the people you should be worried about, not fat people. They're not doing anything to your health insurance premiums, because, as you can see, these calculations are absolute nonsense—they do not make sense, there is no value. And really, the only reason we create these calculations is so that companies such as Novo Nordisk can make money. Because there's no other purpose to this.

So I had this idea—it was like a thought experiment. I asked AI, "If I were to commission a report into the cost of being male to the United Kingdom, using similar methodology as they did for this Tony Blair Institute report, what would it find?"

And Claude said, "Interesting question! That's really interesting." Let me tell you. First of all, it would find very striking results. Number one, when we look at the individual quality of life—so individual costs—it would find substantial QALY losses, because men in the UK live approximately 3 to 4 years less than the average woman.

And I'm saying "man" and "woman" and "male" and "female," acknowledging that the gender binary is nonsense, acknowledging that gender and sex have nothing to do with each other, and acknowledging that there is a whole entire group of people who are missing from this equation. But I'm going to put all of that to one side because this is a thought experiment, and there's only so many plates I can spin at the same time.

When I talk about "male" and "female," I apologize to intersex people for excluding you from this thought process, but quite frankly, I'm just not that smart.

So men in the UK live approximately 3 to 4 years less than women on average. So if we use the same 66,780 QALY valuation, it will translate to a massive cost, because 50% of the UK is male. And that's 4 years, 66,000, and you can do the math.

And what about the cost to the NHS, to healthcare? Well, remember PAFs—population attributable factors—where we basically asked ourselves what percentage of this disease in the population would be eliminated if we got rid of males in this case.

Well, let me tell you, cardiovascular disease is much more common in males—earlier onset, higher severity. Many cancers, including lung, colorectal, liver, bladder cancers, accidental injuries, and deaths—much higher in males than in females. Suicide—approximately 3 times higher in males than females.

So there you go. If you just wanted to dig down and look at population attributable factors and calculate the cost of being male to the NHS, well, it would be quite substantial, wouldn't it? Again, a reminder—fat people make up 25-30% of the UK, but males make up 50% of the UK, so significantly higher costs.

There'd be increased healthcare utilization costs because men use the healthcare system more than females. There would be productivity impacts because of how many days of work males are missing, and the impact of social care, etc.

And also we have to remember behavioral factors. There are higher rates of risk-taking behaviors in males, substance use, delaying healthcare—all of these things higher in males than females.

So if I were to use the same methodology that the Tony Blair Institute used, if I was to commission this report, I would find the cost of being male probably far exceeds the 98 billion a year.

And you might say, "But Asher, one can't help being male." Yeah, but actually, the parallels are much, much closer than we'd like to think. Because, like being fat, like obesity, being male has some modifiable components—risk-taking behavior, not accessing healthcare quick enough. There's some modifiable factors; however, when it comes down to it, the majority is not modifiable. These are biological, hormonal, genetic, DNA factors that we cannot control. So actually, there are a lot of similarities between being male and being obese.

Again, the methodology is going to blur correlation and causation. We can't say for sure that being a man is the cause of your heart attack. Come on. You can't say that, no more than we can say that being fat is the cause for your heart attack. The lines between correlation and causation are blurred either way.

And then how would you feel, Dude Bros, if I commissioned this report and said to you, "Actually, you're costing us a lot of money. What if we got rid of you? What if we just eliminated you from the equation? Got rid of males just like we're getting rid of obesity?"

Let's expand on this thought experiment. We don't need that many males to keep the population afloat, right? Because at the end of the day, we need females. Females are the ones that gestate, incubate—they have the oven for the bun, as it were. Males just produce the ingredients, and so we therefore need fewer males to maintain our birth rates—you just share them around is what I'm trying to say.

So what if I were to discover or create a drug that you could give to people prior to conception that would basically reduce your chances of conceiving a male by like 90%? So we won't completely eradicate males, or maybe it reduced it by 100%, so we could only conceive females. And then we allowed a certain number of males to be born, but we monitored that. We absolutely controlled how many males we allowed to be born in society, and so we were predominantly a female society, and that would reduce healthcare costs massively, wouldn't it?

So why aren't we doing that? Just out of curiosity, why are we not doing that?

So I guess this thought experiment exposes some of the limitations of how we frame health economics when we calculate the cost of being fat, the cost of being disabled. Why don't we calculate the cost of being male? It would be so good to calculate the cost of being male.

Essentially, what we're doing is we're comparing an idealized, unattainable alternative, right? An alternative reality in which we could just completely eradicate fatness off the face of the earth, as some would love to do.

I mean, there are people out there who want to get rid of all immigrants. They want to get rid of all sick people or disabled people. There are people out there who genuinely think society would be a better place if we didn't have these groups of people. These people are vile. There is no other word in the English language that quite encompasses it. They are the scum of the earth. They are disgusting for even thinking that we should be eradicating any group from society in order to better society. But they exist—eugenicists, fascists, Nazis. You can call them whatever you want.

There are people out there who think that way, but I just wondered what would happen if we turned the tables and just made it about males.

The last thing I want to do before I come to a close is actually calculate the cost of calculating the cost. Because this is the thing, isn't it? We owe society a debt of health. And so what we're going to do—that's the theory, we owe society a debt of health—we're going to calculate just how much we owe. We are going to calculate the bill. And here it is, the bill to the United Kingdom. Fat people like myself: 98 billion, please, per year. That's the bill for being fat.

So I want to know, what is the cost of calculating that cost? And I've thought about it, and I think that perhaps I haven't developed it as much as I ought to. But think of the stigma it causes. This calculation is responsible for all the stigma that we're experiencing, and we all know how stigma impacts people.

Think about the denied healthcare. We are using this number, these risks that we're calculating, this implied causality to deny people healthcare. It's messing with people's insurance premiums. This is giving insurance companies the excuse to charge fat people higher premiums. We're putting a financial burden on fat people by asking them to pay for weight loss.

We're excluding fat people from society. And I say fat people because I'm thinking about fat people. Because I'm always thinking about fat people. You could replace that with disabled people. You can replace that with Black people. You can replace that with any marginalized group, oppressed group.

When we calculate the cost of individuals, groups of people to society, we are intentionally stigmatizing them. We are intentionally excluding them from society. We are intentionally profiting off them. That's the cost of calculating the cost.

So my question was, do we owe society a debt of health? I think you know where I stand on this. I think I could have just gone "no" and ended the podcast. But hopefully, you found my thought experiment useful. Hopefully, you found my analysis of this disgusting paper useful also. Just knowing the origin story, just knowing that it was commissioned by Novo Nordisk should give it away really—in time for the NICE approval of Wegovy just puts everything into perspective.

So we've come to the "everything you've been told about weight loss is a lie" portion of the podcast, and today I am talking about a paper by Stevens and Co.: "Adults and childhood weight influence body image and depression through weight stigmatization." That is the title of the article from the Journal of Health, 2017.

This study looked at how weight stigma, which they defined as being judged or treated badly because of your weight, might explain the link between body mass index in childhood and adulthood, depression, and body dissatisfaction. So they were looking at these three things: your weight (body mass index), your levels of depression and body satisfaction, and they were looking at your weight in childhood and your weight in adulthood.

It included 299 female university students. Males not accepted—part of my thought experiment if you will. The average age was 20.5. The average BMI was 23.3. There are limitations to the study. It was done on thin women, most of whom were white. But still, it's a study. And studies are studies. And so we need to take these limitations into consideration as we're looking through the research.

So they basically tested whether lifetime experience of weight stigma acted as a mediator for depression and for being fat. In other words, whether stigma was the reason why people with higher BMI felt more depressed and/or dissatisfied with their bodies.

And they found that weight stigma explained the link between BMI and body dissatisfaction, the link between BMI and depression, and the link between being a fat child and depression.

In fact, the model they used explained 45% of the variation in depression and 28% in the variation in body dissatisfaction. As I'm reading this, I'm wondering if I've done this study before. Maybe I did it for a course. It's just, I'm having a déjà vu moment. If I've already covered this study in a previous podcast episode—hormones, I forget things.

But yeah, fascinating stuff, right? So what they found was weight stigma was actually responsible for about almost 50% of the variation in depression, which kind of takes us back to the antidepressant thing.

Novo Nordisk is obsessed with mental health at the moment. I have noticed they're spending an awful lot of money on research that involves psychiatry, which is weird because they don't make any mental health drugs. They don't make psychiatric drugs. So you've got to wonder why Novo Nordisk is so obsessed, why they are spending millions and millions on organizations, on doctors, on research into mental health.

And I suspect it has something to do with the fact that they are using the link between depression and being fat as a means of pushing weight loss. But this study directly speaks to that, because what it's saying is actually the real issue here is the weight stigma. So instead of eradicating the weight, we can just eradicate the weight stigma. And that's actually much easier than eradicating the weight, because it's impossible to eradicate the weight.

We know that weight loss is unsustainable. We've known that for a very long time, and Novo Nordisk's drug isn't making a difference to that. It just helps you to lose weight for a period of time. It doesn't help you lose weight forever and has all sorts of risks associated with it.

So eradicating fatness is not really possible. Eradicating weight stigma is absolutely possible. It's quite easy and very cost-effective. It's quite cheap to eradicate weight stigma. It's not going to cost much—for some people, it's not going to cost anything at all. So if you want to get down to the costs, this study is a really important study, isn't it?

Weight stigma has a very powerful negative effect on mental health, and the study really supports that. And so reducing weight stigma improves body dissatisfaction and body image. It also reduces depression, almost certainly more than actually focusing on weight itself.

So next time somebody says to you, "I see you're depressed. Maybe you should consider losing weight," you could say, "Actually, there's a study from 2017 that disproves this, that it would be much better, much more effective, much more useful and helpful for me—for society—to address weight stigma than for me to lose weight. So it's a you problem, not a me problem. Thank you very much."

And finally, the "ask me anything" portion of the Fat Doctor Podcast. I have been saving up this question for this episode, and you'll see why shortly. This was part of a conversation I was having with somebody. In a nutshell, my brother is—she didn't say "an asshole"—she said, "My brother is constantly reminding me that being fat and disabled, chronic pain, being fat and disabled, is a drain to society." He doesn't necessarily say to her, "You're a drain to society." He's just constantly bringing up the fact that people who are fat and people who are disabled are a drain to society. And so she was basically asking me, "What can I say to shut him up?"

My first option, because you mentioned it was your brother, was to say, "Yeah, being male is a much bigger drain to society. Just so you know, the biggest drain to society—one of the biggest drains—you can say, is being male, much bigger drain than being fat."

And another thing you can say is, "Shut up! I'm not having this conversation with you."

And I think that is really the main message of this podcast episode. Do we owe society a debt of health? The hell we do. We do not owe society a debt of health, absolutely not. I have autonomy.

And whilst I do believe that to a degree we have a responsibility as a collective, as a society, as a community, to look out for each other, to support one another, you have to support me before I'm going to start supporting you, because at the end of the day, I'm the one that's being oppressed. I'm the one that's being badly treated. 

Now, if you make healthcare access equitable, if you stop stigmatizing me, if you create a world in which I am no longer punished for being fat, then I tell you what—then I will agree with you. Then I will say you make a fair point. We do, in a Utopian society, probably almost certainly have a collective responsibility, have a responsibility to the collective, maybe. 

But not in this society—not in this society where thin, white, cisgender, heterosexual, non-disabled, wealthy men essentially are making decisions that affect all of society. No. I don't owe you anything until you get rid of them. 

I think I might turn the coin back around to the brother and say, "And what are you doing that's contributing to society? How are you helping people in society? How are you addressing economic inequality, injustice?" Have a list of things. 

What are you doing? "Drain to society—really? You think that you can calculate how much you're worth? Go ahead and calculate it, and then I will calculate how much I'm worth, and I will prove that I'm worth more than you." That's what I would say to my asshole brother, if I had an asshole brother. Thank God I don't. 

All right. This was a very rage-filled podcast. I knew it was going to be rage-filled. I make no apologies for my rage-filled podcast. I warned you at the beginning it was going to be somewhat triggering, and that I was going to be very angry. I am filled with anger, filled with swear words, filled with righteous fury towards those who had the audacity to calculate how much I am worth, how much my life and my health is worth. 

Fuck you, Tony Blair, fuck you Novo Nordisk, fuck you Google for telling me this in the first place, fuck everybody who ever quotes this statistic, and also let it be known that the sole purpose of creating this report was so that Novo Nordisk made money—more than 98 billion, much more than 98 billion. 

So thank you for listening. Hope you enjoyed today's podcast. I hope you'll come back next week and you aren't too put off. I will have a new made-up, fictional person for you to enjoy—for those of you who like my podcasts. We've done all sorts of people so far. Who was last month? Can't remember. Was it Charlie? Don't know. I'll have a new one for you. What else do you need to know? 

Weight Inclusive Wednesdays—are you coming to Weight Inclusive Wednesdays? That's for members, for people who are part of my memberships, but you can join if you want to join, and you're not part of my memberships—you can join as well. Are you reading my newsletters? I'm only sending one a week. Have a look through. They're full of useful information, and we just had my first Coffee and Catch-up. I think we had it a couple of weeks ago. 

That's going to be a monthly thing now, and this is for all of the community. You don't have to be a member of any of my memberships. You don't have to pay. This is completely free. It is something that you have to register for. I've tried to create a safe space away from social media. It is why I'm not doing IG Lives anymore. I don't trust social media. We're living in 2025, people. I'm not putting my content out there anymore. 

If you want to come and spend some time with me, I absolutely encourage you to do so. But we're going to do it in a safe space where no one is watching. So it's absolutely free to come. I'm hosting it on Zoom at the moment because that feels relatively safe. We'll see. Watch this space. But for now, it's a Zoom call once a month, last Wednesday of the month at 5 PM UK time. Anyone can register. I send a link out in my newsletter. I put it on my social media feed. I send an email. All you need to do is register and come be part of a really safe space. 

I'm trying to hold space for community. That's all I'm trying to do. For those of you who can and want to be there, who have the time and the energy to spare and just want to meet other like-minded people, I'd love to have you there. So it's called Coffee and a Catch-up, and it's on the last Wednesday of every month. 

So there's Weight Inclusive Wednesdays, which is the second Wednesday of the month, which is more a bit more teaching. I mean, it's mainly conversation, but we'll have topics and thoughts, and perhaps we'll be looking at some of the issues that came up in the membership programs. And then there's Coffee and a Catch-up, which is just coffee and a catch-up. I will see you next week, or I will be here next week, and you can join me or not, depending on how you feel. 

Take care! Have a great week.