There is no such thing as a healthy weight

We've been told our entire lives that there's such a thing as a "healthy weight" - but the foundations of this belief are built on quicksand. In this episode, I trace the shocking history of how weight categories were created, exposing the corrupt origins of BMI and "ideal weight" tables invented by life insurance companies to maximize profits. I reveal how Louis Dublin, an employee of the Metropolitan Life Insurance Company who literally wrote a book called "The Money Value of a Man," created arbitrary weight standards that had no basis in reality - and how these numbers kept dropping with no scientific justification.

What would life be like if Dublin had got decided that "abnormally tall" people needed to shrink to be healthy? I use this thought experiment to demonstrate the absurdity of medicalizing body size, especially since we've no evidence that “excess weight” causes illness or that intentional weight loss improves health outcomes.

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Transcript

And welcome to Episode 2, Season 6 of the Fat Doctor Podcast. I am your host, Dr. Asher Larmie, aka The Fat Doctor, here with you today to leave you in no doubt that there is no such thing as a healthy weight.

No such thing!

Nobody can tell you what your healthy weight is, because it doesn't exist. It's not a thing. It's like saying there's no such thing as a healthy height, or a healthy eye color, or a healthy shoe size. Or a healthy… I'm running out of things to say. But yeah, there's a thing. And I know a lot of you are gonna be like, because all your life, all your life since you were a tiny little baby, somebody has told you that there is a healthy weight. You didn't understand it when you were a baby, but your parents were taking you to see a health visitor, or a pediatrician, or whatever, and you were getting weighed on a regular basis when you were an infant, and they were just telling you, or telling your parents, this is a healthy weight, this isn't a healthy weight. So even when you were an infant, even when you were a few days old, we were telling you that there was such a thing as a healthy weight.

And I should put a little caveat in here, that it is possible to be underweight. What constitutes underweight? I don't want to get into that, because I don't want to detract from the message here, but it is possible to be underweight, and of course, when you're an infant, you know, failing to thrive, not growing properly, can be a sign of an underlying illness, and it's very important, and I'm not saying we shouldn't be weighing children or anything like that. Well, yes and no, but it depends. I don't think… I don't have any issue with weighing patients when we're concerned that they are underweight, or that they're losing weight, because this can be a sign of a serious underlying pathological condition that we should not ignore, ever. So, I am not talking about underweight here, alright? I'm never going to mention that term again. It is important, of course it's important. Let's not be disingenuous, okay?

So, I am talking about a healthy weight in terms of being overweight, because you can't call somebody quote-unquote overweight unless you've defined a healthy weight, right? Logic.

So, today, get ready, strap in. All the haters on YouTube, you're gonna love this one.

So, how do we determine… how do we, the medical profession, determine when something is a healthy anything? Alright, let's go for a different example. We're gonna go for blood pressure. Alright, there are all these quote-unquote markers of health, and I've picked blood pressure just because I don't know. I was kind of interested in it, and I read an article once about it, and I thought it was interesting. So I focused on it, and I included it in the book. And as you are going to come to know, as I keep saying this over and over again, over Season 6, this will be in the book. This is in Chapter 1 of the book, in fact. It's the beginning of Chapter 1 of the book, like, how do we, as a healthcare profession as a whole, determine what is healthy and what isn't? So let's look at blood pressure.

Right? If I said to you, what is a normal blood pressure? I remember learning in medical school, normal blood pressure at 120 over 80, but actually, that's like saying the due date for when someone's going to be born. A lot of people… I think it's only 5% of babies are born on their due date, and the majority are born before or after their due date, so there has to be a range, right? So, we call that, in pregnancy, we call it term. Anything between 37 weeks and around 42 weeks, depending on who you ask, is term, right? 40 weeks on the nose, that's your due date, but no, between 37 and 40 is fine. It's fine. Somewhere in there, right?

Same with blood pressure. So, what is considered low? Again, it kind of depends, it depends on who you are, and it's different for each individual, but, you know, we don't really want to go below 100 systolic, definitely not below 80 systolic, and we don't want to go below 60 diastolic, because, you know, you might faint, collapse, depends on who you are. I knew somebody whose resting blood pressure was 80 over 60, that was just their blood pressure, but, you know, that's quite unusual.

But we don't really focus too much on low blood pressure, because that's generally not a worry unless someone's bleeding out, or, you know, for other important reasons. So, we talk about high blood pressure now. How do we determine what is quote-unquote normal, and what is high?

So how did we, you know, these are numbers that we all know, and that we can all quote, although I have to say, it differs, depending on where you are. If you're in the US, the numbers that constitute high are actually lower than if you live in the UK, and if you go by the WHO's, the numbers are even higher, so, I mean, not everyone agrees. But we'll just, well, just for argument's sake, say that high blood pressure is 140 over 90. That's the WHO definition. Right, that's high. So anything under high is considered normal.

So, how'd we get there? How did we decide? First of all, this is gonna sound obvious. We first have to measure the thing that we're talking about, right? The so-called health marker. We have to measure it. We didn't always measure blood pressure. I don't remember exactly when it was, but somebody invented the sphygmomanometer, which is the thing that used to measure blood pressure before the electrical one, you know, the thing we used to pump. And it was right at the tail of the 20th century, somebody called Korotkoff discovered that there was two sounds, top sound, which is the systolic blood pressure, and the bottom sound, which is the diastolic blood pressure. And then we started measuring it, and we started measuring it without really understanding what it did. We just knew that it existed. It's a thing we could measure.

And we didn't recognize that it was a risk factor for disease. We had all sorts of theories about blood pressure to begin with, but nobody actually realized it was a risk factor for disease. Except, after a while, pathologists were performing autopsies, and they noticed that people who died of heart attacks tended to have very hard, very rigid arteries supplying the blood vessels supplying the heart. They were just very rigid, very firm, they could feel them, and they were like, oh, that's a bit odd. Wonder what that is? And they rather logically, I guess, noticed that, actually, people who had heart disease and these hard arteries also had high blood pressure, and that makes sense, because these arteries are so hard. So, of course your blood pressure has to go up to push the blood through these hard arteries, you know that? The extra work, that's what they theorized.

And then over time, started doing some studies. There's a famous study called the Framingham Study, which is, a lot of our preventative medicine, and what we understand about heart disease and how to prevent it, comes from the Framingham studies. And basically, it was a town of Framingham in Massachusetts. We followed a whole bunch of… it was over 5,000 people, from very young, for decades. And I think we're into the third generation of Framingham participants now, third gen. But, we were just following them, and the researchers realized, oh, people who have high blood pressure at the beginning of the study were more likely to have a heart attack, or a stroke.

So, maybe the two are related. One is associated with the other. Now, remember about association, it is not the same as causation. Just because one thing precedes the other, doesn't mean the first thing calls the second thing, right? That's a logical fallacy, to assume that just because one thing happened and the next thing happened, that one caused the other. We needed a bit more evidence, but now we're starting to think, oh, hang on a minute, I think we think that blood pressure and heart disease might be related somehow. We are seeing that people who have high blood pressure end up with heart disease. Does the heart disease cause the high blood pressure? Does the high blood pressure cause the heart disease? Or does something else cause both of them? We don't know. We can't tell. But we're beginning to see a pattern, an association.

And then there were all these researchers who started looking at blood vessels under the microscope, and start to realize, actually, high blood pressure appears to damage the inner lining of the blood vessel wall. This is called endothelium, the inner lining of the wall. Endothelial damage seems to… that's what blood pressure does. Oh, hang on. It's damaging the wall, and then we noticed that by damaging the wall, it created space for these build-ups, these fatty deposits, these plaques, to build up inside the artery walls. And, like, they narrow the artery walls, and after a while, that causes chest pain or angina, and if they fully block, then you get heart attack. So now we have this biologically plausible mechanism. We have, like, you know, we've sat down and we've said, here's how it works. You get blood pressure, high blood pressure, that damages the inside of the blood vessels, slowly plaques build up, we call this atherosclerosis. Once they cause narrowing of the arteries, that significant narrowing of the arteries, you get chest pain and angina, and if you get a full blockage, you get a heart attack. That was the mechanism. We managed to prove that.

This is all well and good. We're starting to realize now, yeah, actually, high blood pressure, heart disease, the two are definitely related, and it's sounding more and more like high blood pressure causes heart disease. But actually, before we could really claim that high blood pressure caused heart disease, what we needed to prove was that reducing blood pressure reduced the incidence of heart disease. Because that's a smoking gun, right? Like, up until this point in time, it's all observational stuff. It's just things we've seen in society as a whole, things we've seen under a microscope. But if we can prove that treating high blood pressure reduces your chance of having a heart attack, that's a risk factor. Now we've got a bona fide risk factor for heart disease.

And that's exactly what we did. In the 1970s, we started off, I believe, with US Veterans, a US veterans study, and we kept on going, and we proved… I mean, there's no question now, there's overwhelming evidence that reducing blood pressure reduces your risk of heart disease. So if we want to prevent you from having, or reduce your risk of having a heart attack or a stroke in the future, one of the most important things we can do is reduce your blood pressure. But by how much?

There's no magic number where suddenly the risk appears. We just know the risk exists. We know that lowering it reduces the risk, and we know that the higher it is, the higher the risk. There isn't a magic number. How did we get to the number 140 over 90?

Well, what happened was a whole group of experts came together, and they took all the studies that they could possibly get their hands on, and they basically decided on the number. You know, when did the benefits of treating high blood pressure outweigh the risks of treating high blood pressure? At what point in time? And, you know, the question that they asked was, when do the benefits outweigh the risks? But were they interested in quality of life? Were they interested in risk reduction? You know, were they more interested in how low the number had to be, how high the number had to be? It kind of depends, right? Like, there's a whole series of questions involved as to when… where do we draw the line? What's the cutoff? We all think, oh, it's a magic number, there's a real reason behind it. It's not, it's just a group of experts got together and made a decision based on their best guess.

And that's why it differs. That's why the WHO has a different level to the National Institute… the NICE in the UK, and to the National Institute of Health in the US, and I'm sure other countries will all have different definitions of what constitutes too high. When do we treat? How do we treat? Etc, etc. Depends on the guidelines. The guidelines depend on the Guidelines Committee. So it's not an exact science.

But at least with high blood pressure, we've got a lot of good evidence, right? And we have none of that for weight. Absolutely none of it.

We do know that higher weight is associated with certain health conditions, but, and I'll get to the but in a minute. We have no biologically plausible mechanisms. There's lots of theories, all of which can be and are easily disproven. So every time somebody goes, oh, it's inflammation, then you could argue, yes, but the inflammation could be caused by XYZ, and then all of a sudden, oh, yeah, well, maybe you're right. There's no definitive, look at it under a microscope, here's your proof.

But don't forget, even with that evidence, that wasn't enough. We needed to prove that reducing blood pressure reduced illness. Increase life expectancy. Decrease your chance of heart disease. Can we prove that with weight? No. We have tried. And over, and over again. And, you know, I said in last week's episode, I spent a lot of time in the guidelines, looking at the research in order to make a recommendation to lose weight to improve whatever condition, say, fatty liver disease. There has to be evidence that losing weight improves fatty liver disease, and there isn't. There isn't any decent quality evidence. It's gotta be high quality. You can't stick with very low quality evidence. I mean, I can find very low quality evidence that's no harm in smoking if I wanted to. I can find lots of very low-quality evidence. I can find low-quality evidence that being bald increases your risk of heart disease. I can find low-quality evidence that being left-handed increases your risk of heart disease. I can find all sorts of low-quality evidence for all sorts of things. But it has to be high-quality evidence, right? And it doesn't exist. There is no evidence that reducing weight improves health. Not like with blood pressure.

No biologically plausible mechanisms. All we have is some half-baked theories. And so, some of you are thinking, well, hang on a minute, how did we get here? Like, how could that possibly be, Asher? Like, come on, that doesn't make sense, I don't believe you. Of course you don't believe me, why would you? I'm gonna tell you. I told you, I'll bring the receipts. I'm gonna tell you, I'm gonna give you a little history lesson.

To start with, I gave you a history lesson about blood pressure, and I'm gonna give you the same history lesson, and believe me, they're very similar. They kind of start off in the same way, and then they diverge.

With blood pressure, we first began to notice that high blood pressure was linked to heart disease. As I said, we were doing autopsies, but also there was data from life insurance companies. We call this actuarial data, right? Insurance companies had data. People with higher blood pressure seemed to die more, or seemed to die earlier.

And actuarial data, or life insurance data, showed a similar thing with weight. Way back in 1897, 1897, that's a long time ago, right? The first ever average height weight tables were published by life insurance companies. I think it was Metropolitan Life, I'm not sure if the first ones were from MetLife. And all they did, all they did, was they started measuring it, and that's, of course, remember, with blood pressure, the first thing we have to do is measure it. We didn't always measure weight. Somebody had to invent the bathroom scales, you know? Somebody had to make it possible to measure people. So we started measuring it, and the life insurance companies were measuring it, because they wanted to measure as many things as they possibly could, so that they could charge you money for it. That was the plan, right? They wanted to increase your premiums, so they measured a whole bunch of stuff.

And so they measured the weight and height of their policyholders, and they published tables with the average weight and height of all their policyholders. So, there was nothing. All we were seeing was just what was average for the population at the time. And not for the entire population, for the population at the time who were rich enough to afford life insurance, which is not everybody.

All we have is an example of the average weight, and so what we found was that in 1897, the average female was 5'4". They were separated by age and by sex, so the average female was 5'4". I don't think that's very different, actually, to today. That's 163cm for those who prefer metric. At the age of 20 to 29 years, the average female, 5'4 female, weighed 126 pounds, that's 57 kilograms, in 1897. And by the age of 50 to 59, she weighed 145 pounds, that's 66 kilograms. She had gained weight! Between her 20s and her 50s, not surprising, because that's what happens, we gain weight. That's what's meant to happen. As we get older, we gain weight. And this is important, it will become relevant in a moment. So, that was just average. Just average.

But we, as a society, have a bit of an obsession with average. For whatever reason, average is normal. We do not like outliers. On either end, really. You ever heard of the bell-shaped curve? You know, it's like a curve, where you put all the data in, and right in the center of the curve, that's the average, that is the mean, that is the most common, and then you've kind of got this bell shape, which is the majority of people are within this bell, and then right at the ends, we call these outliers, you know, the people who don't fit inside the bell. We don't like outliers as a society.

And I'm not going to tell you all the different reasons why society hated fat people, but by the time… by 1897… 1897, they did. Alright? Great books out there, go read them, Fearing the Black Body is an excellent example by Sabrina Strings. Why does society hate fat people? Well, there was lots of reasons. Racism, anti-black racism, was the number one reason. Religion, you know? Morality. Fat people were considered to be immoral, greedy, lazy, you know, selfish. During the war effort, you know, oh, they're stealing the rations from our hard-working troops, you know? Fat people were ugly. You know, people didn't like them. And that's changed over time, wasn't like that always, but certainly by the turn of the 20th century, and definitely the beginning part of the 20th century, fat people were considered ugly.

Fashion's changed. Like, once upon a time, we wore corsets… female women. I don't want to say women, because I don't like that term, because obviously it excludes people like myself, but I'm going to use it for this, for the purpose of explaining this. You know, women wore corsets. And then were liberated from the corset. And then soon after, in the 1920s, it was the flappers. Do you remember the 1920s flapper dresses, very low-waisted, very androgynous, no shape, shapeless. Didn't look great if you were fat. And then, not that long after, soon after, sort of, World War II ended, you know, I think it was Dior, or I can't remember who it was, possibly Dior, came along with the cinched waist. Now, all of a sudden, like, women wore corsets, and then they removed the corsets, but now women had to look like they were wearing a corset, even though they weren't wearing a corset. That cinched waist came back into fashion. Fashion's changed, and, you know, being fat was considered really unfashionable and really ugly, and immoral, and people didn't like… especially very fat people, didn't like them.

Even in 1897, if your weight… if you were outside of the average, if you were more than 20% above the average, you were charged a higher premium. But by the sort of 1930s, 1940s, there was a real, kind of, almost moral panic among society about fat people.

Again, remember, back at the turn of the 20th century, the majority of people were still dying of infectious diseases. Influenza, tuberculosis, pneumonia, and being thin increased your risk of dying of those illnesses, so actually having a bit of extra weight meant you had more robust health. But then, thanks to changes in sanitation and vaccination, penicillin, the end of 1920s, and then vaccinations, we got rid of polio, we got rid of pertussis and diphtheria and all the things that were causing people to die of infectious diseases. Now the most common cause of death in vast swathes of society were non-communicable diseases like heart disease and cancer. People were living longer. And, so our, you know, this idea that a bit of extra padding protected you was no longer important. Relevant.

Enter a chap named Louis Ezra Dublin. Now, I have mentioned him many times, it's because I hate him, because he really, like, he's played a very crucial role in the pathologization of fat bodies, and so his name will come up again and again. Dublin, and a chap called Alfred, I think, Lotka, wrote a book in the 1930s, entitled, The Money Value of a Man. And that should tell you everything you need to know about Lewis Dublin. He worked for the MetLife insurance company. He was really well respected in public health, and amongst doctors. But he worked for MetLife, his whole career. So he had this kind of, like, on the one hand, he was all about life insurance and making profit, and on the other hand, it was about public health and the well-being of the public. I don't think that those two ever can go together personally, but there you go.

Lewis Dublin, aside from calculating how much a man was worth, and I assume a woman as well, created in 1942, the ideal weight tables. Now, these differed from the original average weight tables, because it was no longer about the average of insurance policyholders. It's what they should weigh, the ideal weights. The first thing they did was they removed the age, because they believed you weren't supposed to gain weight throughout your lifetime. Why? Because people in their 20s didn't die as much as people in their 50s, so obviously, the weight you are in your 20s is much healthier than the weight that you are in your 50s. That was their logic. I shit you not. So, they removed the age.

Your average 5'4" female should now weigh between 116 and 125 pounds if she is quote-unquote small frame. I don't know what a small frame is. Nobody really knew what a small frame was. But that was the ideal weight throughout her entire life, she shouldn't go over 125 pounds. Now, for those who are paying attention, the average female in 1897 at 20 to 29 weighed about 126 pounds. So, I don't know why the ideal weight was less than average, but there we go. And that was in the 20s, as I said, as you got to 50s, you gained more. You weighed… the average female weighed 145, so significantly more. So the ideal weight was significantly less than the average weight, is what I'm trying to say. So not even average people, forget fat people, just not even average was good enough. That was the ideal weight.

And Dublin and his colleagues at MetLife, like, they had the Gospel of thinness, and they preached it wherever they went. And it wasn't just Dublin, it was a whole bunch of other doctors and politicians and religious leaders, all sorts of people were preaching the gospel of thinness. We had become obsessed by this point in time.

By 1959, so, like, less than 20 years later, they put new tables in, so it was the average weight tables, the ideal weight tables, now the desirable weight tables. Now, in the desirable weight tables, the average 5'4", small-framed female was supposed to weigh between 108 and 116 pounds. So the average was 126, then it dropped to 116 to 125, now it's dropped from 108 to 116! Throughout her entire life.

Now, you might be thinking, well, maybe people just got smaller, Asher, maybe people got thinner, maybe the average female weighed a lot less in 1959 than in 1897, but no. She didn't. Not at all. In fact, possibly she weighed more, but there was no correlation between average weights and desirable weights. These were just numbers.

And you might be thinking, where'd they get the numbers from? Good question! I don't know. Did we have studies that support this? No. I mean, there was observational data, maybe, but like I said, I can find any low-quality study to tell you anything I want to tell you about anything. Like, it's just very easy to find something to back up your beliefs, but that was exactly what was happening. They believed being fat was wrong, they believed being thin was good, fat was bad, thin was healthy, fat was unhealthy, and so they just created these tables!

And don't forget, these are insurance tables. Created by MetLife, the Metropolitan Life Insurance Company. If the Metropolitan Life Insurance Company said your weight should be between 108 and 116, and your weight is above 116, they had the right to charge you more. And that's exactly what they did, and continue to do, they don't exist anymore, but insurance companies continue to charge fat people more for insurance than thin people. It's just part of life, isn't it?

So, in 1959, we had the desirable weight tables. Of note, Weight Watchers was founded in 1963. In 1972, a man named Ancel Keys, which you will have heard of, published a paper. He and his team published a paper in the Journal of Chronic Diseases, the paper that created the Body Mass Index.

Now, what was the purpose of his paper? The purpose of his paper was to test a number of different methods to calculate healthy weights. At no point in time did anyone ask, should we be calculating a healthy weight? Nobody asked, is there such thing as a healthy weight? Nobody asked. What is a healthy weight? Like, what's it got to do with anything? Does healthy weight mean less heart disease? Does healthy weight mean less diabetes? Nope, that wasn't included in the data. That's not what the data was… that's not what the paper was about. The paper was about which of these methods of calculating healthy weight, quote-unquote, is actually the most accurate. And they tested, I think, 6, I think 6.

And they decided that BMI, which, they called it Body Mass Index, but it was a complete misnomer, anyway. But this, I'm sure you will have heard of Quetelet, I'm not going to repeat myself. Adolphe Quetelet, who 100 years previously had looked at, and this is interesting, he had looked at 48 individuals, 12 tall men, 12 tall women, 12 short men, and 12 short women. And he measured their height, and he measured their weight, and he found that weight was roughly proportional to height squared.

And, Ancel Keys and the team took this, you know, weight, height squared, weight over height squared equals a calculation, body mass index, that's what they came up with, body mass index, they created it. It was a thing. It's a statistical tool, it's a calculation. It's a really basic calculation, also. Very basic. Very, very basic. Based on a study of 48 individuals 100 years ago. Not a real study, like a pretend study. A study that was a study during its time, but would not be considered a study by today's standards.

So that's what it was based on. And at the time, and I'm sure I've mentioned this many times, at the time, Ancel Keys and the team, when they published the paper, said, this is not suitable for individual assessment. This is purely for population-based data. He also said it's the best of the bunch. Kind of, you know, like, politicians, you know? Pick the best of the bunch. None of them were great, none of them were perfect.

What is the purpose of BMI? It is to calculate two things. To calculate what is a healthy weight, or I guess, because we're obsessed with fat, what is a healthy amount of fat? Does BMI accurately calculate that? No. We have studies to show that it gets it wrong 50% of the time. So if you have a definition of what is too much fat, I mean, I don't personally think there's such a thing, but, you know, if you were able to define excess fat and then measure excess fat using modern-day techniques, and then measure BMI, you will find that it gets it wrong 50% of the time. So it's fucking useless. Translation. Absolutely, this only has one job to do, and doesn't do that job properly.

And yet, it is the only measurement we use to calculate a quote-unquote healthy weight. If you go to any website, or you go to any healthcare professional and say, can you calculate whether I have a healthy weight, they will measure your BMI. That's where we're at.

At no point in time was there a question… have we questioned whether there is such a thing as a healthy weight? There's no question as to whether this is actually going to benefit people. That just went without saying, because we hated fat people, we reviled fat people. By this point in time, we were convinced that being fat was bad for your health, based on absolutely nothing but a bunch of useless actuarial or life insurance data. That was all we were basing our theories on, and a whole bunch of moral and racist beliefs.

We stopped… we didn't actually ask why? Why are we calculating a healthy weight? All we asked was, how do we calculate a healthy weight? And nowadays, I mean, we just kept doing it, like, we haven't stopped. Nobody is questioning. You have been told, I'm sure if you're listening to this, that your BMI, if it's high, makes you unhealthy. You're unhealthy because your BMI is over a certain whatever. And that was because a whole bunch of experts decided that that was the case, but they've never proven it, not once. To this day, there isn't a shred of evidence that A, BMI is accurate at calculating health, because it's not. Doesn't accurately calculate whether or not a person has got narrowing of their arteries. It doesn't accurately calculate whether a person is going to get cancer or not. You know, it doesn't accurately calculate whether a person is… it's just not a good way of calculating anything.

Just because there are associations between higher weight and any number of diseases doesn't mean that having… being a high weight puts you at risk. Until you can prove causation, then it's just two things that happen to be happening at the same time.

With blood pressure, we know that high blood pressure damages the vessels. We can see that damage under microscopes. We have proven, without a shadow of a doubt, that lowering blood pressure reduces the risk of heart attacks, reduces the risk of stroke. It is a reliable marker of health. Weight is none of these things.

Now, I just want us to suspend the belief for a moment, and imagine that 100… 150 years ago, we decided that people who were over 6'2" were abnormally tall, right? 6'2", the average was 5'8", and, you know, anyone between 5'4 and 6'2 was normal, but above 6'2", that's abnormally tall. We can give it a name, if you like, ideally a Latin name, you know, a Latin name that sounds very clinical, you know, make it sound pathological, but basically, abnormally tall. Easy to measure, right? Just to measure your height, oh, you're abnormally tall.

And let's just say that we then decided that people who were abnormally tall were immoral. And were a threat to social cohesion, we're a threat to society as a whole, we're an economic burden. Let's just say we decided that they, that, you know, they'd done something wrong, that they were tall for a reason. Like, clearly, I don't know, it could be the devil, it could be… I don't… you decide.

And let's just say that the people in charge, the health experts, the public health pioneers at the time, the Lewis Dublins of the world. Let's just say that they really dislike tall people, like, they, like everyone else, believe that tall people were bad, convinced that they were unhealthy, because anything that's different, any outlier, anything that's outside of what is average, what is standard, is unhealthy. It's literally a disease, a threat to society.

So we went around telling people for 100 years, it's immoral, it's ugly, it's unhealthy. And then, after a while, we started noticing that people who were abnormally tall had higher rates of back pain, heart disease, and I don't know, what else? Cancer.

And we didn't consider the fact that maybe they have back pain because they're constantly having to stoop in a world that doesn't accommodate people their height. We don't consider the fact that, you know, they've got heart disease because they're super stressed, because they get treated like garbage, and it's very hard to get a job, and it's very hard to get a house, and it's very hard to get into secondary education, like, you know, just life is harder when you're abnormally tall and ostracized by society. We don't consider that they're more likely to die of cancer because they don't go and see the doctor, because they're afraid to go and see the doctor, because every time they see the doctor, the doctor is going to stigmatize them for being abnormally tall. We don't consider any of that stuff. All we say is, well, look, there's studies that show that tall people, very abnormally tall people, have heart disease and cancer and back pain, so what do we do?

Instead of thinking, well, maybe we should accommodate them more, we say, hey, how do you feel about limb shortening surgery? Make you a few inches shorter. How about this drug that stops your child from growing too tall? Mmm, they're looking a bit like they're gonna tip over into the abnormally tall. Treat them now, before that happens.

We don't, you know, we don't… we wouldn't… that's what we do. We don't consider what… we just say, oh, abnormally tall is to be avoided. And so, we don't have doctors, every time their abnormally tall patients come in going, well, what did you expect? No. We don't have doctors refusing to treat their abnormally tall patients until… Sorry, I'm kind of getting lost here, but yeah, the doctors will be like, I'm not going to treat you until you go and have limb shortening surgery, then I'll treat you. Like, that's the kind of thing that is happening to fat people every day. But imagine if we did it for tall people. It was just as reasonable, just as, you know, we picked fat, I mean, we could have picked anything.

That's how we did it. That is all it is. You know, you cannot label somebody as overweight, or fat, or obese, whatever word you want to use, unless you've established, or until you've established what a healthy weight is. And we have never been able to establish what a healthy weight is. A whole bunch of experts have declared it to be so, but just because they said it was so doesn't mean they were correct.

Next week, I'm going to explain why obesity… I hate that word, but you know, I'm going to explain why obesity, or being fat, is not a disease. It's not even… it's not a thing. It's just an observation, just like being tall. I'm gonna prove it, I'm gonna bring in the receipts, it's not a disease, it's just not… doesn't meet any definition for a disease. And that's why we shouldn't be measuring it.

Hope you enjoyed today. There's plenty more in the book about this. I've got lots of really interesting things, some quotes from Lewis Dublin. I read some of his articles that he wrote, especially the magazine articles. What a dick. I've got some quotes in there that maybe I'll share one day in a podcast, but otherwise you'll just have to wait till the book comes out. I hope you enjoyed today, as I said, and I'll see you next week. Have a good one!