How Big Pharma Made Up a Disease

In 1995, the WHO published a report stating clearly: "There are no clearly established cutoff points for fat mass or fat percentage that can be translated into cut-offs for BMI." Just three short years later, they published a completely different report calling ob*sity a "disease". Not just a disease, but a "rapidly growing threat" and a "global epidemic" that needed managing. What changed? Professor Philip James established the International Ob*sity Task Force—funded by the pharmaceutical industry—specifically to persuade the WHO to create ob*sity policy. When asked how he determined BMI cut-offs of 25, 30, and 40, Professor James admitted it "just seemed to fit"—a "reasonable, pragmatic cut-off." 

In this episode, I prove that being fat doesn't meet the definition of a disease: there's no impaired function, no characteristic symptoms, no causative agent. But calling it a disease created a market worth billions for weight loss companies, drug manufacturers, and bariatric surgeons. You're not the one who benefits from being diagnosed with ob*sity—they are. 

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Transcript

Hello, and welcome to Episode 3 of Season 6 of the Fat Doctor Podcast. I am your host, Dr. Asher Larmie.

Last week, we talked about how there's no such thing as a healthy weight. Some of you did not like that. Most of you did, some of you didn't. Today, I'm going to tell you one step further. I'm going to prove to you that being fat, it's not a health risk at all. It's not a disease, it's not anything to worry about, it just is. And again, I'm going to bring the receipts, and you're not going to like it. Some of you are really not going to like it, and that's okay. I can live with myself. I still sleep soundly at night, even though some of you are getting very upset.

So just a little recap. We know that blood pressure is a risk for disease, for heart disease especially, high blood pressure. Why do we know that? Because we've seen that high blood pressure damages blood vessels, we've seen that damage under microscopes, we've proved that if we lower blood pressure, that lowers the risk of heart attacks and strokes and stuff. But we don't have the same for weight. We don't have the smoking gun. We don't even have a gun. Smoking or not, we don't have anything. Just a whole bunch of wishful thinking and confirmation bias. That's all we have. A bunch of actuarial data from life insurance companies trying to make money off people. That's basically as far as we got, right? The BMI, which we agreed, doesn't work. And it's completely useless and redundant.

So, we've already established that. We've established that no one has ever been able to prove what a healthy weight is, and yet, and yet, we treat people who are quote-unquote overweight, or if you're very overweight, you are called quote-unquote obese, as you're well aware. So we treat that, don't we? Even though we've never been able to prove that it's a thing, we still treat it. Interesting. Curious. Shall we find out why? How that came about, shall we?

When I last left you, we were in 1972 with Ansel Keys and his paper that he published in the Journal of Chronic Disease, and I'm going to fast forward to 1995. Quite a lot has happened. But the WHO, the World Health Organization, published a report in 1995, and I'm going to quote from that report now. "There was no agreement about cut-off points for the percentage of body fat that constitutes obesity. There are no clearly established cutoff points for fat mass or fat percentage that can be translated into cut-offs for BMI."

Whole bunch of experts got together, published a report saying, no, there isn't such a thing in 1995.

Around the same time, there was a chap, Professor Philip James, director of the Rowett Institute in, dare I say it, Scotland, and Senior Lecturer in Nutrition Public Health. He was asked by the Scottish Government, by the Scottish healthcare system, to provide a set of guidelines on the diagnosis and treatment of quote-unquote obesity. Now, we have never been able to establish what is a healthy weight. The WHO has said there's literally no cut-off point for what is or isn't obesity. Like, we can't give you a number, sorry. At the same time, the Scottish Government is like, yeah, how do we diagnose and treat obesity? That's weird, isn't it? On the one hand, they're going, there's no such thing, and on the other hand, they're going, oh, but how do we treat it? Pay attention. How do we treat it? How do we treat it, they said.

Now, I'm going to quote Professor James. "The WHO obesity policies developed from bizarre beginnings," he says, "when I was asked to undertake radio and TV work to gain international acceptance for the importance of obesity. But I knew this really required the WHO to accept the importance of obesity. So first, I established the International Obesity Task Force at an international charity based at the Rowett, which is where he worked, to develop the rationale for a change in WHO policy."

Take a moment to dissect that statement, shall we? To start with, bizarre beginnings! Bizarre beginnings. It sounds good, but I don't think it was that bizarre. Financially motivated beginnings, probably a better way to put it, but we'll get there.

Radio and TV work. I was asked to undertake radio and TV work. It's all about PR. Even in 1995, it's all about the PR, we knew that. Right? How to convince, how to get people to go along with you? Is radio and TV work. I mean, now it would be social media, but then it was radio and TV. Why? Because we wanted to gain international acceptance for the importance of obesity. It wasn't important enough, clearly not important enough. We needed to make it more important.

But Professor James says, but I knew that in order for the WHO to accept the importance, first, I had to establish a Task Force. Sometimes it's a federation, sometimes we love to use these big words, task force. When you say task force, already it sounds very important. Right? Very, like, this is, yes, it's a task force, clearly there's something that needs doing here, we haven't just made it up for the sake of making it up and making money. So, don't forget, the task force is an international charity.

Who funds the international charity, you might be asking yourself. What? The pharmaceutical industry, says Professor James. He admits that he was getting cheques for £200,000 each time, cheques for £100,000. Here you go! To do his work. His one-man show of talking on the radio and television, I don't know. He was doing stuff. I'm sure he was working, I'm not suggesting he wasn't, but you know, he's, again, kind of like Louis Dublin and Ansel Keys. Professor Philip James had a very, played a very strong role, had a very important role in pathologizing fatness, so he is an important man to pay attention to, and there are accolades to his life, if you want to read, you know, all about the incredible man that was Professor James. All we need to do is go to the World Obesity Federation website. You'll find out all about him. Because they paid him lots of money.

So, he sets up the task force. In 95, same year that the WHO says, meh, no, no cut-offs. And the purpose of the task force was simply to persuade the people, the good people at the WHO, to create a policy for the diagnosis and the treatment of obesity.

I have already done an episode previously that talks about the hows and whys and what he did. I'm not going to repeat myself, you can go back, I'll try and link it to the show notes. But, I've read the report, the 1998 report that came out. So in 95, there was a report for the WHO, as I said, I've quoted from it now. This is the 1998 report. It's got a very different title, it says, "Obesity, Preventing and Managing the Global Epidemic."

Remember, 95, no way to even find a cut-off point that constitutes it, and now in 1998, it's how to prevent and manage the global epidemic. No. First page in the report, after the contents, is the acknowledgements page, and the first sentence in the acknowledgements page. "The WHO deeply appreciates both the financial and technical contributions of the International Obesity Task Force, chaired by Professor WPT James at the Rowett Research Institute, Aberdeen, UK, in convening this consultation." In other words, we wouldn't be here today if it weren't for Professor Philip James and the money he provided through the International Obesity Task Force.

First thing. Second thing. Page 1. Paragraph 1. They talk about obesity as being a disease. Based on what? They just say it, like it is. Just, we made an announcement. Obesity is a disease. Okay. What constitutes a disease, folks? What does a disease even mean? If you go to the Oxford English Dictionary, a disease is a condition in which the function, and often also the structure of the body or part of the body, is disturbed or impaired. I'll say that again, because I did not read that out correctly, a condition in which the function, and often also the structure of the body or part of the body, is disturbed or impaired. In particular, it goes on to say it's a condition in which characteristic symptoms, typical physiology, and anatomical changes, and often a specific causative agent or factor, can be identified.

Now, to be fair, there are other definitions of disease, I mean, it's like health and every other word out there that can mean lots of different things, but we'll use the Oxford English Dictionary. Not because I'm, you know, from the UK, I'm not saying it's a superior dictionary, I'm just, we're going to use it because it's the one that I looked at. You'll just have to deal with it.

So, let's analyze being fat, obesity, through the lens of the definition of a disease. A condition already, it's not a condition, it's an observation, in which the function or the structure of the body, or part of the body, is disturbed or impaired. Well. Doesn't that, I mean, fat, aka adipose tissue, in fat people functions perfectly normally. In some cases, it doesn't, but, I mean, that's just, you know, in some cases, fat in thin people doesn't function normally either. Everybody has fat, right? We know this. Some have more than others. But everybody has fat. You can't live without fat. Fat is an essential part of the body. Fat, the organ, adipose tissue, is an essential endocrine organ. We need it. It has multiple roles to play within the body. It's like skin. You can't live without skin, you can't live without fat. So everybody has fat. It's a part of the body. But the function and the structure is not impaired.

People who look like me tend to have larger fat cells than people that look like, what, think of a thin person now. I don't want to pick a random one, because then it'll be like I'm picking on them, but, like, a thin person. Like, mine will be larger, my fat cells will be larger than theirs. But, it's not disturbed or impaired, it's bigger. You know, just like some people are taller, some people are shorter. So, there's no impaired function just from being fat. I'm not saying that there aren't some people who have fat, or have a lot of fat, who don't have disturbed or impaired function. Of course, but as I said, that could happen to anybody. That's not specific to fat people. Not all fat people have disturbed or impaired function of their adipose tissue.

Are there characteristic symptoms of being fat? No, apart from being fat. There's a symptom. Right? I mean, there's no symptom of blood pressure either, but there's no symptom for being fat. Typical physiological and anatomical changes, aside from having more fat. This is it. Like, it's not like, and also this, and this, and this, and this. A specific causative agent. Now, we've never been able to find one of those, and we'd love to say it's because we eat too much and don't exercise enough, but that's not true, and we'll be getting into that in more detail certainly later on in the series.

Take pneumonia, right? Pneumonia is a condition in which the function and the structure of the lungs, or at least part of the lungs, impaired or disturbed. Right? You get pus in the lungs. Inflammation and pus in the lungs. That's pneumonia. Right? It's a condition in which there are characteristic symptoms. Generally a fever, shortness of breath, chest pain, cough productive of sputum, most likely to be rusty-coloured, if you're unlucky. That's textbook pneumonia.

Those are the symptoms. Typical physiological and anatomical changes, yes, if you were to cut open the lungs of somebody with pneumonia, you would be able to see that person had pneumonia. The lungs would be filled with pus, or at least part of the lungs would be filled with pus. Also, typical physiological changes, you would expect an increased heart rate, you would expect an increased respiratory rate, probably an increased temperature, reduced arterial oxygen levels, high white cell count, high CRP, high ESR, like, you know, it's very easy to diagnose pneumonia, generally. We can just diagnose it, and we do an x-ray, and there it is, on the x-ray, you don't have to cut a person open to see it. So, that's a disease. Right? At one point in time, it was the most common cause of death. One of the most common causes of death.

Angina, right? Angina. So disease, right, is a condition in which the function and the structure of the heart are disturbed or impaired? Specifically, the blood vessels supplying the heart. Characteristic symptoms. Why, yes. Yes, there are. In fact, you can't diagnose it without the characteristic symptoms. Central, often crushing, chest pain that radiates to the neck, the left shoulder, the left arm, sometimes even down into the fingers. It comes on with exertion, it is relieved by rest, or a couple of sprays of GTN spray. That's angina! Typical physiological anatomical changes? Yes! Yes, there are. Again, if you cut somebody open, you'd be able to see, but you don't have to cut them open, you can give them a, you can inject some dye into their bloodstream, and you can see the blockage, and you can do a scan nowadays, but of course, there are typical physiological and anatomical changes. What is the causative agent? Atherosclerosis. Fatty buildup in the arteries. Fatty and calcium build-up in the arteries, most likely a result of a number of things, but certainly high blood pressure being one of them.

That's angina! Like, I can do it for all different kinds of diseases if you want, but you get the picture, right? Being fat is an observation. Doesn't meet the criteria for a disease. And at no point in time did the committee on the WHO, at no point in time did they defend the idea, the concept that obesity, they just said it is a disease. They didn't explain why they said it was a disease. They didn't feel they needed to. And they didn't need to, because we all have accepted it. By that point in time, everyone has accepted it. Like, we've had years and years of brainwashing. We didn't need evidence, we didn't need, you know, who needs evidence when you have the gospel of thinness?

So, obesity is a disease, they say. In fact, look at the title of the paper. It's not even just a disease, it's an epidemic! It's a contagion. It is literally spreading through society and infecting poor, innocent people. Maybe not so innocent. It's an epidemic. They call it in the paper, quite early on in the report, as I said, I've read it, "rapidly growing threat to the health of populations."

What the fuck? Where'd they get that from? Rapidly growing threat, why is it a threat? Like, I know that we've always perceived fat people as a threat, or not always, but certainly for a long period of time. But based on what? Well, they would argue, based on quote-unquote obesity-associated conditions. Diabetes, heart disease, you know, arthritis, you name it. And I'm going to be talking at a later date about how we determined what is, we'll determine this threat, how we came up with the calculations and used population attributable fractions and stuff like that. I'll be talking about that at a later date. Let's not bother to get into it too much now, but I just want to point out that these conditions would all still exist if fat people didn't exist.

Diabetes, angina, all of those things. Now, some of you will be going, yeah, but they wouldn't be as common. You don't know that. How do you know that? Like, literally, you have no way of knowing that. You can't prove it. Oh, because it's more common in fat people, so? Just because it's more common in fat people doesn't mean that if you get rid of fat people, that you get rid of the disease. That's wishful thinking on your part. Don't be making logical fallacies, logical errors in front of me and expect to get away with it.

All of these conditions would exist if fat people didn't exist. How do I know this? Because they all exist in thin people. Lots of fat people don't have these conditions, lots of thin people do have these conditions, and most importantly, even though we have tried time and time again to prove that losing weight reduces the incidence of these conditions, reduces the severity of these conditions, we have failed every single time.

Again, we'll get into it more, and I've talked about this ad nauseam in the first 5 seasons, so, you know.

So, this rapidly growing threat to the health of populations is, you know, it's like the boogeyman, you know? It's more a myth than it is reality. But it's in a WHO report, funded by The International Obesity Task Force. Funded by the weight loss industry, the pharmaceutical industry, I should say.

So, when asked, Professor James is quoted, you know, why'd you come up with, because, you know, the numbers, you know the numbers, you don't need me to tell you the numbers, 25 to 30 is overweight, 30 and above is obese, like, where'd you come up with the numbers? He said, well, you know, the death rates went up in America at 25, and they went up in Britain at 25. So it all fits the idea that BMI of 25 is the reasonable, pragmatic cut-off point across the world. So we changed global policy. It just kind of fit, you know? Seemed alright. That is how we changed world policy.

It just seemed to fit, because, you know, and he says, you know, well, look at the MetLife tables, like, we already had those, and we were already using them, it wasn't that much of a stretch, you know, geez.

Ansel Keys specifically said, do not use BMI for individual assessment? He invented the thing, and he said, don't do it, it's not meant for that, that's not its purpose. Here we are! Couple of decades later. You know, because look at the UK and the US, because, of course, that's the two most important countries in the world, nobody else really matters. It fits! It's just, it's a good cut-off, you know? And like I've always mentioned, just happened to be multiples of 5. Not 24.3, not 26.9, no, 25. Thirty. 40. How very fucking convenient. Arbitrary cut-offs, arbitrary statistical calculations, based on some very vague observational data. Even Professor James, architect of this whole entire fucking thing, he couldn't come up with more than, well, it just seemed to fit. Reasonable, pragmatic cut-off, he says.

So that's who you can thank. Are you being denied care because your BMI is over 30, or over 35, or over 40? Well, you can thank Professor James and the good people at the International Obesity Task Force, because that's how they came up with the numbers, just like that. Just like that.

So, let me ask you a question. Who benefits? Do you or I benefit? No. There's no benefit to being told that. Because, as you will discover throughout the course of this season, weight loss doesn't improve your health. More importantly, the more you lose weight, or you attempt to lose weight, the fatter you get. Weight stigma and weight cycling are just as likely to be the reason why fat people have health conditions in higher numbers than the fat itself, just as likely.

We do not benefit from having our BMI measured, from being diagnosed with quote-unquote obesity. But who does benefit? Well, once upon a time, it was the life insurance companies, because they got to charge higher premiums. And then it was the weight loss companies, because they got to sell you weight loss, even though they knew it didn't work. Even though they knew you'd be coming back over and over again, they didn't care. It was a great way to make money. Then came the drug companies and the bariatric surgeons. By the 1990s, the drug companies knew exactly what was what. They knew that they needed a piece of this pie.

It's funny, isn't it? Fat people are greedy, because they eat too much. But life insurance companies and weight loss programs and the sellers of diets, the drug companies, the bariatric surgeons, they're not greedy. Corporate greed, perfectly acceptable. But when I eat a burger in public, I'm a greedy fat bastard. Make that make sense.

Why are we even measuring weight in the first place? Why? Apart from so that people can make money, what reason do we have for measuring weight? Does measuring weight and attempting weight loss benefit us at all? You already know the answer to that, but I will come back next week with some receipts, just as a refresher, as a reminder to get things in your mind, because, you know, this book, and you know this is the book, this book is following an argument, a rational argument, and taking you through the process.

So, we've started off by agreeing that there really is no such thing as a healthy weight. And then, also, that this idea that being fat is some kind of health risk and a disease, it's just predominantly made up. And then we're going to be talking about, well, is there any point to weighing people, and what benefits? And how does weight loss, and then we're going to talk about weight, in general, what controls our weight. Again, a lot of you are going to know this, but it's a bit of a refresher, because we're forming an argument, and I'll try and pick out the interesting bits that may be less well-known, or less common knowledge. And then, we'll move on to this idea that we are what we eat, and the moralizing around food, and eat less and exercise more, because obviously that's the thing that doctors are telling their patients all the time. So, we're going to cover the foundations, and then the next part, we're going to talk about how the problem only exists because of the solution. Like, what came first? The solution came first, and then it became a problem, not the other way around. Problem exists because of the solution, and that is, I hope, going to blow your mind.

Stick with me, kids! Stick with me! I hope you enjoyed this episode, hope you got something out of it. If you have questions, if you have comments, if you have feedback, if you have advice about how to self-publish a book, you know where I am, I'd love to hear from you. I'd love to hear your feedback. I'm busy writing this book, but I do still have time, space, energy, to work with people who are struggling to get the healthcare that they need, so if that's you, and you want to consult with a doctor who actually cares, then, you know where I am. And I work with people around the world, internationally, no problems. I work virtually, and you can find out more about that on my webpage, on my website. I should say, thank you very much for listening.

Next week, adaptive thermogenesis. A fancy way of saying that the more we try to lose weight, the more weight we gain. Adaptive thermogenesis. And more. I look forward to speaking to you then! I'll be back, actually, next week. I'm not taking a break at the moment. I'll see how that goes. Maybe I'll start flagging, but I will be back next week, with your next installment! Episode 4! Join me then! Take care.