The Weight Loss Lie: A History of Medical Mistakes

 We've been told our entire lives that losing weight will prevent health problems. But where did this belief come from? In this episode, I trace the shocking history of how insurance companies, pharmaceutical funding, and arbitrary statistical cut-offs created the mythical illness we now know as "ob*sity" crisis. From Quetelet's obsession with the "average man" to the International Ob*sity Task Force's pharmaceutical funding, I expose how we've been working off logical fallacies for over a century. There's no evidence that being fat causes health conditions, no evidence of a "healthy weight for height," and no evidence that weight loss improves health outcomes. It's time we stopped treating statistical artifacts as medical truth. 

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Chapters

• 7:23 Adolphe Quetelet and the Average Man
• 15:09 The WHO Expert Panel and Arbitrary Cut-offs
• 24:31 Correlation vs Causation
• 31:41 Why We Still Believe Logical Fallacies

Transcript

Hello, and welcome to episode 33, Season 5 of the Fat Doctor podcast. I'm your host, Dr. Asher Larmie, aka The Fat Doctor. Today we're going to be talking once again about a very important principle that we all need to be aware of, a foundational principle for weight-inclusive care, which is that losing weight won't prevent health problems.

I know that, and hopefully you know that, and if you don't know that yet, it's alright. Welcome. Maybe you're new here. But yeah, losing weight won't prevent health problems. I have created 17 masterclasses on 17 different conditions that are supposed to be linked to being fat, quote-unquote obesity-related conditions, where I demonstrate, in no uncertain terms, that being fat doesn't cause them.

But there's more, there's always more. Today, I'm not going to explain the science as much as I love to. This is going to be more of a history lesson than anything else. I want to challenge this belief by asking you, why do you believe it in the first place?

I get it. You've been told your whole life that being fat is bad for your health. Anything other than that seems ridiculous. But we didn't always believe this, and when we find out how we came to believe this, it's very interesting.

For a very long time, fatphobia and fear of the fat body has existed for several centuries. There's a very good book called Fearing the Black Body by Dr. Sabrina Strings, and I recommend that you read it. It's a weighty book, but it's full of really important facts that will help shape your understanding of how society came to hate fat people, because we didn't always. Once upon a time, fat was revered. Being fat was a sign that you were wealthy, so being fat was considered a good thing, if anything. It was either neutral or good for thousands of years, and then things changed.

I will mention one chap. His name is Adolphe Quetelet. He is known to some as a G-list celebrity within the weight-inclusive, health at every size, anti-diet world. He was a man of many side hustles, very millennial. He was a statistician and an astronomer and various other things.

He was very much inspired by early 19th century error theorists. Error theory was basically discovering what we now know as the bell-shaped curve. They discovered that when you look at a population, whatever you're looking at, say height, the majority of the population is centered around the middle of this bell-shaped curve. Most people are on either side of average. Then there are a few stragglers, and there's fewer and fewer as you go out, so it forms this little bell shape. What we call normal distribution. This is the case for most things.

Quetelet observed that certain human features, like height and weight, were also normally distributed, just like everything else he studied. He studied a handful of Western European, predominantly male soldiers. That was how he came to his conclusions. I don't think he's wrong. Height and weight absolutely do follow the normal distribution curve, and that's the case for everybody.

What was interesting about Quetelet, though, is that he had decided, in his infinite wisdom, that average, mean, median, middle of the bell, was ideal. He published work called L'homme Moyen, which basically means the average man. What he was doing was he took a statistical artifact, the fact that there was an average, and he turned it into a moral value.

He linked the average man to beauty, to health, to moral goodness, to all of these things, and he therefore said that those who deviated from the mean, especially those at the ends of the bell shape, were linked to vice, immorality, illness, ugliness, all of that jazz.

So that's a bit problematic, isn't it? Who says normal is good? Who says average is what we should all aspire to be? I'm not quite sure that's right. It's interesting, isn't it? In certain cases we want to be above average. Above average intelligence, above average athletic ability, above average beauty, if one could define beauty. So it's weird, isn't it? On the one hand, we want to be above average, but in this case, we're being told that average is where we want to be.

Now, a lot of people think that Quetelet is responsible for the BMI. He is not. He just discovered that height and weight follow a normal distribution, and that was it.

Then, much later, so Quetelet was mid-19th century, Louis Israel Dublin, turn of the 20th century. He was a public health pioneer. He was employed by the Metropolitan Life Insurance Company for his entire career, so he is attributed with being one of the founders of modern-day public health. His obituary was published in the American Journal of Public Health.

As I said, he worked the entire time for an insurance company, and actually his obituary says, a mutually supporting partnership. Do you get that? So the insurance company and public health were mutually supporting each other. And by that, what I mean is that he and his colleagues literally developed what they called the formulation, a calculation of the monetary value of a man.

The monetary value based on how long he was going to live, and they provided dimensions for the length of life and the outlook based on measurements that they calculated to decide how much a man was worth.

So we went from average being desirable to now this is literal value, a tangible value. We put a price on it, quite literally, and we put a price on it so that an insurance company could get rich.

Dublin and his team created the MetLife height and weight tables, and we've used the height and weight tables for decades. These were created for profit, not for health. But they existed, and he should be credited with it. And even though his health recommendations clearly served corporate interests, his work also became medical gospel. It is canon. It is the foundation of a lot of work that came after him, basically trying to prove his theory.

After Dublin, in the mid-20th century now, there was a chap named Ancel Keys. Again, he's also a bit of a celebrity in this corner of the internet. You might know him because he was the lead investigator of the Minnesota Starvation Experiment. If you don't know what that is, I suggest you look it up, it's quite interesting.

Lesser-known fact about Ancel Keys, he launched the Seven Countries Study in 1958, which explored the relationship between diet, cholesterol, and cardiovascular disease. Again, a lot of the information that we have is based on these studies. He really did not like fat people. He really didn't. Not a fan.

He published a paper in 1972 that basically introduced the concept of the body mass index, which he said, in his paper, if not fully satisfactory, at least as good as any other relative weight index as an indicator of quote-unquote relative obesity. Even he said it wasn't that great.

He launched the Seven Countries Study, and he was also a huge fan of the Mediterranean diet. He was a pioneer of the Mediterranean diet. When you hear people banging on about the Mediterranean diet, I find it really interesting to hear how people describe it, especially because the Mediterranean diet supposedly has very few carbs, which is hilarious, because I feel like Italians really do know how to use carbs well. Can we agree? Pasta, pizza, bread, all of that stuff. They really know how to use carbohydrates. But anyway, I won't go into it in too much detail. Suffice to say, I'm not a fan of this concept of the Mediterranean diet. I love Mediterranean food, I just don't agree with it. He had a best-selling cookbook published in 1975, How to Eat Well and Stay Well the Mediterranean Way. My man was obsessed.

Now, a lot of people talk about body mass index, and I kind of get irritated because I haven't quite understood where that comes from.

This study published in 1972 took 7,400, again, men from different countries, to find the best way to measure if someone, as they described it, was at a healthy weight relative to their height. We had become obsessed with healthy weight relative to height since Lewis Dublin and the MetLife height and weight tables, possibly even before, even going back to Quetelet and his obsession with the average man.

But the purpose of this study was to figure out the best way to measure if someone is a healthy weight relative to their height. And the issue I have with this is, who says there's such a thing as a healthy weight relative to height? When did we decide that there was such a thing in the first place? We didn't always believe that, and then we did believe that, and I'm curious to know what changed.

Public opinion changed, because that was the purpose of this paper. What he did was he tested a whole bunch of mathematical formulas. He was looking at just average weight. He looked at weight divided by height. He looked at weight divided by height squared. He looked at something called the Ponderal index, which I won't get into because it's really complex. But basically, they were looking at all these different ways to measure whether a person is quote-unquote a healthy weight for them relative to their height.

And they found that the BMI was the best choice out of the different ones that they chose, because it was reasonably good at all of the criteria they set out, and it was simple to calculate. So it was just like, oh, this is easy, we can use this, we can apply this very simply.

That was the purpose of this study, to figure out how to measure if someone's a healthy weight relative to their height, but nobody actually explained why they were doing it in the first place. I mean, they gave an explanation, but it wasn't an actual explanation.

And at the time of this study, in 1972, Ancel Keys and the team, the paper clearly said that BMI was appropriate for population-based studies only. It was not meant for individual evaluation, because there was no evidence supporting its use.

That was 1972. Then he published his cookbook in 1975, and then he goes off and does his thing, and then we never have to hear from him again.

The MetLife standard tables, the ones I was talking about from MetLife, in 1942, they were the ideal weight, and then in 1959, they changed them, or they republished them for the desirable weight. We went from ideal to desirable, and then finally, just height-to-weight tables in 1983. But in 1985, the second edition of the Dietary Guidelines for Americans translated the quote-unquote desirable weight-to-height tables from MetLife into BMI. And they decided, I know we're not supposed to use this for anything other than population-based data, but we're gonna do it anyway.

So we went from ideal weight, desirable weight, BMI is the best way to calculate out of all of the formulas out there, but only in population studies, to now we're just going to tell you what is and what isn't. This is correct, this is wrong. That was in 1985.

Now, I'm saying this because I was born in 1980, so this is happening in my lifetime.

Ten years later, the WHO got together an expert panel, and they published a very comprehensive report where they tried to define, again, healthy weight for height, and to define what was, quote-unquote, overweight. They did not use the other O word, obesity. It was not in the 1995 WHO report.

They did, however, create these lovely little cut-off points of 25, 30, and 40 for BMI. Completely arbitrary cut-offs. No real basis in any evidence whatsoever, just arbitrary.

And actually, in that 1995 report, it says there is 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. Very explicit in 1995.

And now pay attention, because this is where it gets, I think, really interesting. The same year as the WHO group of experts said, well, actually, we can't find a cut-off, the International Obesity Task Force was formed. What's that, you might ask? You've probably never heard of it. It was led by... okay, I'm gonna just be really honest with you. It started here in Scotland.

As a Scottish person, I am ashamed. I'm ashamed to admit it. I am very proud to be Scottish. The Scots have produced a lot of amazing things in society today. There were so many things that Scotland has produced, and you should be grateful, but this is not one of them.

The International Obesity Task Force was led by Philip James, who is the director of what is now known as the Rowett Research Institute. It was a self-appointed task force. They decided to appoint themselves as a task force, so it wasn't set up by the WHO or by any organization that existed at the time, just its own one. Set up as a charity, as they always are, funded... and can you guess who funded it? Wanna hazard a guess? It was funded almost entirely by contributions from the pharmaceutical industry.

In 2013, Philip James told a reporter, they used to give me checks for about £200,000, £250,000 at a time. This was in 1995, so it's a lot more now. At a time. I think I had a million or more. He got a lot of money. He was just getting money, got very rich.

I have a quote here. At its inception, the International Obesity Task Force had its explicit purpose, so why did they exist? The purpose was to convince the WHO to hold a special consultation solely devoted to obesity.

As you know, there was an expert panel in 1995, at the same time that these guys were born. However, they wanted to push this agenda. That was their job, to push the agenda, and when I say they, I mean the pharmaceutical industry that set up this self-appointed task force that set up as a charity.

The money that was raised by this charity provided a very large grant to the World Health Organization to fund this consultation that they absolutely insisted needs to happen. So this consultation happened in 1997.

And then, it turned out that there was going to be this huge backlog in the WHO, and it's going to take years to publish all the findings of this, and the IOTF were not having that. Philip James and his lot, nope, that's not acceptable. So they decided that it was going to take too long, so they would just publish it. They'd just publish the original version and send it immediately to everybody. To anybody and everyone that they could. And they did, to all sorts of politicians, organizations, whatever. They just published it without waiting for the WHO to do it.

Now, at the same time this is all happening in the World Health Organization in Europe, in Scotland, at the same time in the United States of America, another expert panel was convened at the same time as the WHO, but this time by the National Institute of Health, by the National Heart, Lung and Blood Institute, and it was tasked with developing clinical practice guidelines for the treatment of, quote-unquote, overweight and obesity. That was the job.

What's interesting is the chair and three other members of the panel, the National Institute of Health panel, the American panel, were also members of the International Obesity Task Force.

And they created some guidelines in 1998, which cited the WHO guidelines that hadn't yet been published, but had been sent out by this task force.

And what's really important then is that they adopted the same cut-offs as the WHO, the same 25, 30, 40. But instead of talking about overweight, which is what the WHO did, they called it obesity.

So the term obesity enters the chat in this moment. And so, in 1997, I think it was published in 1998, came into force in 1999, I can't remember, but anyway, turn of the century. You're just sitting there, minding your own business, and then one day you're told you're obese. It just happened. You weren't, and then you were.

And I know for a lot of people we think, oh, this has always happened, this has always existed, this term, this terminology has always existed. It didn't. It came into being, it entered the chat in 1999, or 1998, somewhere around there.

That's really not that long ago, is it? I was at medical school. I can't believe that, actually, when I think about it. I was at medical school.

Now, prior to 2004, the Centers for Medicare and Medicaid Services stated very clearly that obesity cannot be considered an illness. It is not an illness. That was in 2004.

By 2013, the American Medical Association had decided, again, against expert advice, to classify obesity as a disease.

So let's go back and review, shall we? 1972, BMI, best of the bunch, not meant for individual assessment. 1985, we changed our mind, we're going to use it for individual assessment. 1995, we're not just going to use it for individual assessment, but we're now going to have some cut-offs for what we call, quote-unquote, overweight. 1998, 1999, no, no, no, not overweight, obese. 2004, still, well, okay, fine, you can call it what you want, but it's not a medical condition. 2013, yes, it is a medical condition.

You know what we still haven't answered? Says who? Where's your evidence? I get the steps that have gone on. I follow the history, but no one has actually told me why you concerned yourself with a healthy weight for height in the first place. Somebody somewhere decided that there was a healthy weight for height. They decided, but I want to know who they were and what evidence they had.

Because it traces back a really long time ago. It's not based on actual science or facts. It's based on theory and religion and morality and eugenics and eugenicist theories, because Quetelet was working at a time where it was all eugenics and criminology and all sorts of terrible things that we no longer consider to be okay.

Lewis Dublin was talking about how to decide a healthy weight for height for an insurance company to make money. Nobody has given me any evidence so far that will persuade me that this is a problem in the first place, that we needed a BMI, and then that we needed to convene a panel by the WHO, and then that we needed to create a task force, and that we needed to have cut-offs. Nobody has convinced me, and even in 1995, the WHO said, there's nothing, we don't have any evidence.

And yet, here we are, 2013, the American Medical Association says, yes, it's a disease. They created a disease based on an arbitrary statistical cutoff, not on any underlying pathology. At no point in time has anyone actually been able to define what obesity is beyond a BMI of over 30.

People have come up with some theories, but no one's actually been able to define it properly. No one... I went to medical school, I studied pathology, I looked at these microscope slides, and they were really boring, by the way. No one has been able to be like, look at this under the microscope. Look at this blood test over here. This is how we define it. No, it's just BMI.

We are treating an abstract statistical category as if it represents a concrete medical condition. That is a logical fallacy. When you conflate a statistical measurement with a diagnostic tool, that is a logical fallacy.

And guess what? We've now come to realize, we've gone full circle. BMI is a load of rubbish. We know this. In 2020, there was a meta-analysis of 32 studies. They just wanted to assess how well BMI identifies what people now call obesity, but basically unhealthy fat, unhealthy weight, or whatever you want to call it.

So we've come full circle. Ancel Keys was like, BMI works, and now we have a meta-analysis that has looked at 32 studies assessing how well it works, and what they did was they looked at BMI, and then they looked at imaging techniques, actual imaging of people's fat mass.

And then they found out that BMI fails to identify approximately half of people, half of people, who have what they call excessive body fat on imaging. However, once again, their definition of excessive body fat is not based on anything other than guesswork. Just somebody decided that's too much, that's enough, that's okay, that's not.

Does anyone else understand how illogical all of this is? Am I the only one that's getting a little bit frustrated?

So basically, we have discovered now that BMI fails 50% of the time at doing the one thing it was tasked to do, which was to measure, remember, back to that 1972 study, healthy weight to height, relative to height. It fails 50% of the time. So it is not fit for purpose, but beyond that, it's assuming, it's based on the assumption that more body fat equals this now condition that is a medical condition that is obesity, as a disease, without proving anything.

I do know this, though. BMI poorly predicts our cardiometabolic health risks, so it is not good at predicting people's health outcomes, whether people will have a heart attack, or a stroke, or this, that, the other. It is not good at predicting.

But the whole thing's a farce, it's a joke. It really is. We've never actually been able to prove that being fat is bad for your health.

We're able to demonstrate an association, but as you all know, correlation is not the same as causation. Assuming that one thing causes the other, just because both are seen in higher levels, does not... it's not logic, it's not correct.

The example that people often give, and I often give, is ice cream sales and drowning, or ice cream sales and shark attacks, whichever one you want to do. Did you know that when there are more ice cream sales, there are also more shark attacks? Facts. Ice cream doesn't cause shark attacks, it doesn't cause drowning. In the summer months, more ice cream is sold, and more people go into the water, and therefore are more likely to drown or be attacked by a shark. That's all it is. It's just correlation. One does not cause the other.

And what is really problematic is because it's been over a hundred years now where we've been telling people that being fat is bad, that there is something wrong with you, and we have been punishing people for being fat. In fact, it's more than 100 years, it's 200 years.

The punishment that we receive for being fat could be the reason why fat people have higher risk of, or higher rates of, you name it. High blood pressure, heart disease, whatever. Pick one, diabetes, you name it. It could just be because it's been long enough now that these correlations that we see could simply be attributed to the fact that fat people are treated poorly in society.

It's like saying there are studies that show that you're more likely to end up in prison if you're black, that black boys are more likely to end up in prison than white boys. That has nothing to do with whether or not black boys are more criminal in their nature. I mean, I know there are racists out there that suggest that they were. Those racists have existed for over 200 years, but there isn't actually any evidence to support that. But the way society that we live in, the way that young black men, and this is predominantly in America, are treated, and then there's the whole issues with incarceration, and how incarceration, actually, some argue, is just another way of continuing slavery. I'm not going to get into it, I'm not an expert in these things, but what I'm saying is that sometimes it is the very violence and harm and unfairness and oppression that is perpetrated upon individuals that is the very reason that they end up in prison or in hospital, and then we blame them, and we say, well, it's your fault. It's not your fault, it's the way society treated you.

So I think it would be fair to argue that it could just be that society has been treating fat people really badly. Weight stigma could absolutely account for increased rates of cardiovascular disease among fat people, diabetes among fat people, but there could also be all sorts of other reasons. Like, for example, diabetes, classic example. Insulin resistance causes weight gain, insulin resistance causes diabetes, ergo, people with diabetes, people who are insulin resistant gain weight and then develop diabetes.

But the doctors, the experts say it's your fault because you gained weight, and it's not. It's because you've got insulin resistance, which is why you gained weight, and then you've got diabetes. It's logic.

But the argument is that weight loss benefits people because being fat is unhealthy. But when you ask people, what proof do you have that being fat is unhealthy? They don't. All they have is just a bunch of associations.

So when you say you should lose weight because it's unhealthy, well, how do you know that? Well, being fat is unhealthy. That is a circular argument, what we call a circular argument. It's just going round and round and round and round without actually introducing any evidence. There is no evidence that being fat causes any health condition. There is no evidence that there is a quote-unquote healthy weight for height. No evidence. There is no evidence that losing weight improves health outcomes.

So my question is, why are we still working off these logical fallacies? I get that they happened in the 20th century. At the time, it was okay for a public health professional to work for an insurance company and get away with it. Not so much anymore. I mean, they still do, but on the down low. They're not allowed to do it and get in trouble if they're too public about it. But the point I'm trying to make is that mistakes were made. That's fine. I'm not even upset about the fact that mistakes were made, but it's 2025 now.

Do we... I've just told you the history. You can... that is the history. It's fact. It's on record as being fact. So what is going on here, folks? Why are we not even addressing the core issue, which is that no one has ever been able to demonstrate that there is a healthy amount of weight for height, ever. And if that's the case, what happens if we just accept that there isn't a healthy weight for height? And that... wow. It's possible to be healthy at every size.

Now, I use the word health, and for those of you who are thinking that health is a very stigmatizing word, that's very true. Go back to the beginning of this series of the podcast. I've talked about that in great detail. We don't owe anyone our health, health is not a moral virtue, et cetera, et cetera, et cetera. The point of today's podcast was simply to prove that there's no such thing as a healthy weight and that losing weight, therefore, won't prevent health problems, because literally the only argument everyone, anyone has ever made is, you should lose weight to improve your health. Why? Because being fat is unhealthy. That's the argument.

Decades of medical research. Millions, probably billions, definitely millions spent on said research, and that's the best we've come up with.

So, hope you enjoyed that. I don't know if it made sense, but I'm not re-recording it, so I'll put it out there. Next week we have Taylor's Story. Don't forget that I have toolkits up on the website, on the No Weigh Movement website, for people who are looking for support with their doctor's appointments. I mentioned it in last week's episode, and I'm sure I'll mention it in the newsletters as well.

I am always available to hear from you, talk to you. I love it when people message me and say, oh, I have a question about the podcast, so feel free to do so. And I'll be back next week.