The One About Cancer

In this episode of ‘The Fat Doctor Podcast’, Dr. Natasha Larmie challenges the claim that ob*sity is a risk factor for cancer, secondary only to smoking.  This is the first time Natasha flies solo and she admits to being a little anxious about it!

Today's podcast includes:

• Why you cannot compare weight with smoking
• Why weight isn't a behaviour or something you can easily control
• The embarrassingly flawed evidence that links weight with cancer
• Why causation is not the same as association (and why everyone knows better but refuses to acknowledge it)
• The real reasons why rates of cancers are higher in fat folk and why change is necessary

Thank you for listening

If you enjoy this podcast and would like to support Natasha so that she can continue making them, you can join her on Patreon.  If you fancy connecting with other like-minded people in a safe and non judgmental environment, then why not join her Facebook group the ‘Friends of The Fat Doctor’? You can also check out her webiste or find her on all the usual social media channels including Instagram, Twitter and Tik Tok. 

Resources and links mentioned in this episode:

Article from the NEJM

Article from the Lancet

Cancer Research UK Campaign

Essay by a medical student on how the Cancer Research UK campaign was flawed (published by the BMJ)

More about the show:

How would you react if someone told you that most of what we are taught to believe about healthy bodies is a lie? 

How would you feel if that person was a medical doctor with over 20 years experience treating patients and seeing the harm caused by all this misinformation?

In her podcast, Dr Natasha Larmie,  an experienced General Practitioner and self-styled Fat Doctor, examines and challenges 'health' as we know it through passionate, unfiltered conversations with guest experts, colleagues and friends.

She tackles the various ways in which weight stigma and anti-fat bias impact both individuals and society as a whole.  From the classroom to the boardroom, the doctors office to the local pub,  weight-based discrimination is everywhere. Is it any wonder that it has such an impact on our health? 

Whether you're a person affected by weight stigma, a healthcare professional, a concerned parent or an ally who shares our view that people in larger bodies deserve better, Dr. Larmie and the team at 'The Fat Doctor Podcast' welcomes you into the inner circle.

Got a question for the next podcast? Let me know!

Connect With Me

• BUY THE BOOK: Never suffer through another through another weight loss lecture from your doctor again
• JOIN THE NO WEIGH MOVEMENT: Get a free script when you sign up
• THE WEIGHTING ROOM: Community with a neurodivergent flavour. **BOOK CLUB** exclusive to Weighting Room members. 
• BOOK A CONSULTATION: For the ultimate transformation in your healthcare journey
• EXPLORE THE MASTERCLASS LIBRARY: Become an expert in your condition and the weight inclusive ways to manage it
• FREE GUIDES:Evidence-based, not diet nonsense

Find me on Instagram, YouTube, and LinkedIn.

Transcript

Copy

Unknown: 0:00

[Intro]

Natasha: 0:21

All right, here we go. This is a new one for me. I am doing something that I haven't done up until now. Which is to do a podcast all by myself. I don't have any guest speakers today, I thought I'd try something new, something different. Up until now, I haven't felt like I had enough to offer really for an entire podcast. And I wasn't sure that anyone would really want to listen to me droning on and on and on by myself. So this could be a complete flop in which case whoops, lesson learned, or you might like it, in which case, I might do it more often. Let me know, you know, your feedback is always greatly appreciated. To begin with. I just want to say that I am going to be using the word obesity from time to time in this podcast. And I sometimes might refer to it as fatness or being fat or it might refer to it as the O word. But sometimes I will use the word obesity. And I know this can be triggering for some people. It's certainly triggering for me. So I wanted to start out right at the very beginning by saying that I do not agree with the medicalization of fatness. I do not believe that obesity is a real medical condition. The term obesity comes from the Latin word obesus, which basically means to eat so much that you become fat. Not only is that offensive, it's also not true. And I believe that the term obesity has been used to stigmatize to traumatize and to dehumanize people for a very long time. So I hate this word I really do. It's the reason I'm the Fat Doctor, not the obese doctor, I don't mind the word fat, I use it as a very neutral term simply to describe my body. And it doesn't bother me at all. I know it bothers some people. But the term obesity is very offensive, not because it implies that I'm fat, because I am fat, but because it implies that there's something wrong with me for being fat. And that's the part that I object to. That being said, obesity is a term that is used by most medical professionals, by researchers, by journalists, and by a lot of laypeople. So, sometimes it's going to be necessary for me to use it, especially if I'm quoting papers. And I just wanted to start off by saying I apologize to those who find this word very difficult to handle. Don't worry, I am going to be debunking a heck of a lot of myths to do with obesity in medical research. So hopefully this will be a positive spin on such a negative word. So today's episode is all about Cancer Research UK's claim that excess weights causes more cases of certain cancers than smoking does. I'm not singling out Cancer Research UK, because I don't like them. I'm singling them out, because they are often the ones that are quoted when it comes to this issue in the UK. And they are also responsible for an advertising campaign that I take issue with. And I'm going to be talking about that a little bit later. Those who don't live in the UK, may never have seen these adverts. So let me explain to you what they look like. They were a few years ago now they were all over like billboards, in the underground on buses on all sorts of places. And basically, it was just cigarette packets. And on the cigarette packets instead of the brand of the cigarette it said obesity. And essentially it was implying that you know, obesity is the new smoking. And that seems to be something that people are claiming left, right and center. I'm sure you will have read somewhere in the news or heard on the news that obesity is set to become, you know, the world's greatest killer, and it's set to overtake smoking, you know, it's gonna be the end of the world as we know it. I really want to spend a bit of time debunking this myth today and talking about how this is just a form of propaganda. It is lies, misinformation, and huge assumptions. So let's start by asking the question, can we compare weights with smoking? Because that seems to be what people like to do. They compare the two. Weight is not a behavior, it's a descriptor, and there's a big difference. The terms overweight or obese or fat are actually adjectives right? Whereas smoking is an action. It's a verb, to smoke or not to smoke. It's very difficult to compare an adjective to a verb or an action to a descriptor, you need to compare like for like. So if you're going to compare weight with something, you can compare it to race, or age, or hair color, you can compare it to anything that describes a human being. If you're going to compare smoking with something that is like for like, you need to compare it with alcohol use, or red meat consumption, hours of sleeping, things like that. Things that are an actions, not something that is innately part of who you are. And of course, we are deluded, we are all deluded into thinking that weight is a behavior that you can change. People in thin bodies believe that they are thin because of something that they've done right, people who are fat, believe they are fat because of something they've done wrong. And that's not our fault. It's not our fault that this is what we've been led to believe it's a myth that has been perpetrated by a number of organizations over the past century, insurance companies, drug companies, the weight loss industry, bariatric surgeons, they have been shown time and time again, to choose profits over people, and they are invested in making us believe that weight is a behavior. Because if it's a behavior, they can sell us the idea that we want to do something about it, whether it's try the latest diets or join Slimming World, or Weight Watchers, whether it's to buy a new drug that cost $1,400 a month, in order to keep us slim for the rest of our lives, whether it's to have a major surgery, whatever it is, they want to sell us the idea that weight is a behavior that we can change. And it isn't. I once heard someone recently say that there are more than 50 different factors that determine our weight. Some are behavioral, okay, such as diet and exercise. But those are few and far between the majority of factors that determine our weights are something that we have no control over. Let's start with genetics. I also read another statistic. Again, I'm not 100% sure of the veracity of this, so you'd need to check it out further. I do know that there are over 100 genes that have been isolated, that are linked to being fat. But I read a statistic somewhere that genetics controls 70% of our weight. And if you compare that to height, which is 80%, you see that's not that much of a difference. Nobody ever does studies about whether being tall causes you to develop cancer. That's just out of the question. And yet, they will do studies about whether being fat causes you to develop cancer, even though it's 80% versus 70%. There are also a number of medical conditions that can cause people to gain weight, things you have absolutely no control over and medications that doctors prescribe that cause people to gain weight. I mean, we, as doctors are prescribing medications that make people gain weight, and then criticizing them for gaining weight. I mean, that's ludicrous. There are also things that we just have no control over. Advancing age that tends to make you gain weight, being female, you're more likely to gain weight, especially because in certain times during your life. So when you're pregnant, and when you go through the menopause, even if you think that we have some kind of control over these things, which we don't in the most cases. But even if we did, there's also the social determinants of health, which also impact our weights. So your postcode, your parents socio economic status, what school you went to the distance from a supermarket, I mean, I could go on and on and on. But all of these factors will impact your weight. More than 50 different factors. So weight isn't a simple thing like smoking. With smoking, either you do or you don't, or you did, but don't anymore. When I'm sitting down, documenting smoking status with my patients, I have three boxes to tick. So that's really simple. Whereas if you're looking at weight, well, a person sitting in front of you could be gaining weights, because you just put them on a new medication, they could be gaining weight, because genetically that's what they're programmed to do. It could be because of a very stressful life event. It could be because of some trauma they experienced in their childhood, and you name it. You can't have sort of tick box exercise. It's not that simple. In its simplest form, really we're talking about genetics and environment. We're talking about nature versus nurture. And I'm sure we've heard this phrase before, right? nature versus nurture? as I said, 70% of your weight is determined by your genetics and the rest by your environment. One of the first times I heard this term nature/nurture was when my mom was talking about mental health. In my family, my mom's side of the family, we have very high incidences of serious mental health conditions like schizophrenia and bipolar. Her mother suffered from one or both. And so it's obviously something that's very close to my heart. So of course, there's a genetic component, you just have to look at my family history to know there is a genetic component. But if you look at serious mental health conditions, you'll also see that there is a link between serious mental health conditions and a history of trauma, drug use, the environment you grew up in, the your parents socioeconomic status, all sorts of things will impact whether a person who is genetically predisposed to a serious mental health condition will go on to develop that condition. Most people, I think, I hope, don't blame schizophrenics or people with bipolar for their condition. I think some people do. And I think there's still a very large amount of stigma surrounding mental health. I know it's not perfect. But in most circles, you wouldn't turn around and look at somebody who was muttering to themselves because they were having an auditory hallucination, and go "ugh, that person brought it on themselves". I'd like to think most human beings are evolved enough not to do that. I grew up with those genes. I am not schizophrenic. I don't have bipolar. My sister grew up with the same genes. She has got bipolar. We grew up in the same environment, went to the same school, had the same parents, same level of trauma. Everything in our life is pretty much the same. We're very close growing up. Yet she developed bipolar. And I didn't. I never once turned around and thought to myself, "I don't have bipolar because I did something right and my sister Tanya has bipolar because she did something wrong". There's no blame here. It just is, you know? I don't want people to pity my sister, because there's nothing to pity. But people sure as hell aren't going to blame her. She hasn't done anything wrong. Also, she's freaking awesome. So why would you pity her or blame her? I'm often saying health is a privilege and not an achievement. And that's because for many of us, you know, there is a genetic or an environmental component that we have absolutely no control over that will determine our health, whether it's our weight, or whether it's our ability or disability, whether it's mental health, whether it's physical health, whether it's diabetes, or, or cancer, in this case, as we're talking about. It's just it's, you know, it's something we have no control over. So people who are in good health have to stop thinking to themselves, "I'm in good health, because I've done something right". No! you're in good health, because you're lucky, enjoy it whilst you can, because everybody gets sick and everybody dies at some stage. So enjoy your health while you have it. And don't blame others if they don't. So we've established that weight is not a behavior, I suppose the next question we have to ask yourself is, is weight something that we can control? And the answer is complicated. Because yes, you can lose weight. But 95% of people will regain the weight that they lost. And two thirds of people will end up heavier than when they first started. Now, I'm sure a lot of you heard me quote this statistic before. But I would like to point out that if 95% of people regain the weight, that means 5% of people don't regain the weights. So you got to ask yourself, what are these individuals doing differently to the rest of us? How comes they can control their weights when most of us can't? And the answer is, we don't know. But Several studies have shown that a lot of these people who have managed to lose a vast quantity of weight and keep it off, engage in quite disordered behavior. A lot of this behavior holds similarities to eating disorders. So things like exercise, addiction, obsessing over food, bargaining, restricting purging. If you have a BMI of under 15, and you engage in this kind of behavior, I as a GP can, and have, arranged for you to be sectioned under the Mental Health Act and forced into treatment for an eating disorder. But if you have a BMI of over 25, and you're engaging in the same types of behavior, chances are you will be rewarded for it. You certainly won't be sectioned, I can tell you that free. So whilst I'm not suggesting that all 5% have an eating disorder or engaging in disordered eating, a lot of the studies suggest that they do. And that food and exercise become an obsession, one that you can never, ever, ever forget, even for a moment because if you do the weight starts piling back on. So on the one hand weight is something that you can control. But in the vast majority of cases, it is not something that we can control long term. And even if we can, we have to ask ourselves do we want to do we want to trade living in a larger body to living a life where we have to obsess over food and exercise? But now let's get back to the original statements made by Cancer Research UK, the idea that weight is the second biggest cause of cancer and in some cases, the biggest cause of cancer in the UK today. Let's take a look at how the researchers arrived at these figures. It's actually really hard to find these studies. If you do a simple Google search, you're gonna struggle to find them. There are quite a few papers, but there are a couple of really important ones that I'm going to quote. The first is a 2003 paper published in the New England Journal of Medicine. And I will put a link to this in the summary of this podcast. It was a prospective study, it started in 1982. And people were followed up over 16 years. So I think that the study looked at 900,000 Americans, and the average age was 57 to begin with. Over those 16 years, there were 57,000 deaths from cancer. So the researchers looked at these 57,000 deaths from cancer, they looked at their BMI back in 1982. And then they used this and some other important information to calculate the risk of death from cancer. Now, you might ask yourself, "hang on a second, if you measured my BMI in 1982 and then 10 years later, I died of cancer, what's one got to do with the other?" And that's a really good question. And we'll come to that. First of all, I want to tell you about some of the issues with the study. And there was some glaringly obvious issues. First of all, cause of death wasn't recorded properly until 1988. Okay, there was a registry, but you couldn't access the registry until 1988. So oops. And second of all, weight and height was self reported back in 1982. So you know, people lie all the time, about their weight and height. So we don't know that we can trust these details. Underweight folks, were excluded. And that's also very interesting, because we all know that people who are underweight actually have very high rates of illness. And so the fact that they've excluded them entirely suggests to me that that's actually going to mess with the statistics. And they accounted for certain confounders, like smoking, and, you know, menopause and things like that. But they didn't account for many because they just didn't have the data. So it's not a great study to begin with. They looked at all the deaths from cancer. And then they essentially looked at what percentage of people who died from cancer were fat, compared to people who were living in a quote unquote, "normal sized body". And they call this calculation, the population attributable fraction. And I am going to tell you the technical definition, which I lifted directly off the WHO website. So the population attributable fraction is the "reduction in mortality, if exposure to a risk factor were reduced to an alternative ideal exposure scenario". I had to read that at least 10 times before I understood it. Why oh why do we have to make things so complicated? I don't understand that. But anyway, I'm going to try and translate. In this case, the risk factor that they're talking about is being fat. Okay? So they look at the number of deaths in thin people, we'll call this group A, and the number of deaths in fat people, we'll call this group B. Of course, they refer to them as normal weight. In other words, a BMI between 18 and 25. And overweight or obese. In other words, a BMI of over 25. So, Group A is the group of people who died of cancer, who were thin, or quote, unquote, normal. And Group B is the group of people who died of cancer who were obese or overweight. And all you do then is subtract A from B. So if there were 10,000 fat people who died and only 5000 thin people who died, you simply subtract five from ten and you get five. So then all you do is take that 5000, divide it over the total number of fat people who died, which was 10,000 in this case, and you get a population attributable fraction of five over 10, or a half or 50%. Does anyone else see the glaringly obvious assumption that they made here? That basically invalidates all the work that they did? They assumed that people who died in a fat body died because of their fat body. And before we can ever make that kind of assumption, we need to ask ourselves, is it possible that something other than the fat itself could account for these findings? I'm going to spend the next few minutes thinking about all the different possible reasons why living in a larger body could mean that your risk of cancer is higher than people living in a smaller body. First of all, there is actually no real evidence that fatness causes any illness, or death. Notice the word I used here causes, there is a difference between causation and Association. Let's look at a different example, shall we? Black boys in America are significantly more likely to end up incarcerated than white boys. But being black does not make you a criminal. In fact, the reason that black boys in America are significantly more likely to end up incarcerated than Caucasians is because of the world that they live in, and the discrimination that they face every single day. It's not the race, it's the RACISM. And that is fundamentally important in understanding these statistics. So in this case, we know that there are some cancers that are associated with obesity, uterine cancer, endometrial cancer is probably the most common one, but also cancers like breast cancer and colon cancer. But causation is not the same as Association. We cannot assume that it is the fat body that causes people to develop more breast cancers. There's no evidence to support this. There's not even decent enough theories. People talk about estrogen production and inflammation and all sorts of other things. But there are plenty of papers that disprove these theories. So the jury's out. There's no sort of legitimate, logical explanation as to why being fat causes you to have more cancers. In fact, All of the explanations that they've come up with are simply excuses, medical excuses even, to legitimize their research. But let's pretend for a moment that the reason isn't the bodies that we live in. But the way society treats those who live in those bodies. In other words, it's not the race, it's the racism. It's not the fat, it's the fat phobia. So what kind of discrimination do we face? Well, first of all, we face discrimination from healthcare providers. And this is fundamentally important when it comes to detecting cancers. I know several people who went to see their doctor, told them that they were losing weight, and were applauded. If a thin person comes to see a doctor and says I'm losing weight, the doctor panics and starts looking for cancer. But unfortunately, in some cases, when a fat person goes into see their doctor and says I'm losing weight, the doctor simply smiles and says well done. Keep at it. Health care providers are less likely to examine patients. There was a study that showed that they are less likely to perform pelvic exams and breast exams on patients. They're less capable of doing so. Performing a breast exam on a patient who has like a KK sized bra compared to someone with a B cup bra is very, very different. Take it from someone who does breast exams on a regular basis. Large breasted women are harder to examine. But if you don't know how to examine a large breasted women, it's not the fault of that women. It's the fault of the doctor who clearly needs to upskill themselves. Because you can't be missing lumps simply because you're not as good as looking for lumps in a larger breast. That's unacceptable. But can we agree that it's possible? So health care providers discriminate, but it's beyond that. You experience discrimination everywhere that you go. In education, in the workplace, in the criminal justice system. And what that means is that people in larger bodies tend to be poorer, fewer of them are in relationships, their education is often affected. stress and mental health is often a problem. And as a result, you have groups of people who are more likely to fall through the net, and less likely to go and see a doctor if they notice something isn't quite right. "That's a funny looking mole, but not sure what to make of it". Let's take education for a moment. If you are getting a poor education as a result of the size of body that you're in, then can we blame you for the impact that it has down the line? If you are less likely to get a job because of the body that you're in, can we blame you for the impact that that has on you down the line? Of course not. But even if we don't blame you, let's think about this for a moment. If you don't have a job, in America, you don't have access to medical insurance. If you don't have medical insurance, you're less likely to go and see a doctor, when you experience a symptom that isn't quite right. So that can have an impact. If you're not getting a good education, and that impacts your understanding of health and sickness, you may not pick up on certain things that you're supposed to pick up on. Like for example, a freckle that changes color, you may not know that that freckle changing color could be a sign of a melanoma. So you may ignore it for a while. And only after a while, or someone points out, "hey, what's that freckle, how comes it's changed color?" And then you go see a doctor, but by then it's too late to. Can you see how discrimination can have such an impact on cancer diagnosis? Then there's the distress, the stress, the stress of living in a larger body, because you know, we experience a lot of trauma. Being shouted at on the street and being called out for being fat is traumatic. Walking into a supermarket and having someone stop you and start pulling food out of your cart and say you shouldn't be eating this, that's traumatic. Being shamed by your teachers in physical education class is traumatic. Being weighed by your doctors is traumatic. We experience a lot of trauma. And it happens on a daily basis. We often talk about microaggressions. It's the looks, it's the it's the judgment, it's the whispers. All of these things add up and they cause quite a bit of additional stress. People who walk around in a smaller body and are not having to deal with anti-fat bias on a daily basis don't understand the kind of stress that we experience on a daily basis. And we all know that stress is bad for your health. We all know that stress has been linked to a number of diseases. And it is not that much of a stretch of the imagination to argue that stress is causing an increase in cancer diagnosis. It's certainly something we ought to be investigating. Oddly enough, there aren't that many studies on that. We also know that weight cycling and dieting has a very negative impact on our health. And people who are fat, especially people who were fat since when they were much younger, are much more likely to have gone on a diet, right? In fact, the majority of us have been on a diet at least once in our lives, it doesn't matter how slim you are, you've probably been on a diet. But you're far more likely to be dieting on a regular basis if you live in a larger body. And more importantly, you're probably losing and gaining a lot more each time. And this large amount of weight loss followed by large amount of weight gain has been shown to be independently bad for your health. So again, not that much of a stretch of the imagination to say maybe that can be linked to why people in larger bodies experience more cancer diagnoses. We don't know as no one's ever studied it, no one's bothered to look. Then, of course, the bit that I've kind of left to last, but I think is probably the most important, is weight stigma itself. And I talk about this a lot. About how weight stigma especially medical weight stigma, has such an impact on people's health and causes such poor health outcomes. Let me explain what I mean by that by giving you an example. If you go and see your doctor about a sore throat, and they bring up your weights, and they shame you or embarrass you or weigh you or lecture you or whatever it is that they do. And then a few years later, you go and see a doctor about you know your painful toe. And again, they bring up your weight and they shame you and embarrass you and all those other things. And then a few years later, you come in you're 40 years old all of a sudden, "oh, we need to check that you're not diabetic". "Oh, why do you think I'm diabetic"?"Because you're fat, so you ought to check". "Okay... Do you check everyone for diabetes"?"No, no, just fat people. So we're going to check it okay"? And now all of a sudden, again, you're feeling super stigmatized. And this keeps happening over and over again. After a while, you lose your trust in your doctors, you lose the ability to communicate with your doctor, you are far less compliant with your doctor's advice. And most importantly, you begin to fear your doctor, you fear them. I have been speaking to people who are so traumatized by the idea of going to visit a doctor that they need actual therapy... some people are turning to things like hypnotherapy, just to be able to walk into a doctor's office. That's how traumatized they are. If you are traumatized by your doctor on a regular basis, and you fear your doctor, you are far more likely to ignore your symptoms. Noticed a bit of a lump? Ignore it! Bit a blood in your poo? ignore it! Lost a bit of weight? Rejoice! Suddenly finding that you're peeing more often than normal? Ignore it! This is a huge problem. Because when it comes to cancer, the earlier we make the diagnosis, the better. There is, of course, the intersection with other marginalized communities as well. So if you're experiencing weight stigma, but you're also black, you have two reasons to fear your doctor. Because not only are they going to stigmatize you due to your weight, but studies show that they also will stigmatize you due to race. Same goes for people who are gender non conforming, or trans. Same goes for people who are queer. Same goes for people who are disabled, most certainly. And all of these kind of intersections can make things even worse. So, weight stigma plays a huge role in health outcomes. And until we have studies that account for weight stigma, when they're when they're looking at this so called link between cancer and obesity, then we can't trust the evidence, because they're ignoring some really important things. There was another paper published in The Lancet in 2014. Similar to the first paper, it looked at the records in the UK of over 5 million people. That's about 9% of our population. They looked at the number of cancers and they looked at their BMI, they did some math to came up with the same thing. And they, they stated that there are higher rates in some, but not all cancers in fat folks. Again, so many flaws for the study, based on GP recordings. GPs don't measure weight on a regular basis. So you've got to ask yourself why is that person's weight being measured? If you don't go and see your GP, your weight doesn't get recorded. So why are these people being excluded? Also, you know, how much of it is self reported? This is how much I weigh, rather than actually getting on a weighing scale. So there's bias being introduced here. There's all sorts of things being excluded. If you put all that to one side, the biggest problem is this. They state in the discussion,"Assuming the relationship to be causal, many cancers are attributable to overweight and obesity". "Assuming the relationship to be causal"."Assuming". ASSUMING. That's a really, really big assumption to make, and yes, they made it. They didn't apologize for it. They didn't mention that this huge assumption, may possibly bias their interpretation of results. They simply went there, unashamedly went there, and got published in The Lancet. This is a question for the medical community right now, this is a question for the public health professionals out there. How can we continue to allow this to happen? We would not allow these kinds of assumptions to be made for other things. And yet, we make this assumption on a regular basis when it comes to fat people. We assume the relationship is causal. We basically say, "maybe way back in the day, we learned that association is not the same as causation, but screw it, we'll assume anyway". So why do we make these assumptions? Why are these researchers allowed to get away with it? That's the question we really need to be asking ourselves, right? Why does Cancer Research UK publish a bunch of statistics that really are so flawed, and so blatantly biased that they have no business being referred to on a regular basis. How does this happen? And the answer is actually just pretty obvious really. It's a mixture of two things. And we can probably guess what they are. The first is money. And the second is bigotry. To begin with, there are lots of financial reasons why people want to prove that being fat is bad for your health. I alluded to that earlier. Insurance companies want to charge you extra insurance premiums. Drug companies want to sell you drugs. The weight loss industry wants to sell you weight loss. Doctors want to perform unnecessary surgeries on you. People can and do earn a lot of money. We're talking billions and billions by telling people that they are fat, and there is something fundamentally wrong with them. And then, of course, there's bigotry. People don't like fat people. They don't like us. They're biased when it comes to us. They have very negative attitudes towards fat folk. And when I say they, I'm talking about the researchers, I'm talking about the the doctors, I'm talking about the health care providers, they are biased, and they have very negative associations with people who live in a larger body. So you mix bigotry with capitalism. And you get weight stigma, you get misinformation, you get lies, you get charities, such as cancer research, UK, advertising all over the place that obesity is becoming the world's biggest cause of cancer. But in reality, Cancer Research UK received 17 million British pounds from a company called Slimming World. And for those who live in the UK, they know that Slimming World is rather like Weight Watchers. It is a diet plan, a very profitable diet plan. It happens to be one of the two organizations that we GPs can refer our patients to if they want to lose weight. That's convenient, isn't it? Cancer Research UK tells you that if you're not careful, and you don't lose weight, you're gonna get cancer. People panic, go to their doctor, and their doctor says, "I know I can do I can refer you to Slimming World". It's scary, isn't it? How money and ignorance and greed and bigotry can cause so much damage to so many people's lives. I constantly hear from people saying, "Oh, I'm so afraid that I'm going to get sick and it'll all be my fault because they can't lose weight". That's the message that we're being fed over and over again. And it's not coming from our enemies. It's coming from the people that we're supposed to trust. It's coming from our doctors, our health professionals, the decision makers, the Department of Health/ These people who are supposed to be looking out for our best interests are making these kinds of decisions and perpetuating these myths. They are essentially part of the propaganda machine that was set up in the first place to make greedy organizations more money. It just it makes me so sad. I hear from people who have been diagnosed with cancer, who feel this tremendous shame and anger towards themselves. Disappointment and all sorts of other feelings because they believe they are at fault for developing cancer. Fault! How can you possibly imply that somebody who has developed one of the nastiest and most aggressive and most awful diseases out there is at fault? They're not at fault, that's nonsense. And it makes me so angry, that this is where we've got to If you have cancer or if you've ever been diagnosed with cancer, I need you to hear this message right now. There is almost zero evidence that your weight has anything to do with it. And all the evidence that exists is completely and obviously biased. You will not find a decent paper out there that links cancer to weight. If you've got breast cancer, if you've ever been diagnosed with breast cancer, you've probably been told "Oh, it's because you've got too much fat. And if the estrogen in your fat cells, and that's what's causing the cancer". The irony is that being fat has actually been shown to be protective before you hit the menopause. Did you know that? Pre menopausal women in larger bodies are less likely to develop breast cancer than pre menopausal women in smaller bodies. So this idea that estrogen is very dangerous for you when you're past the menopause. But it's absolutely protective before the menopause and... what the hell? You know, it's... it doesn't make sense. Yes, we know that estrogen and fat cells are linked in some way. But it's a huge leap to then assume that a person sitting before you who has breast cancer is at fault, because they had excess fat on their body. It's not okay. It's never been okay. The medical profession owes you an apology. And I know that this is kind of pathetic and weak. But if it helps at all, on behalf of the medical profession, I apologize, you deserve better. If you're listening to this right now, and you, like me live in a larger body. I want to remind you, that you have very little control over your weight. But you do have control over whether or not you continue to blame yourself, for being fat, for getting sick, for being disabled. It's not your fault, it was never your fault. The reason you believe it's your fault is because you've been lied to your whole entire life. But that has to stop. Because the more you blame yourself, the poorer your health becomes. So if you have any symptoms that are suggestive of cancer, my advice to you is go and get it checked out. And yes, I understand how terrifying it is for some of you. I really do. Those that have been paying attention will remember that not too long ago, I spoke about the fact that I was terrified of getting a diabetes test. Episode Three with Dr. Greg Dodell, we chatted about this in great detail. And I have gone off and I have got that diabetes test done because I realized that I've got to stop blaming myself. And I had to start taking responsibility for my health, irrespective of how doctors have treated me in the past. Is it fair? No. Should I have to overcome medical weight stigma? Absolutely not. Shouldn't my doctors be apologizing to me? Yes, you're damn right they should be. But they're not gonna. So I had to take the decision to get my blood checked. And it wasn't fun. And I wasn't massively happy with the outcome, but I did it. If you're a health professional listening to this right now, you need to fix up! Even if you're a nice one, even if you're one of the good ones, you need to fix up because you work with people who are not nice. You work alongside people who are actively fat phobic who are making negative comments, who are shaming their patients, who are discriminating against their patients. Who are harming, dehumanizing, traumatizing, and are killing their patients through their own negligence. And if you're listening to this right now you have a responsibility to those patients. I know it's hard, I get it. It's hard to stand up. It's hard to make a stand. But what's the alternative? Keep quiet. Keep chugging along, hoping that no one will ever notice you. This is life or death. This is cancer. This isn't a joke. Whoever you are, I want to leave you with this story. It's the story of my own mother, who grew up ashamed of her body, desperate to be thinner. Living in a family who were all obsessed with their weights, and surrounded by friends and colleagues who were equally obsessed with their weights. My mother did everything that she could to be slim. She restricted, she denied herself. She didn't enjoy things when she could have done and she punished herself on a regular basis. She also binged, by the way, and it's only recently that I realized that. But actually she was quite a healthy person. We have a Mediterranean diet in my family because we're from the Mediterranean. And she ate lots of vegetables and fruit and she exercised and she walked plenty of places. She actually had a very, very healthy lifestyle. She never had any problems with high blood pressure or high cholesterol or anything like that. My mom was pretty healthy. Back in 2011, 2012 my mum finally thought she'd cracked it. She was so excited. "Girls, I've been going to my salsa classes and I've been eating lots of salads and I'm starting to lose weight. And look! My jeans are loose! They're loose on me girls, look at this!" She was so happy. And then one day she turned yellow. And about two weeks after that she was diagnosed with pancreatic cancer. And three months after that she was dead. For about a year, she was losing weight. She hadn't changed her lifestyle. She'd been doing salsa classes for years, and it hadn't had any impact. And she'd been eating salad all her life, and it hadn't had any impact. But she didn't care. She was finally thin. I wonder sometimes what would have happened if she had been more proactive about her weight loss? If she had recognized just how dangerous it was, and gone to see a doctor sooner. I often wonder if she had been in a quote unquote, normal sized body. Would she have waited a whole year? Wouldn't she have worried if all of a sudden her jeans weren't fitting her anymore? I wonder whether she'd be alive today. I wonder if she'd have had a few more years she got to see my daughter grow up a little bit. You know, Grace was three months when she died. I wonder a lot of things. But I don't want to end up like my mother. She didn't enjoy her life. Not to the fullest, because she was so obsessed with her weight. And then she died really young nyway. When she died, she was bviously at her thinnest. And he looked awful. She looked bsolutely awful. She looked uch better when she was fat. A d that's what I carry with me o a day to day basis now. Life is for living. Everyone gets sick eventually. If you're living in a thin body, it's not because you did something right. And if you're living in a fat body, it's not because you did something wrong. It just is. You have nothing to be ashamed of. You have nothing to blame yourself for. And your health is something you should enjoy whilst it lasts. Health is a privilege, not an achievement. Thank you so much for listening to me today. I can't believe I waffled on for an entire episode. This time next week, I promise you'll have a guest on. But until then, have a good week.[outro] Thank you for listening and I hope you've enjoyed yourself today. If you want to get more involved with the Fat Doctor podcast, then why not check out my Patreon I am at the Fat Doctor. And on there, I offer a variety of different tiers. Depending on how much you can afford each month you get this same access no matter which tier you subscribe to. And one of the many benefits of joining my Patreon is you get a chance to listen to some extended podcast episodes. I've also got a Facebook group friends of Fat Doctor, and there's my website www dot Fat doctor.com. For those of you who follow me on social media on Instagram or on Twitter, I'm even on tik tok. Can you believe it? Join me next time for another episode tackling weight stigma and fat oppression.