we’re not actually above anyone. we’re not smarter than this.
September 27, 2021 9:39 AM Subscribe
“Being a fat lady and trying to do all the things that fat ladies are supposed to do took me right there,” Ms. Gordon said. “I’ve been doing all the things, and it’s not really producing the result that I’ve been promised for, you know, the majority of my life. And I’m also seeing other people who have been in search of that promise for the majority of their lives also not getting what they thought was going to happen. At a certain point, you kind of got to go, well, maybe it just doesn’t work.” Aubrey Gordon and Michael Hobbes spend each episode of their podcast "Maintenace Phase" exploring what they call the “wellness-industrial complex,” debunking health fads and nutritional advice. [archived link]
I really like this show; it's well worth listening to.
posted by suelac at 9:52 AM on September 27, 2021 [2 favorites]
posted by suelac at 9:52 AM on September 27, 2021 [2 favorites]
I really enjoy Michael’s podcast You’re Wrong About, with Sarah Marshall; I’ll have to check this out.
posted by hurdy gurdy girl at 9:55 AM on September 27, 2021 [11 favorites]
posted by hurdy gurdy girl at 9:55 AM on September 27, 2021 [11 favorites]
In an episode on the obesity epidemic, the show laid out some of the consequences of weight stigma, including people’s delaying medical care for fear of doctors’ offices. That resonated for Mr. Cave: Once, after injuring his finger, he went to an urgent care clinic where he said he was told: “We don’t think your finger is broken. It might be, but you’re very fat, so you should probably deal with that.”
I saw a doctor about a sudden leg rash through a telemedicine appointment early in the pandemic. Because of problems with the video conferencing tech -- it wouldn't allow me to use the back camera on my phone, only the selfie-cam -- he couldn't see my rash well enough to tell me what it was so suggested I should go to the clinic in person the next day. Then he followed up by asking if I had considered bariatric surgery.
My esprit d'escalier suggests I should have asked him if that would help my rash, but I'm sure at the time, I just bungled through something to try to get off the damn video call.
I have read a lot about Maintenance Phase and I always mean to try to listen to it, but podcasts are just so much not my thing. I might go make a point of finding out what they have to say about Keto, though, since that's my fad diet of the moment.
posted by jacquilynne at 10:01 AM on September 27, 2021 [8 favorites]
I saw a doctor about a sudden leg rash through a telemedicine appointment early in the pandemic. Because of problems with the video conferencing tech -- it wouldn't allow me to use the back camera on my phone, only the selfie-cam -- he couldn't see my rash well enough to tell me what it was so suggested I should go to the clinic in person the next day. Then he followed up by asking if I had considered bariatric surgery.
My esprit d'escalier suggests I should have asked him if that would help my rash, but I'm sure at the time, I just bungled through something to try to get off the damn video call.
I have read a lot about Maintenance Phase and I always mean to try to listen to it, but podcasts are just so much not my thing. I might go make a point of finding out what they have to say about Keto, though, since that's my fad diet of the moment.
posted by jacquilynne at 10:01 AM on September 27, 2021 [8 favorites]
I love this show so much. My only wish is that people in my life who haven't had to deal with dieting, being obese, and all such, would listen to this podcast. Same with reading Aubrey's book.
posted by lizjohn at 10:13 AM on September 27, 2021 [12 favorites]
posted by lizjohn at 10:13 AM on September 27, 2021 [12 favorites]
I came to this podcast via Michael Hobbes' other podcast You're Wrong About. Both are fantastic with great snarky humor and serious deep research.
Incidentally, the co-host of You're Wrong About, Sarah Marshall has another podcast with Alex Steed called You Are Good (formerly 'Why Are Dads') in which they dissect favorite movies with a guest host. It is seriously good ear candy, especially if you are a child of the 80's/90's.
posted by kaiseki at 10:24 AM on September 27, 2021 [3 favorites]
Incidentally, the co-host of You're Wrong About, Sarah Marshall has another podcast with Alex Steed called You Are Good (formerly 'Why Are Dads') in which they dissect favorite movies with a guest host. It is seriously good ear candy, especially if you are a child of the 80's/90's.
posted by kaiseki at 10:24 AM on September 27, 2021 [3 favorites]
Yesyesyes, this podcast is SO great! Wish it came out every week. I'm already squarely in the anti-diet, HAES camp so their philosophy is not new to me, but so many of the episodes do surprise me by deconstructing my 1980s/1990s cultural childhood memories (Snackwells cookies! Presidential Physical Fitness Test! Olestra!) and connecting those to modern-day fatphobia and the diet culture we all live in.
I also like that it's damn funny, and so irreverent that I can share it with people who aren't as earnest/true-believer as I am. For those who want to continue on this path, the Food Psych podcast (currently on hiatus while the host writes a second book, but reruns are still relevant) and the How To Love Your Body podcast (a little more mushy and less-science based, but the two hosts have a LOT of experience with healing from body shame/disordered eating) are both great.
posted by rogerroger at 10:29 AM on September 27, 2021 [12 favorites]
I also like that it's damn funny, and so irreverent that I can share it with people who aren't as earnest/true-believer as I am. For those who want to continue on this path, the Food Psych podcast (currently on hiatus while the host writes a second book, but reruns are still relevant) and the How To Love Your Body podcast (a little more mushy and less-science based, but the two hosts have a LOT of experience with healing from body shame/disordered eating) are both great.
posted by rogerroger at 10:29 AM on September 27, 2021 [12 favorites]
Love love love this podcast. Came to it through "You're Wrong About". I even back them on Patreon to get their free episodes and because I love how there are no ads in the podcast and I want to support them.
posted by kathrynm at 10:31 AM on September 27, 2021 [6 favorites]
posted by kathrynm at 10:31 AM on September 27, 2021 [6 favorites]
I love this podcast, so pleased to see it on the blue!
I've always been skinny, and I have really noticed how that's made, for example, being disabled less crappy in certain very specific ways for me than for the fat disabled people I know. It's always sort of surprised me how invisible that seems to be to most thin people. For that and various other reasons I have A Lot Of Feelings about how deeply shitty and just plain wrong our cultural ideas about diet, weight and fatness are, and I love how Maintenence Phase brings all the research together and presents it so clearly and accessibly. Plus it's just plain funny, fascinating, and enjoyable to listen to.
posted by BlueNorther at 10:40 AM on September 27, 2021 [14 favorites]
I've always been skinny, and I have really noticed how that's made, for example, being disabled less crappy in certain very specific ways for me than for the fat disabled people I know. It's always sort of surprised me how invisible that seems to be to most thin people. For that and various other reasons I have A Lot Of Feelings about how deeply shitty and just plain wrong our cultural ideas about diet, weight and fatness are, and I love how Maintenence Phase brings all the research together and presents it so clearly and accessibly. Plus it's just plain funny, fascinating, and enjoyable to listen to.
posted by BlueNorther at 10:40 AM on September 27, 2021 [14 favorites]
since that's my fad diet of the moment.
I think they do a pretty good job of pointing out that you should do what works for you. I.e. just because studies haven't found something to be effective for people long term, individuals vary. So if eating X works for you, then yay! Keep doing it.
The podcast is very much not about saying any member of the general public is doing it wrong. It's more about societal failings and sometimes the fraudsters who take advantage of those failings
posted by ghost phoneme at 10:41 AM on September 27, 2021 [16 favorites]
I think they do a pretty good job of pointing out that you should do what works for you. I.e. just because studies haven't found something to be effective for people long term, individuals vary. So if eating X works for you, then yay! Keep doing it.
The podcast is very much not about saying any member of the general public is doing it wrong. It's more about societal failings and sometimes the fraudsters who take advantage of those failings
posted by ghost phoneme at 10:41 AM on September 27, 2021 [16 favorites]
I also heard about them on "You're Wrong About," which I heard about here.
I love that both of them can still be shocked and angry about what they learn. Michael will read something outrageous or tragic, and Aubrey and I will both say "What?!" in unison. (Except that she doesn't disturb my neighbors, because I walk at 6:30am.)
Man, every aspect of society sucks, and for every standard deviation that you are away from Thin, Middle-Class, White Guy, the suck increases.
(I squirm listening to the show, because I hear echoes of myself in their accounts of Generally Shitty Attitudes. I'm trying to get better, I swear!)
posted by wenestvedt at 10:45 AM on September 27, 2021 [12 favorites]
I love that both of them can still be shocked and angry about what they learn. Michael will read something outrageous or tragic, and Aubrey and I will both say "What?!" in unison. (Except that she doesn't disturb my neighbors, because I walk at 6:30am.)
Man, every aspect of society sucks, and for every standard deviation that you are away from Thin, Middle-Class, White Guy, the suck increases.
(I squirm listening to the show, because I hear echoes of myself in their accounts of Generally Shitty Attitudes. I'm trying to get better, I swear!)
posted by wenestvedt at 10:45 AM on September 27, 2021 [12 favorites]
The show presents “relatively radical ideas about this issue,” Mr. Hobbes said, but still tries to avoid alienating listeners. One way the hosts do this is by turning the narrative on themselves, taking on topics and ideas they have personal experience with.
“At some point we’ll do CBD,” Ms. Gordon said. “I have been a CBD person, and I’ll be made uncomfortable by my own research. It feels important to the show and important to me as a person, to be like, we’re not actually above anyone. We’re not smarter than this. We’re not better than this.”
I think that's a really important element to the whole wellness discussion. There are so many ways it comes up, and some of the less obviously "one weird trick to flatten your stomach" techniques are just as unsupported by evidence and feed into the same dynamic. It's so easy for discussions of the problems of wellness discourse to get sidetracked into "well, yes, x diet is garbage but that's why y diet is what really works" with little to no acknowledgment that your solution, even if it works for you (which is great!), is likely just another One Weird Trick for others.
(Not trying to start a fight about CBD - that's just the example used in the quote I wanted to highlight. I have no knowledge or opinions about the effectiveness of CBD.)
posted by the primroses were over at 10:50 AM on September 27, 2021 [9 favorites]
“At some point we’ll do CBD,” Ms. Gordon said. “I have been a CBD person, and I’ll be made uncomfortable by my own research. It feels important to the show and important to me as a person, to be like, we’re not actually above anyone. We’re not smarter than this. We’re not better than this.”
I think that's a really important element to the whole wellness discussion. There are so many ways it comes up, and some of the less obviously "one weird trick to flatten your stomach" techniques are just as unsupported by evidence and feed into the same dynamic. It's so easy for discussions of the problems of wellness discourse to get sidetracked into "well, yes, x diet is garbage but that's why y diet is what really works" with little to no acknowledgment that your solution, even if it works for you (which is great!), is likely just another One Weird Trick for others.
(Not trying to start a fight about CBD - that's just the example used in the quote I wanted to highlight. I have no knowledge or opinions about the effectiveness of CBD.)
posted by the primroses were over at 10:50 AM on September 27, 2021 [9 favorites]
This is such a good show. And if you think that fads and issues around wellness don't affect you because you're not into dieting or you're fine with your body...still give it a listen. Some of this stuff is so deeply intertwined with our culture at large that it affects everyone. Things which you might have taken just as "common sense" have their foundations in simple grifters being very successful at their grift. It's so good and they are really entertaining.
posted by amanda at 10:54 AM on September 27, 2021 [16 favorites]
posted by amanda at 10:54 AM on September 27, 2021 [16 favorites]
Definitely sounds interesting; will read it as soon as I finish this eighth glass of water.
posted by TedW at 11:01 AM on September 27, 2021 [13 favorites]
posted by TedW at 11:01 AM on September 27, 2021 [13 favorites]
Love this podcast; they have a Patreon, which seems like a good way of supporting this sort of work. It's a weird feeling to be laughing at the same time that you're getting quietly furious about the abusive practices and exploitative marketing that they discuss, but it works for me.
posted by Halloween Jack at 11:32 AM on September 27, 2021 [5 favorites]
posted by Halloween Jack at 11:32 AM on September 27, 2021 [5 favorites]
Wow, this looks (sounds) terrific.
For people like me who may not get around to listening to the podcast right away, a few notes:
The podcast site has a page for each episode, with lots of links for further reading (here's The Obesity Epidemic, with links to What exactly is a disease? (excellent question!) and The “Childhood Obesity Epidemic”: Health Crisis or Social Construction? among the 20 or so links), and wow, the latest episode is on Marianne Williamson, wow). Episodes run about an hour.
(I kind of wish there were transcripts, but you can't have everything.)
Also, there are links to their individual blogs: Mike, Aubrey.
I am really looking forward to listening. Thank you so much for posting this, sciatrix!
posted by kristi at 11:48 AM on September 27, 2021 [9 favorites]
For people like me who may not get around to listening to the podcast right away, a few notes:
The podcast site has a page for each episode, with lots of links for further reading (here's The Obesity Epidemic, with links to What exactly is a disease? (excellent question!) and The “Childhood Obesity Epidemic”: Health Crisis or Social Construction? among the 20 or so links), and wow, the latest episode is on Marianne Williamson, wow). Episodes run about an hour.
(I kind of wish there were transcripts, but you can't have everything.)
Also, there are links to their individual blogs: Mike, Aubrey.
I am really looking forward to listening. Thank you so much for posting this, sciatrix!
posted by kristi at 11:48 AM on September 27, 2021 [9 favorites]
I've become an unabashed fan of everyone on YWA and this one, and the shows have also both introduced me to some really interesting people through the guests they've had on. I too am a methodology queen, like Michael, and I really appreciate his research skills, and Aubrey has the best goddamn laugh I've ever heard.
posted by kitten kaboodle at 11:52 AM on September 27, 2021 [6 favorites]
posted by kitten kaboodle at 11:52 AM on September 27, 2021 [6 favorites]
I think they do a pretty good job of pointing out that you should do what works for you. I.e. just because studies haven't found something to be effective for people long term, individuals vary. So if eating X works for you, then yay! Keep doing it.
One of my favorite moments on this podcast (sorry, I can't remember the episode) was when the question somehow came up, what should you do if you think a friend is engaging in disordered eating. And Aubrey just talked so empathetically and sensibly about this, in a way I've never heard someone do before. She talked about thinking first about your relationship, if you are close enough to this person to have that kind of conversation. Then she said to ask for consent, and if you get it, approach the conversation in a very curious and open-ended way. Not "I'm worried about you and you're doing something Bad," but more along the lines of asking questions and finding out what the person is getting out of their diet or whatever it is.
I like that they are somewhat radical, but also extremely grounded in science and just very empathetic. They're not the radicals that want you to feel personally guilty about Living in a Society - they want you to understand how these systems have fucked things up for many of us, and to dismantle them. And there's lots of jokes. It's just the best.
posted by lunasol at 12:26 PM on September 27, 2021 [21 favorites]
One of my favorite moments on this podcast (sorry, I can't remember the episode) was when the question somehow came up, what should you do if you think a friend is engaging in disordered eating. And Aubrey just talked so empathetically and sensibly about this, in a way I've never heard someone do before. She talked about thinking first about your relationship, if you are close enough to this person to have that kind of conversation. Then she said to ask for consent, and if you get it, approach the conversation in a very curious and open-ended way. Not "I'm worried about you and you're doing something Bad," but more along the lines of asking questions and finding out what the person is getting out of their diet or whatever it is.
I like that they are somewhat radical, but also extremely grounded in science and just very empathetic. They're not the radicals that want you to feel personally guilty about Living in a Society - they want you to understand how these systems have fucked things up for many of us, and to dismantle them. And there's lots of jokes. It's just the best.
posted by lunasol at 12:26 PM on September 27, 2021 [21 favorites]
METAFILTER: the radicals that want you to feel personally guilty about Living in a Society
posted by philip-random at 1:23 PM on September 27, 2021 [7 favorites]
posted by philip-random at 1:23 PM on September 27, 2021 [7 favorites]
I look forward to each new episode of this podcast! Highly recommended.
I wasn't sure that I would like it at first because I already knew about HAES, already thought most diets are wishful thinking at best and scams at worst, already hated "wellness"*, etc. But I've learned a lot. They get deeeeep into the history of a lot of health fads.
I like that they are somewhat radical, but also extremely grounded in science and just very empathetic
Yes, this! The hosts are really open about the fact that they're still learning and sometimes being challenged by what they learn, too. And while they're not really shy about calling things bullshit, they don't make it personal.
This is one of the things I like about You're Wrong About too.
* By "wellness" I mean the capitalist health woo industry, not like... generally taking care of yourself
posted by Kutsuwamushi at 1:36 PM on September 27, 2021 [4 favorites]
I wasn't sure that I would like it at first because I already knew about HAES, already thought most diets are wishful thinking at best and scams at worst, already hated "wellness"*, etc. But I've learned a lot. They get deeeeep into the history of a lot of health fads.
I like that they are somewhat radical, but also extremely grounded in science and just very empathetic
Yes, this! The hosts are really open about the fact that they're still learning and sometimes being challenged by what they learn, too. And while they're not really shy about calling things bullshit, they don't make it personal.
This is one of the things I like about You're Wrong About too.
* By "wellness" I mean the capitalist health woo industry, not like... generally taking care of yourself
posted by Kutsuwamushi at 1:36 PM on September 27, 2021 [4 favorites]
This is such a great show. It's compassionate and informative, but it's also fun as hell. Like, there's a moment in an early episode where Aubry is reading some quotes from the founder of Moon Juice, and Michael groans "ohh nooo, she's like someone who studied abroaaad" that just made me laugh so hard.
I came to this podcast via Michael Hobbes' other podcast You're Wrong About. Both are fantastic with great snarky humor and serious deep research.
Incidentally, the co-host of You're Wrong About, Sarah Marshall has another podcast with Alex Steed called You Are Good (formerly 'Why Are Dads') in which they dissect favorite movies with a guest host. It is seriously good ear candy, especially if you are a child of the 80's/90's.
I hope Michael Hobbes and Sarah Marshall are going to start a podcast network at some point, because all three shows are excellent.
posted by Ragged Richard at 1:49 PM on September 27, 2021 [7 favorites]
I came to this podcast via Michael Hobbes' other podcast You're Wrong About. Both are fantastic with great snarky humor and serious deep research.
Incidentally, the co-host of You're Wrong About, Sarah Marshall has another podcast with Alex Steed called You Are Good (formerly 'Why Are Dads') in which they dissect favorite movies with a guest host. It is seriously good ear candy, especially if you are a child of the 80's/90's.
I hope Michael Hobbes and Sarah Marshall are going to start a podcast network at some point, because all three shows are excellent.
posted by Ragged Richard at 1:49 PM on September 27, 2021 [7 favorites]
These three shows are my absolute favourite trifecta of awesome right now. They seriously brighten my days.
Sarah’s laugh is identical to an antivax conspiracy friend I parted ways with at the start of the pandemic. Every time I hear it I am reminded of my friend, but in a good way, and I feel less estranged from the world.
posted by iamkimiam at 2:04 PM on September 27, 2021 [3 favorites]
Sarah’s laugh is identical to an antivax conspiracy friend I parted ways with at the start of the pandemic. Every time I hear it I am reminded of my friend, but in a good way, and I feel less estranged from the world.
posted by iamkimiam at 2:04 PM on September 27, 2021 [3 favorites]
Seeing these 3 shows talked about on the blue is like having my favorite work friends meet my favorite college friends at my wedding, and it makes me feel all warm inside.
posted by selfmedicating at 3:35 PM on September 27, 2021 [21 favorites]
posted by selfmedicating at 3:35 PM on September 27, 2021 [21 favorites]
I'd also like to say--and I realize what a can of worms this might be--but based on the discussions I have seen in every MeFi thread about weight/obesity over the last 15 years of my membership on this site . . .
I think the episodes of this podcast about BMI and 'The Obesity Epidemic' should be required listening.
posted by kaiseki at 4:37 PM on September 27, 2021 [21 favorites]
I think the episodes of this podcast about BMI and 'The Obesity Epidemic' should be required listening.
posted by kaiseki at 4:37 PM on September 27, 2021 [21 favorites]
Aubrey has the best goddamn laugh I've ever heard
She and Danielle Henderson of the I Saw What You Did podcast are neck and neck for me.
posted by LindsayIrene at 4:48 PM on September 27, 2021
She and Danielle Henderson of the I Saw What You Did podcast are neck and neck for me.
posted by LindsayIrene at 4:48 PM on September 27, 2021
I'm not a podcast listener, but their approach as described in the article and the comments here sounds marvelous.
posted by Dip Flash at 5:09 PM on September 27, 2021 [1 favorite]
posted by Dip Flash at 5:09 PM on September 27, 2021 [1 favorite]
I rebooted my account just to share my love for this podcast.
I think it represents the best in the conversational-did-you-know genre. It's informative, thoughtful, compassionate, and really has its finger on a very toxic area of North American/West/Capitalist culture. I loved how Michael Hobbes was like 'I covered Brian Wansink' and I was like ME TOO BUT FOR A WOMAN'S MAGAZINE." It's just the best. I like all three podcasts a lot but Maintenance Phase is the one I rush to listen to whenever an episode drops.
posted by warriorqueen at 5:25 PM on September 27, 2021 [22 favorites]
I think it represents the best in the conversational-did-you-know genre. It's informative, thoughtful, compassionate, and really has its finger on a very toxic area of North American/West/Capitalist culture. I loved how Michael Hobbes was like 'I covered Brian Wansink' and I was like ME TOO BUT FOR A WOMAN'S MAGAZINE." It's just the best. I like all three podcasts a lot but Maintenance Phase is the one I rush to listen to whenever an episode drops.
posted by warriorqueen at 5:25 PM on September 27, 2021 [22 favorites]
And the newest episode, dropped today, is about RACHEL HOLLIS YESSSSSS this show is so relevant to my interests I CAN'T WAIT
posted by rogerroger at 8:09 AM on September 28, 2021 [1 favorite]
posted by rogerroger at 8:09 AM on September 28, 2021 [1 favorite]
And if you think that fads and issues around wellness don't affect you because you're not into dieting or you're fine with your body...still give it a listen
Yes--I will say, one of the reasons I love this podcast as a scientist is that some of the more historical episodes have a very nice lens on how scientists can make mistakes and entire disciplines can be lead down rabbit trails by One Neat Grifter. It's very thorough, and there are a lot of really interesting stories about how public health policy comes to be.
today's Rachel Hollis episode
I got about two hours of sleep last night and I freely confess I am one of the category of people who had no idea who Rachel Hollis is, but I had fun listening to Michael flailing about his frustration with this lady's terrible stock of advice while I stood staring at my shower.
posted by sciatrix at 8:18 AM on September 28, 2021 [6 favorites]
Yes--I will say, one of the reasons I love this podcast as a scientist is that some of the more historical episodes have a very nice lens on how scientists can make mistakes and entire disciplines can be lead down rabbit trails by One Neat Grifter. It's very thorough, and there are a lot of really interesting stories about how public health policy comes to be.
today's Rachel Hollis episode
I got about two hours of sleep last night and I freely confess I am one of the category of people who had no idea who Rachel Hollis is, but I had fun listening to Michael flailing about his frustration with this lady's terrible stock of advice while I stood staring at my shower.
posted by sciatrix at 8:18 AM on September 28, 2021 [6 favorites]
One of my favorite moments on this podcast (sorry, I can't remember the episode) was when the question somehow came up, what should you do if you think a friend is engaging in disordered eating.
This was probably the Eating Disorders interview, which I found to be incredibly insightful--especially about the way that eating disorders are often constructed to not "count" if you're not successful enough at weight loss. I should re-listen to that one; I thought it was a really interesting perspective on eating disorders from an interview with a specialist whose work has a distinctly different perspective than anything I'd encountered before.
posted by sciatrix at 8:21 AM on September 28, 2021 [4 favorites]
This was probably the Eating Disorders interview, which I found to be incredibly insightful--especially about the way that eating disorders are often constructed to not "count" if you're not successful enough at weight loss. I should re-listen to that one; I thought it was a really interesting perspective on eating disorders from an interview with a specialist whose work has a distinctly different perspective than anything I'd encountered before.
posted by sciatrix at 8:21 AM on September 28, 2021 [4 favorites]
Every episode of this podcast I have listened to has been so interesting! Aubry feels like the kind of person I would instantly tell way too much of my life to because she is so warm and empathetic.
I'm in school for nursing and don't have a lot of podcast time, but if there is a particular episode or two I should listen to so I can Respectfully Ask Questions when we talk about BMI/obesity in my classes, PM me or put it in the thread please! Sounds like there are 2 specifically about each of those things but maybe there's more.
posted by Emmy Rae at 10:30 AM on September 28, 2021 [2 favorites]
I'm in school for nursing and don't have a lot of podcast time, but if there is a particular episode or two I should listen to so I can Respectfully Ask Questions when we talk about BMI/obesity in my classes, PM me or put it in the thread please! Sounds like there are 2 specifically about each of those things but maybe there's more.
posted by Emmy Rae at 10:30 AM on September 28, 2021 [2 favorites]
From a health care perspective, I would suggest that "Anti-Fat Bias", "The Body Mass Index," "Eating Disorders", and "The Obesity Epidemic" are your top four to listen to first. Those four are very specifically about things that are really relevant to patient care and medical treatment in a US/possibly European context.
"The Great Protein Fiasco" is a neat one about public health in an international development context, and "School Lunches, P-Hacking, and the Original Pizzagate" is a very effective and useful pass through a lot of the dietary One Weird Trick research that underlies a lot of the "weight loss is easy, just buy smaller plates!" kinds of advice. (That's the Brian Wansink episode.)
And then maybe "Fen Phen and Redux", about a drug intended for weight loss that had some terrifying side effects, might be another useful one.
Is that a useful quick list?
posted by sciatrix at 11:19 AM on September 28, 2021 [10 favorites]
"The Great Protein Fiasco" is a neat one about public health in an international development context, and "School Lunches, P-Hacking, and the Original Pizzagate" is a very effective and useful pass through a lot of the dietary One Weird Trick research that underlies a lot of the "weight loss is easy, just buy smaller plates!" kinds of advice. (That's the Brian Wansink episode.)
And then maybe "Fen Phen and Redux", about a drug intended for weight loss that had some terrifying side effects, might be another useful one.
Is that a useful quick list?
posted by sciatrix at 11:19 AM on September 28, 2021 [10 favorites]
I *just* started listening to this podcast, because a friend told me to listen to their "Twinkie defense" ep. I really enjoyed it and am eager to listen to more (despite some nitpicking on my part about queer history and Harvey Milk.)
Overall they did a great job with it, and I learned a bunch of stuff I hadn't known -- its relationship to so-called victim's rights bills, in particular.
posted by gingerbeer at 11:46 PM on September 28, 2021
Overall they did a great job with it, and I learned a bunch of stuff I hadn't known -- its relationship to so-called victim's rights bills, in particular.
posted by gingerbeer at 11:46 PM on September 28, 2021
I listened to a few episodes. They’re funny and charming, but there were huge fact gaps and missing context in the information they presented… a clear emphasis on colorful stories rather than comprehensive information.
Against a background of so many people doing incredibly dumb and harmful things re: covid, while confident that they had “done their research”—frankly, this podcast made me cringe.
Take it as entertainment but don’t mistake it for expertise.
posted by Sublimity at 3:12 AM on September 29, 2021 [1 favorite]
Against a background of so many people doing incredibly dumb and harmful things re: covid, while confident that they had “done their research”—frankly, this podcast made me cringe.
Take it as entertainment but don’t mistake it for expertise.
posted by Sublimity at 3:12 AM on September 29, 2021 [1 favorite]
I'm curious: what contextual detail and fact gaps did you observe? That's a big statement, and it hasn't been something I've noticed when episodes hew close to areas I do know a lot about. But it's always possible I've missed something. Can you give us more details about what exactly you're thinking of?
posted by sciatrix at 4:36 AM on September 29, 2021 [2 favorites]
posted by sciatrix at 4:36 AM on September 29, 2021 [2 favorites]
Sure. Some gripes from the keto episode—a subject I know well, from my experience as a person who has successfully followed this way of eating for years, and have followed with scientific interest as a PhD in biochemistry:
They asserted that “if someone is tracking their macros, they’re doing keto.” This is a silly generalization. There are a variety of diets and circumstances that lead people to pay attention to macros.
The lengthy focus on Barnarr what’s his name, who is a funny and colorful persona though a minor historical figure…but complete omission of the ongoing, legitimate scientific debate about the carbohydrate-insulin model (most recently here on the blue.)
Gary Taubes is unquestionably the person most responsible for raising the profile of ketogenic diets in the last 20 years. He’s totally missing from their talk (though he’s quite enough of a character to merit some lively discussion.) If the lens of their podcast is how public perception is shaped, his essay in the NYT in 2002 inarguably qualifies as it’s reverberated for 20 years.
Taubes also is responsible for elevating the notion that sugar consumption is associated with cancer (his book The Case Against Sugar) and this was hugely influential in the bro sphere. They focus on Tim Ferris and Joe Rogan perpetuating that idea. I share their dismay at those dudes’ general hucksterism, but if the intent is to inform their listeners, they don’t actually dig in to where that concept came from or put it in context—they just dismiss it out of hand. In fact, studies of metabolism of cancer cells is legit and inhibiting glucose uptake has been a target of oncology drug development.
Lots more in that vein. They’re funny but they have no idea what they’re talking about.
posted by Sublimity at 8:53 AM on September 29, 2021
They asserted that “if someone is tracking their macros, they’re doing keto.” This is a silly generalization. There are a variety of diets and circumstances that lead people to pay attention to macros.
The lengthy focus on Barnarr what’s his name, who is a funny and colorful persona though a minor historical figure…but complete omission of the ongoing, legitimate scientific debate about the carbohydrate-insulin model (most recently here on the blue.)
Gary Taubes is unquestionably the person most responsible for raising the profile of ketogenic diets in the last 20 years. He’s totally missing from their talk (though he’s quite enough of a character to merit some lively discussion.) If the lens of their podcast is how public perception is shaped, his essay in the NYT in 2002 inarguably qualifies as it’s reverberated for 20 years.
Taubes also is responsible for elevating the notion that sugar consumption is associated with cancer (his book The Case Against Sugar) and this was hugely influential in the bro sphere. They focus on Tim Ferris and Joe Rogan perpetuating that idea. I share their dismay at those dudes’ general hucksterism, but if the intent is to inform their listeners, they don’t actually dig in to where that concept came from or put it in context—they just dismiss it out of hand. In fact, studies of metabolism of cancer cells is legit and inhibiting glucose uptake has been a target of oncology drug development.
Lots more in that vein. They’re funny but they have no idea what they’re talking about.
posted by Sublimity at 8:53 AM on September 29, 2021
Gary Taubes promotes some weird ideas (and himself quite strongly) and doesn't seem to be too concerned about facts. He's been banging the same drum for a very long time. There are definitely disagreements in this area, but to insist that someone has to address Gary Taubes isn't reasonable.
That said, I tried to listen to the Obesity episode and had to turn it off in frustration. The information presented was not always factual. I'm sure you could find someone who said the things they claim, but to present it as fact seemed quite misleading to me. And this is an important subject, with major health impacts! I don't think it helps anyone to breezily make claims that aren't supported by the evidence. Unfortunately, there's a lot of misinformation from many sides when it comes to obesity.
This podcast is obviously coming from a specific angle and that seems to influencing them to make claims that certainly aren't widely supported.
posted by ssg at 9:18 AM on September 29, 2021
That said, I tried to listen to the Obesity episode and had to turn it off in frustration. The information presented was not always factual. I'm sure you could find someone who said the things they claim, but to present it as fact seemed quite misleading to me. And this is an important subject, with major health impacts! I don't think it helps anyone to breezily make claims that aren't supported by the evidence. Unfortunately, there's a lot of misinformation from many sides when it comes to obesity.
This podcast is obviously coming from a specific angle and that seems to influencing them to make claims that certainly aren't widely supported.
posted by ssg at 9:18 AM on September 29, 2021
I’m not insisting anything—it’s their podcast, they can do what they want. But it’s pretty funny that they’re dumping on Ferris and Rogan for… what they themselves are doing? Getting fans by entertainingly talking about stuff that they don’t actually know anything about?
Do you want ivermectin? This is how you get ivermectin.
posted by Sublimity at 9:54 AM on September 29, 2021
Do you want ivermectin? This is how you get ivermectin.
posted by Sublimity at 9:54 AM on September 29, 2021
The information presented was not always factual.
Do you have specific examples of this?
posted by rogerroger at 10:23 AM on September 29, 2021 [2 favorites]
Do you have specific examples of this?
posted by rogerroger at 10:23 AM on September 29, 2021 [2 favorites]
Yes, any examples of information that was not factual? I am pretty sure these hosts are rigorous in reading actual scientific studies, and I have not heard anything that goes against recent scientific research. They do tear down a lot of "accepted" wisdom of course, and it can be difficult to discover we may have long-held beliefs that are not supported by the most current (and non-biased) evidence.
As for claims that are not widely supported, well. It doesn't matter if they are widely supported - what matters is what the actual evidence shows.
posted by Glinn at 10:46 AM on September 29, 2021 [4 favorites]
As for claims that are not widely supported, well. It doesn't matter if they are widely supported - what matters is what the actual evidence shows.
posted by Glinn at 10:46 AM on September 29, 2021 [4 favorites]
I just gave two examples of topics where they didn’t make the faintest mention of current state of knowledge (including uncertainty or controversy.)
posted by Sublimity at 10:59 AM on September 29, 2021
posted by Sublimity at 10:59 AM on September 29, 2021
Do you want ivermectin? This is how you get ivermectin.
Ehn. I think this 'slippery slow' argument decontextualizes the discussion that Maintenance Phase is joining and the audience they're aiming for.
This is not a medical podcast, nor is it a podcast that is laying out a nutritional or health path for anyone. And trust me, the cultural discourse around weight and health is not scientific.
MP is a culture podcast examining the very, very, VERY VERY rich and influential diet industry, now the health and wellness industry, as an element of popular culture and as presented in popular media. They are deconstructing narratives that other people have constructed. It definitely "fails" in the way that You're Wrong About fails at times in that it's not a rigorous attempt to find The Truth, but rather an examination of how a particular story, or in this case, particular trend in diet/health advice/snake oil salesmanship has been presented to the public.
I'll come right out and say that having worked in lifestyle magazines for 15 years, I cannot stress enough how horrific coverage of weight issues is, even when an editorial team is trying. And they will be, because you have to run wellness content. Because without "health" (read: weight loss) editorial, you don't get to access the massive advertising spend.
As a not-super-prominent editor of a women's magazine I received press releases about weight loss studies at a rate of between 30-50 a week. I received weight loss products and ARCs for diet books at about 1-2 a day. Not only that, but being a woman in media surrounded by women in media, easily 1/3 of my team was on a diet at every health meeting and our own bodies were up for discussion. When juice cleanses hit honestly there were betting pools for who would snap first every day (because juice cleanses make you crabby.)
It's snakes all the way down, my friend.
This: In fact, studies of metabolism of cancer cells is legit and inhibiting glucose uptake has been a target of oncology drug development is true and I have covered this story! It does not, however, relate to weight loss.
posted by warriorqueen at 12:24 PM on September 29, 2021 [13 favorites]
Ehn. I think this 'slippery slow' argument decontextualizes the discussion that Maintenance Phase is joining and the audience they're aiming for.
This is not a medical podcast, nor is it a podcast that is laying out a nutritional or health path for anyone. And trust me, the cultural discourse around weight and health is not scientific.
MP is a culture podcast examining the very, very, VERY VERY rich and influential diet industry, now the health and wellness industry, as an element of popular culture and as presented in popular media. They are deconstructing narratives that other people have constructed. It definitely "fails" in the way that You're Wrong About fails at times in that it's not a rigorous attempt to find The Truth, but rather an examination of how a particular story, or in this case, particular trend in diet/health advice/snake oil salesmanship has been presented to the public.
I'll come right out and say that having worked in lifestyle magazines for 15 years, I cannot stress enough how horrific coverage of weight issues is, even when an editorial team is trying. And they will be, because you have to run wellness content. Because without "health" (read: weight loss) editorial, you don't get to access the massive advertising spend.
As a not-super-prominent editor of a women's magazine I received press releases about weight loss studies at a rate of between 30-50 a week. I received weight loss products and ARCs for diet books at about 1-2 a day. Not only that, but being a woman in media surrounded by women in media, easily 1/3 of my team was on a diet at every health meeting and our own bodies were up for discussion. When juice cleanses hit honestly there were betting pools for who would snap first every day (because juice cleanses make you crabby.)
It's snakes all the way down, my friend.
This: In fact, studies of metabolism of cancer cells is legit and inhibiting glucose uptake has been a target of oncology drug development is true and I have covered this story! It does not, however, relate to weight loss.
posted by warriorqueen at 12:24 PM on September 29, 2021 [13 favorites]
You are correct, it is not related to weight loss. Did they relate the overblown claims to the contextualized facts? No they did not. Did they present this concept as a self-evident fraud, so all proximate ideas are also evidently fraudulent? Yes they did.
I believe you completely about snakes all the way down. Folks upthread seem to take what these people say as gospel truth, though, when it looks to me like just a friendlier, funnier snake.
If anything, your observation about the firehose of low quality information, desperately deployed to obtain money from suckers, strengthens the parallel to the weird milieu of covid denialism. Same “do your research!!” spirit, same distancing from/mistrust of expertise.
posted by Sublimity at 1:47 PM on September 29, 2021 [1 favorite]
I believe you completely about snakes all the way down. Folks upthread seem to take what these people say as gospel truth, though, when it looks to me like just a friendlier, funnier snake.
If anything, your observation about the firehose of low quality information, desperately deployed to obtain money from suckers, strengthens the parallel to the weird milieu of covid denialism. Same “do your research!!” spirit, same distancing from/mistrust of expertise.
posted by Sublimity at 1:47 PM on September 29, 2021 [1 favorite]
My question about factual inaccuracies was based on ssg's comment about the Obesity episode, who said they had heard factual inaccuracies in that episode specifically.
posted by rogerroger at 2:06 PM on September 29, 2021 [1 favorite]
posted by rogerroger at 2:06 PM on September 29, 2021 [1 favorite]
. It definitely "fails" in the way that You're Wrong About fails at times in that it's not a rigorous attempt to find The Truth, but rather an examination of how a particular story, or in this case, particular trend in diet/health advice/snake oil salesmanship has been presented to the public.
This is definitely part of what I like about those two podcasts. I don't think they're necessarily trying to find The Truth, but remind us that the story we know is frequently warped, and not always deliberately. And sometimes people who set whatever (society, nutrition advice) on a bad path had the best of intentions, but that in the end doesn't really absolve anyone.
I also really like when they debunk the debunking.
posted by ghost phoneme at 2:37 PM on September 29, 2021 [4 favorites]
This is definitely part of what I like about those two podcasts. I don't think they're necessarily trying to find The Truth, but remind us that the story we know is frequently warped, and not always deliberately. And sometimes people who set whatever (society, nutrition advice) on a bad path had the best of intentions, but that in the end doesn't really absolve anyone.
I also really like when they debunk the debunking.
posted by ghost phoneme at 2:37 PM on September 29, 2021 [4 favorites]
Here are a couple examples of significant errors:
1) At about 4:40 Aubrey claims that rates of obesity are increasing (true) but rates of overweight are not (true, at least in the US in the last roughly 20 years), and then claims that this does not mean "thin people are becoming fat".
In fact, as rates of obesity have increased, there are fewer people in the "normal" BMI category. It is absolutely the case that there are fewer thin people and more fat people, by a very significant amount. If it's not clear, I'm using "thin" and "fat" here because those are the words they use, not the words I'd use myself.
This is all in the context of a claim that the issue of obesity is overblown and isn't increasing as much as people believe it is. That's a difficult claim to prove or disprove because it's about what people perceive, but obesity rates have increased significantly and continue to do so, now exceeding 40% in the US. That seems pretty concerning and not like something we should minimize, as Aubrey is clearly doing.
2) Around 17:30, Aubrey says that correlations between health outcomes and BMI kick in at 35 or 40 — a very small proportion of the population. This is absolutely not true. Relative risks for heart disease, diabetes, certain cancers and overall mortality are significantly higher for those with 30+ BMI versus 20-25 BMI. This a major claim which is personally relevant to a lot of listeners and it just isn't true. If people come away from this podcast believing that their risk at 33 BMI or even 37 BMI isn't much higher than at 25 BMI, I think that's pretty bad (of course, with the caveat that people's BMI varies and it is an imperfect measure, etc).
There certainly is some debate and equivocal data when you compare people at roughly 27 BMI to 23 BMI, but I don't think you'll find any respected researcher who says there is no significantly elevated risk until 35 or 40 BMI. Of course, risks are significantly higher above 40, but that doesn't mean they aren't high at 30 as well.
I think these two examples are pretty key to the argument they are making in the episode. I certainly agree with many other arguments they make (and think the ways our health systems and our culture in general deal with obesity are generally bad and often counter productive), but it's essential to get the facts right, especially on an issue like this which is so politicized.
posted by ssg at 2:58 PM on September 29, 2021
1) At about 4:40 Aubrey claims that rates of obesity are increasing (true) but rates of overweight are not (true, at least in the US in the last roughly 20 years), and then claims that this does not mean "thin people are becoming fat".
In fact, as rates of obesity have increased, there are fewer people in the "normal" BMI category. It is absolutely the case that there are fewer thin people and more fat people, by a very significant amount. If it's not clear, I'm using "thin" and "fat" here because those are the words they use, not the words I'd use myself.
This is all in the context of a claim that the issue of obesity is overblown and isn't increasing as much as people believe it is. That's a difficult claim to prove or disprove because it's about what people perceive, but obesity rates have increased significantly and continue to do so, now exceeding 40% in the US. That seems pretty concerning and not like something we should minimize, as Aubrey is clearly doing.
2) Around 17:30, Aubrey says that correlations between health outcomes and BMI kick in at 35 or 40 — a very small proportion of the population. This is absolutely not true. Relative risks for heart disease, diabetes, certain cancers and overall mortality are significantly higher for those with 30+ BMI versus 20-25 BMI. This a major claim which is personally relevant to a lot of listeners and it just isn't true. If people come away from this podcast believing that their risk at 33 BMI or even 37 BMI isn't much higher than at 25 BMI, I think that's pretty bad (of course, with the caveat that people's BMI varies and it is an imperfect measure, etc).
There certainly is some debate and equivocal data when you compare people at roughly 27 BMI to 23 BMI, but I don't think you'll find any respected researcher who says there is no significantly elevated risk until 35 or 40 BMI. Of course, risks are significantly higher above 40, but that doesn't mean they aren't high at 30 as well.
I think these two examples are pretty key to the argument they are making in the episode. I certainly agree with many other arguments they make (and think the ways our health systems and our culture in general deal with obesity are generally bad and often counter productive), but it's essential to get the facts right, especially on an issue like this which is so politicized.
posted by ssg at 2:58 PM on September 29, 2021
1) At about 4:40 Aubrey claims that rates of obesity are increasing (true) but rates of overweight are not (true, at least in the US in the last roughly 20 years), and then claims that this does not mean "thin people are becoming fat".
In fact, as rates of obesity have increased, there are fewer people in the "normal" BMI category. It is absolutely the case that there are fewer thin people and more fat people, by a very significant amount. If it's not clear, I'm using "thin" and "fat" here because those are the words they use, not the words I'd use myself.
She's not claiming that there are not fewer people in the "normal" BMI category, though. What she's saying is that the whole distribution is adding weight more or less evenly, not that people at one extreme of the population distribution are adding large amounts of weight: people on average are going up a few BMI points, not your friend with a BMI of 21 going to a BMI of 31. That is, she is making a claim about the change in the population distribution of weight change as a whole over time, not a change in the number of people in each bin. Your assertion that she is factually wrong is a misunderstanding of what she is saying.
2) Around 17:30, Aubrey says that correlations between health outcomes and BMI kick in at 35 or 40 — a very small proportion of the population. This is absolutely not true. Relative risks for heart disease, diabetes, certain cancers and overall mortality are significantly higher for those with 30+ BMI versus 20-25 BMI. This a major claim which is personally relevant to a lot of listeners and it just isn't true.
I don't know what to tell you, because I went looking for the research justifications for this claim and I find this study that formally evaluates the relative mortality rates by BMI. (Admittedly, it is cited by one of the peer reviewed articles listed in the show notes for that episode, not one of those peer reviewed articles itself, but that article has a pretty good summary of the claims.) That study makes a fairly strong case that people in the 25-30 BMI range ('overweight') have better mortality rates than people in the 18.5-25 ('normal') range, and that people in the 30-35 ('level 1 obesity') range have approximately similar mortality rates.
Here is that summary, borrowed from Campos et al. 2006:
A followup Flegal et al. meta-analysis in 2013 finds the same thing: a sizeable jump in health risks not at BMI 30 but right about BMI 35, at the transition of stage 2 obesity. Now, granted, if you look at the data along a curve rather than categorically, death risk does rise rather gently on the curve (cf. perhaps these orange curves from de Gonzalez et al 2010, although I will point out that insofar as there is a sharp acceleration of that curve I don't know that I would place the peak of the acceleration all that farther leftward by eyeing it). But that doesn't make Gordon wrong. I agree, it is very important to get the facts right, which is why I have gone checking in the parts of the literature she does not cite and the citations of the most relevant source she does cite (again, Campos et al 2006), but that has been rather time intensive to check.
The question of how to handle smokers in the dataset, smoking being notoriously both very unhealthy for your long term mortality but also something that drags weight levels down, is a question under contention in quite a bit of this literature. I note this because the literature that claims Type I obesity (the contentious 30.0-35.0 BMI range we are presently discussing) is particularly dangerous is often looking at datasets from which all smokers have been excluded, since we know that smoking is unhealthy. But what this is doing is taking a broad, mixed data set and separating out a single easily quantified behavior associating weight loss with earlier death. Since smoking is the only trait which is treated this way, it seems a little odd to jigger the odds in our dataset that way--especially given that we are doing purely correlational work without yet trying to disentangle causation. Since you also cannot tell a smoker from a nonsmoker by looking, especially if you are a medical professional trying to estimate someone's odds of mortality based on a visual assessment of their bodies (as weight judgements and the messaging of health and wellness frequently encourage people to do), it is doubly odd to remove them from our dataset as we encourage people to make those judgements.
I will be blunt--my personal studies of fat as an endocrine organ in its own right bias me to think that BMI as a blunt instrument is not particularly useful, because there are a number of proximate effects of fat on other tissues (e.g. gonadal tissues) that demonstrate cis-acting effects of local adipose tissue which are specific to the fat pad in question. That means that the distribution of fat in the body--that is, which fat pats contain how much adipose cells and what those cells are doing--matters, and it matters a lot. Even if you assume that BMI distributions refer solely to fat and that there is nothing else changing on a population scale, where individuals are depositing additional fat matters tremendously, and BMI has absolutely no way of assessing that.
My personal studies also bias me to think about fat deposition as something that is likely to happen secondarily to other metabolic changes: i.e., another metabolic syndrome starts happening, and weight gain manifests as a symptom of that change, such that weight gain is less a risk factor and more of a symptom for a given condition. You can see my comments in the Gary Taubes thread Sublimity links above about why I think an overall weight distribution are likely to change for a whole population over time, and I will point out that we know stress is much worse for overall health outcomes than weight, and we know that it is also far easier to control with either structural or personal changes than weight is, particularly over the long term (5yrs+).
I do think it is rather silly to claim that the researchers here are incorrect when they do cite peer reviewed literature for every claim they make, which you can look up yourself in the literature if you don't trust them. And I am mildly grouchy about the amount of time I have been spending trawling through a complex literature and trying to anticipate kneejerk and largely referenced criticisms today, so I will leave it at that and go back to running mice.
posted by sciatrix at 8:33 AM on September 30, 2021 [18 favorites]
In fact, as rates of obesity have increased, there are fewer people in the "normal" BMI category. It is absolutely the case that there are fewer thin people and more fat people, by a very significant amount. If it's not clear, I'm using "thin" and "fat" here because those are the words they use, not the words I'd use myself.
She's not claiming that there are not fewer people in the "normal" BMI category, though. What she's saying is that the whole distribution is adding weight more or less evenly, not that people at one extreme of the population distribution are adding large amounts of weight: people on average are going up a few BMI points, not your friend with a BMI of 21 going to a BMI of 31. That is, she is making a claim about the change in the population distribution of weight change as a whole over time, not a change in the number of people in each bin. Your assertion that she is factually wrong is a misunderstanding of what she is saying.
2) Around 17:30, Aubrey says that correlations between health outcomes and BMI kick in at 35 or 40 — a very small proportion of the population. This is absolutely not true. Relative risks for heart disease, diabetes, certain cancers and overall mortality are significantly higher for those with 30+ BMI versus 20-25 BMI. This a major claim which is personally relevant to a lot of listeners and it just isn't true.
I don't know what to tell you, because I went looking for the research justifications for this claim and I find this study that formally evaluates the relative mortality rates by BMI. (Admittedly, it is cited by one of the peer reviewed articles listed in the show notes for that episode, not one of those peer reviewed articles itself, but that article has a pretty good summary of the claims.) That study makes a fairly strong case that people in the 25-30 BMI range ('overweight') have better mortality rates than people in the 18.5-25 ('normal') range, and that people in the 30-35 ('level 1 obesity') range have approximately similar mortality rates.
Here is that summary, borrowed from Campos et al. 2006:
Campos et al. then go on to discuss two or three other studies using similar US-based samples that find similar results. This aligns with my own memories of the literature, so I am glad that I went and checked. But okay, I think to myself, perhaps the ~2,000 citations of Campos et al. are all criticisms, and perhaps sometime in the last fifteen years we have found other studies that find heightened risk of mortality between 20-25 and 25-30 ranges of BMI. Or perhaps, I find rereading your comment, it is just that you think there is some kind of sharp, steep hardline drop-off at 30 BMI where your mortality risk knows it's crossed a natural threshold and tries to strangle you. Flegal et al 2005 don't find much in the way of change in mortality rates between 30-35 BMIs--they're just slightly worse than 18-25s--but perhaps in the past fifteen years we've found something different?Claim #2: ‘Mortality rates increase with increasing degrees of overweight, as measured by BMI.’—WHO, 2003 (p. 61)This claim, central to arguments that higher than average body mass amount to a major public health problem, is at best weakly supported by the epidemiological literature. Except at true statistical extremes, high body mass is a very weak predictor of mortality, and may even be protective in older populations. In particular, the claim that ‘overweight’ (BMI 25–29.9) increases mortality risk in any meaningful way is impossible to reconcile with numerous large-scale studies that have found no increase in relative risk among the so-called ‘overweight’, or have found a lower relative risk for premature mortality among this cohort than among persons of so-called ‘normal’ or ‘ideal’ [sic] weight. Among the obese, little or no increase in relative risk for premature mortality is observed until one reaches BMIs in the upper 30s or higher. In other words, the vast majority of people labelled ‘overweight’ and ‘obese’ according to current definitions do not in fact face any meaningful increased risk for early death. Indeed the most recent comprehensive analysis of this question within the context of the US population found more premature deaths associated with a BMI of < 25 than with a BMI above it. This was largely owing to the finding that lowest death rates fell within the BMI range of 25–29.9—some 86 000 fewer ‘excess’ deaths than was observed in the referent group, the so-called ‘normal weight’ BMI range of 18.5–24.9. Additional analyses that controlled for potential confounders such as length of follow-up, weight stability, weight loss caused by illness, or smoking status did not change the results. For this nationally representative cohort of US adults—National Health and Nutrition Examination Surveys I, II, and III—the ‘ideal’ weight for longevity was ‘overweight’.
A followup Flegal et al. meta-analysis in 2013 finds the same thing: a sizeable jump in health risks not at BMI 30 but right about BMI 35, at the transition of stage 2 obesity. Now, granted, if you look at the data along a curve rather than categorically, death risk does rise rather gently on the curve (cf. perhaps these orange curves from de Gonzalez et al 2010, although I will point out that insofar as there is a sharp acceleration of that curve I don't know that I would place the peak of the acceleration all that farther leftward by eyeing it). But that doesn't make Gordon wrong. I agree, it is very important to get the facts right, which is why I have gone checking in the parts of the literature she does not cite and the citations of the most relevant source she does cite (again, Campos et al 2006), but that has been rather time intensive to check.
The question of how to handle smokers in the dataset, smoking being notoriously both very unhealthy for your long term mortality but also something that drags weight levels down, is a question under contention in quite a bit of this literature. I note this because the literature that claims Type I obesity (the contentious 30.0-35.0 BMI range we are presently discussing) is particularly dangerous is often looking at datasets from which all smokers have been excluded, since we know that smoking is unhealthy. But what this is doing is taking a broad, mixed data set and separating out a single easily quantified behavior associating weight loss with earlier death. Since smoking is the only trait which is treated this way, it seems a little odd to jigger the odds in our dataset that way--especially given that we are doing purely correlational work without yet trying to disentangle causation. Since you also cannot tell a smoker from a nonsmoker by looking, especially if you are a medical professional trying to estimate someone's odds of mortality based on a visual assessment of their bodies (as weight judgements and the messaging of health and wellness frequently encourage people to do), it is doubly odd to remove them from our dataset as we encourage people to make those judgements.
I will be blunt--my personal studies of fat as an endocrine organ in its own right bias me to think that BMI as a blunt instrument is not particularly useful, because there are a number of proximate effects of fat on other tissues (e.g. gonadal tissues) that demonstrate cis-acting effects of local adipose tissue which are specific to the fat pad in question. That means that the distribution of fat in the body--that is, which fat pats contain how much adipose cells and what those cells are doing--matters, and it matters a lot. Even if you assume that BMI distributions refer solely to fat and that there is nothing else changing on a population scale, where individuals are depositing additional fat matters tremendously, and BMI has absolutely no way of assessing that.
My personal studies also bias me to think about fat deposition as something that is likely to happen secondarily to other metabolic changes: i.e., another metabolic syndrome starts happening, and weight gain manifests as a symptom of that change, such that weight gain is less a risk factor and more of a symptom for a given condition. You can see my comments in the Gary Taubes thread Sublimity links above about why I think an overall weight distribution are likely to change for a whole population over time, and I will point out that we know stress is much worse for overall health outcomes than weight, and we know that it is also far easier to control with either structural or personal changes than weight is, particularly over the long term (5yrs+).
I do think it is rather silly to claim that the researchers here are incorrect when they do cite peer reviewed literature for every claim they make, which you can look up yourself in the literature if you don't trust them. And I am mildly grouchy about the amount of time I have been spending trawling through a complex literature and trying to anticipate kneejerk and largely referenced criticisms today, so I will leave it at that and go back to running mice.
posted by sciatrix at 8:33 AM on September 30, 2021 [18 favorites]
Is this, gentlemen, how you get ivermectin?
posted by sciatrix at 4:45 AM on October 1, 2021 [2 favorites]
posted by sciatrix at 4:45 AM on October 1, 2021 [2 favorites]
My mistake! I tried to check but it is, of course, always possible to make errors.
Still, I might be getting unnecessarily combative, and I apologize for that. It's a complicated literature (and, if you consider wellness, field) with a lot of people who make strong claims without great displayed evidence. There is absolutely room here for differences of opinion, emphasis, and interpretation.
It's just that what you're describing about their approach to keto vs the approach you wish they had taken? That's a difference of emphasis, opinion, and interpretation. It's not a difference in expertise or familiarity with literature or research or sloppiness. And I do actually think that's a distinction worth making and defending here.
posted by sciatrix at 9:42 AM on October 1, 2021 [3 favorites]
Still, I might be getting unnecessarily combative, and I apologize for that. It's a complicated literature (and, if you consider wellness, field) with a lot of people who make strong claims without great displayed evidence. There is absolutely room here for differences of opinion, emphasis, and interpretation.
It's just that what you're describing about their approach to keto vs the approach you wish they had taken? That's a difference of emphasis, opinion, and interpretation. It's not a difference in expertise or familiarity with literature or research or sloppiness. And I do actually think that's a distinction worth making and defending here.
posted by sciatrix at 9:42 AM on October 1, 2021 [3 favorites]
Disagree. To use an old saw, they were "not even wrong"--about the points I raised as well as several others. In that episode and others as well. Hence my alarm.
I, too, have limited bandwidth to get into this and at this point I'm moving on. Thanks for the conversation.
posted by Sublimity at 12:51 PM on October 1, 2021
I, too, have limited bandwidth to get into this and at this point I'm moving on. Thanks for the conversation.
posted by Sublimity at 12:51 PM on October 1, 2021
weight gain manifests as a symptom of that change, such that weight gain is less a risk factor and more of a symptom for a given condition.
Not precisely on point, but my experience definitely lines up with medical professionals focusing on weight rather than the actual condition.
I have, and always had, high blood pressure (pretty much whole family line has). When I was 21 and solidly normal BMI, just throw pills at it.
10 years later, when I'm a little bit heavier (slow and gradual gain), but still normal...re-upping my prescription always comes with a diet and exercise lecture. Even though my blood pressure is the same. My weights gone up a bit, but my BP is ever the same.
Maybe talking to me about diet and exercise is helpful for something else, but definitely not for my BP. But that's what they tie it too.
I'm a horrible patient and have let my prescription expire. Haven't gone back because I've not lost all of my pandemic weight, and I just don't want to go through the rigamarole for a medicine they tell me I need but doesn't change how I feel day to day.
And that's actually (I think) a small part of what leads to Ivermectin, I think. Medical professionals who tell you X will be helped by losing weight, despite direct evidence to the contrary. It chips away at the trust a patient has in their provider.
I know part of it is that providers don't have enough time to spend with individual patients to really get a full picture. And definitely not enough time to walk through nuances of why their recommending certain things. And forget about discussing specific studies, and how some say Y, others say X, but Y is more applicable to your particular case (or X turned out to be garbage) . But that's getting even further off track.
posted by ghost phoneme at 2:33 PM on October 1, 2021 [2 favorites]
Not precisely on point, but my experience definitely lines up with medical professionals focusing on weight rather than the actual condition.
I have, and always had, high blood pressure (pretty much whole family line has). When I was 21 and solidly normal BMI, just throw pills at it.
10 years later, when I'm a little bit heavier (slow and gradual gain), but still normal...re-upping my prescription always comes with a diet and exercise lecture. Even though my blood pressure is the same. My weights gone up a bit, but my BP is ever the same.
Maybe talking to me about diet and exercise is helpful for something else, but definitely not for my BP. But that's what they tie it too.
I'm a horrible patient and have let my prescription expire. Haven't gone back because I've not lost all of my pandemic weight, and I just don't want to go through the rigamarole for a medicine they tell me I need but doesn't change how I feel day to day.
And that's actually (I think) a small part of what leads to Ivermectin, I think. Medical professionals who tell you X will be helped by losing weight, despite direct evidence to the contrary. It chips away at the trust a patient has in their provider.
I know part of it is that providers don't have enough time to spend with individual patients to really get a full picture. And definitely not enough time to walk through nuances of why their recommending certain things. And forget about discussing specific studies, and how some say Y, others say X, but Y is more applicable to your particular case (or X turned out to be garbage) . But that's getting even further off track.
posted by ghost phoneme at 2:33 PM on October 1, 2021 [2 favorites]
sciatrix: Regarding obesity and overweight prevalance, I think you're splitting hairs here. The whole argument is that the rise in obesity is overblown, when the data shows it is very significant and appears to be continuing. Who is claiming that bunch of thin people suddenly became fat? No one.
This seems, at best, to be an argument against a strawman on some specific details — but the central thesis they are arguing is very different. If you'd prefer to call it an argument that doesn't add up, that's fine by me.
Regarding BMI and mortality, I would refer you to this meta-analysis of prospective studies including more than 10 million participants. This is a much stronger approach than Flegel 2005, which is based on a couple orders of magnitude smaller sample from NHANES.
But mortality is certainly the most contentious area here and one in which there are a lot of confounding factors (smoking, as you note, but many others as well). I agree with you that there are widely differing results from different studies. The claim was about health outcomes in general and that certainly includes type II diabetes, heart disease, etc. Taking type II diabetes as an example, I think this is quite a different story with pretty clear evidence for significantly increased risk.
I do think it is rather silly to claim that the researchers here are incorrect when they do cite peer reviewed literature for every claim they make, which you can look up yourself in the literature if you don't trust them.
Are you looking at something different than I am? I'm looking at the page for the podcast episode on their site. They provide a bunch of links, but as far as I can tell only one is actually peer-reviewed science (and it's not relevant to what we are talking about here). All the others are opinion and commentary or articles in the media, etc. They are definitely not citing peer-reviewed literature.
BTW, the "peer reviewed" article you refer to is in fact an opinion piece.
I certainly agree with you that there are a lot of public health interventions we should be doing, but aren't (including those that target stress). I do think that our food systems do not serve us well when it comes to our health (certainly not limited to obesity) and it would valuable to make changes here as well.
posted by ssg at 5:47 PM on October 1, 2021
This seems, at best, to be an argument against a strawman on some specific details — but the central thesis they are arguing is very different. If you'd prefer to call it an argument that doesn't add up, that's fine by me.
Regarding BMI and mortality, I would refer you to this meta-analysis of prospective studies including more than 10 million participants. This is a much stronger approach than Flegel 2005, which is based on a couple orders of magnitude smaller sample from NHANES.
But mortality is certainly the most contentious area here and one in which there are a lot of confounding factors (smoking, as you note, but many others as well). I agree with you that there are widely differing results from different studies. The claim was about health outcomes in general and that certainly includes type II diabetes, heart disease, etc. Taking type II diabetes as an example, I think this is quite a different story with pretty clear evidence for significantly increased risk.
I do think it is rather silly to claim that the researchers here are incorrect when they do cite peer reviewed literature for every claim they make, which you can look up yourself in the literature if you don't trust them.
Are you looking at something different than I am? I'm looking at the page for the podcast episode on their site. They provide a bunch of links, but as far as I can tell only one is actually peer-reviewed science (and it's not relevant to what we are talking about here). All the others are opinion and commentary or articles in the media, etc. They are definitely not citing peer-reviewed literature.
BTW, the "peer reviewed" article you refer to is in fact an opinion piece.
I certainly agree with you that there are a lot of public health interventions we should be doing, but aren't (including those that target stress). I do think that our food systems do not serve us well when it comes to our health (certainly not limited to obesity) and it would valuable to make changes here as well.
posted by ssg at 5:47 PM on October 1, 2021
Who is claiming that bunch of thin people suddenly became fat? No one.
From 1998, CNN: Millions of Americans became "fat" Wednesday -- even if they didn't gain a pound -- as the federal government adopted a controversial method for determining who is considered overweight.
This literally happened - a bunch of people who were considered to be at a healthy weight were suddenly considered to be at an unhealthy weight once the BMI was adopted. So yes, a bunch of "thin" people suddenly became "fat".
I really gained a lot from some of the conversation in this thread, and I appreciate sciatrix contributing time and expertise to inform this conversation. I would love it if there were specific threads on MetaFilter where weight, health and body size could be discussed in ways that did not devolve into either "This One Weird Diet Worked For Me!" or "Critiquing Diet Culture Is As Dangerous As Ivermectin."
posted by rogerroger at 6:52 PM on October 1, 2021 [4 favorites]
From 1998, CNN: Millions of Americans became "fat" Wednesday -- even if they didn't gain a pound -- as the federal government adopted a controversial method for determining who is considered overweight.
This literally happened - a bunch of people who were considered to be at a healthy weight were suddenly considered to be at an unhealthy weight once the BMI was adopted. So yes, a bunch of "thin" people suddenly became "fat".
I really gained a lot from some of the conversation in this thread, and I appreciate sciatrix contributing time and expertise to inform this conversation. I would love it if there were specific threads on MetaFilter where weight, health and body size could be discussed in ways that did not devolve into either "This One Weird Diet Worked For Me!" or "Critiquing Diet Culture Is As Dangerous As Ivermectin."
posted by rogerroger at 6:52 PM on October 1, 2021 [4 favorites]
I'm pretty sure no one, not even Mike and Aubrey, are trying to take away the system that works for you and makes you feel good in and about your own body. If halo top or Weight Watchers or keto works for you, great! That it doesn't necessarily work for someone else or someone else's body, doesn't mean that your'e doing it wrong, and it doesn't mean that that someone else has not been rigorous enough in their approach either. I've been fat since I was seven years old, raised in a family of thin privileged white women who genuinely could not figure out what was wrong with me and have pushed every new strategy on me (with the best of intentions, even if rarely felt that way). I played sports in high school I was enrolled in countless fat programs. I have been given every incentive imaginable to lose weight. I have tried EVERYTHING, from Jane Fonda to Keto to lengthy humiliating consultations with bariatric specialists. And I'm still a fat person. I still fit into my prom dress. Which is a size 16-18 . And at 45 years old, I am metabolically healthy. My blood pressure is excellent. I'm a distance runner. I eat well, objectively speaking. I will probably always be classed as obese. And the fact that I feel like I have to make all of these points to anyone, in order to defend my right to even have an opinion about my own fucking body, is the reason why I am grateful this show exists.
posted by thivaia at 9:25 PM on October 1, 2021 [17 favorites]
posted by thivaia at 9:25 PM on October 1, 2021 [17 favorites]
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