The Flawed Foundations of Weight Science
In part two of my exploration of the fatphobic history of medicine, I want to dive into the pervasive influence of money on weight science and health policy.
The Origin of "Ideal Weight"
Let’s return once again to the Metropolitan Life Insurance Company, which introduced the concept of the “ideal weight” about a century ago. Let’s be clear – this wasn’t rooted in rigorous science, but it did provide an opportunity to charge higher premiums to higher weight folks.
Louis Dublin and the Metropolitan Life Insurance Company claimed that higher weight individuals didn’t live as long, justifying higher insurance rates. But their exact methodology and the calculations behind these claims remain a mystery and their validity is questionable at best.
Nowadays, anyone who dares question whether an ideal weight exists is laughed out of the scientific community. Because the proof exists, right?
Or does it?
Have you ever watched the movie Inception? I’m not sure I fully understood it, but it is based on the premise that you can plant an idea in someone’s mind without them realizing it. And I would argue that is exactly what happened here.
For over a century we have been told that Fat people are more likely to get sick, and don’t live as long. As a result, Fat people have been slowly excluded from society. We have less money, less power, less influence, and less access to healthcare. And these have a profoundly negative impact on our health.
If we had just as much money, power, influence and access to healthcare as our thin counterparts, would we have better health outcomes? Almost certainly. But then insurance companies would have to find another way to make money…
The Evolution of Weight Science
Initially, height-weight tables were used to determine the so-called ideal weight. These tables were later translated into the Body Mass Index (BMI) by the Dietary Guidelines for Americans in 1985. Sounds very official, and therefore trustworthy, right? So who writes them?
They were first released by the Departments of Agriculture and Health and Human Services in 1980, and is updated every 5 years. The Departments use an “external Federal Advisory Committee to review the current body of nutrition science”. Which means the guidelines are only as good as the evidence they are reviewing, but more on that later.
Trust the professionals!
But don’t worry. “The draft Dietary Guidelines goes through several rounds of review and revisions by peer-reviewers outside of the Federal government and all Agencies with nutrition policies and programs across USDA and HHS, such as NIH, FDA, CDC, ARS, FNS, and FSIS.”
That’s a lot of acronyms. A lot of very important and totally trustworthy organisations such as the Federal Drug Agency, the Center For Disease Control, and the Agricutlural Research Service. We can rest in the knowledge that these totally impartial organisations have the public’s best interest at heart.
I think I strained my eyes rolling them so hard.
Just like Louis Dublin and his team straddled the fence between the public health and private sector so hard I’m surprised they were able to walk straight, so too do all of these organisations. Just look at their track history. Money has and will continue to always come first.
Enter the BMI
Less than a decade after the Dietary Guidelines for Americans translated the “ideal weight” into BMI, The World Health Organization (WHO) created arbitrary cut-offs at 25, 30, and 40. The National Institutes of Health (NIH) followed soon after, and we have been using these random numbers to classify an individuals’ health status ever since.
I know what you’re thinking – surely I’m not going to cast doubt and aspersions upon the WHO? Damn right I am. And I most certainly am not the only one. There are numerous studies indicating that the healthiest individuals often don’t fall within “normal” BMI ranges.
BMI also has a false positive rate of 50% and false negative rate of 30% when it comes to predicting cardiometabolic health. Even the American Medical Association agrees that the BMI is unreliable, yet this flawed system persists throughout healthcare.
Competing Interests
The insurance industry’s influence extends beyond historical height-weight tables. Even today, higher premiums are charged based on BMI. I remember the first time I applied for income protection insurance. Despite being young and healthy, my insurance premiums were nearly double those of my husband, solely because of my BMI!
Like so many others out there, this bias meant that I had to forgo essential insurance coverage, which I later desperately needed.
Fat people struggle to get life insurance, which means some of us can’t become homeowners. Fat people struggle to get health insurance, which means poorer health outcomes. And people wonder why our health is impacted?
The Role of Pharmaceutical Companies
Pharmaceutical companies, particularly Novo Nordisk and Eli Lilly who have together cornered the weight loss injection market, wield significant influence over medical practices. These companies train doctors and promote their drugs extensively, often overshadowing other treatment options.
They are allowed to influence policy around the world. They even have the ear of the United Nations! The medical profession’s obsession with prescribing weight loss drugs for various conditions, regardless of their actual efficacy, exemplifies the deep-rooted issues within the medical and pharmaceutical industries.
The Weight Loss Industry and Bad Science
The weight loss industry is vast, encompassing not just drug companies and insurance, but also diet foods, weight management programs, and more. This industry’s pervasive message is that being thin is inherently better, creating a lucrative market for various products and services.
But this narrative is deeply embedded in bad science, with arbitrary metrics like BMI and flawed studies driving public health policies and perceptions. Remember my Inception analogy? It started with a few individuals with their own agenda. But society was more than ready to accept these beliefs as facts, because human beings love nothing more than oppressing one another.
The Exclusion in Medical Studies
The roots of weight science are intertwined with eugenics, a disturbing fact that underscores the problematic nature of current practices. The Metropolitan Life Insurance Company’s height-weight tables, the transformation into BMI, and the subsequent adoption by global health organizations all stem from a foundation built on exclusionary and biased science.
Modern medical research continues to exclude significant portions of the population. Studies often focus on older white men, leaving out women, non-whites, and other minorities. This exclusion means that the data and conclusions drawn from these studies are not representative of the broader population, perpetuating biases and ineffective treatments.
Conclusion: Challenging the Status Quo
It’s crucial that we recognize the flawed foundations of weight science and the pervasive influence of financial interests. The reliance on metrics like BMI, driven by outdated and biased science, needs to be reevaluated. We must continue to advocate for more inclusive research and challenge the entrenched narratives perpetuated by the weight loss industry.
And if nothing else, remember this – when someone tells you to lose weight, there’s a good chance that there are underlying financial motivations influencing their advice. It’s time to question and rethink the standards that have shaped our understanding of health and weight.