Episode 174 Transcript

Read the transcript alongside the audio.

.You're listening to the Fierce Fatty Podcast episode 174, Is The AMA Saying BMI Should Be Scrapped!? I'm your host Vinny Welsby. Let's do it.

Hello, welcome to this episode. If you don't know who I am, Vinnie, my pronouns are V them. I'm British living in Vancouver, which is the traditional ancestral and unceded territory of the Coast Salish people. Squamish labeled with an Musqueam nations. And I'm an activist, and I'm your host. We'll be talking about stuff Hey, most people have already listened and like yeah, man, we know who you are. So before we get started today, you might have noticed that you had a week between episodes. So for this month, it's going to be two episodes this month. And that is down to Ko Phi, Kofi, Kofi donations. Thank you, everyone who has donated on kofi to make the podcast happen to continue to happen, an update of where we were. So one month ago, we were at 32 subscriptions. And that equals 210 $1 has in income for the month. And today we're at 34. So that's two extra subscribers in the last month. And $240 income subscription found value. So that's an extra $30 a month. So why am I talking about this because I am striving to make the podcast self sufficient instead of me having to pay for it should have done this a long time ago instead of 170 episodes then. But what can you do? So if you'd like more than two, and then next month is going to be one episode a month if you'd like more than one episode a month. We want to get to $680 a month in subscription donations and then we can have four whole episodes a month so we are third of the way there. So if you appreciate the show if you like what I'm doing if you want to spend your money on a on a fatty and fats podcast, then go to Kofi The link is in the show notes but you can just type KOF I Vinnie Vinny Welsby. First fatty I'm sure Google will point you in the right direction. Oh no. Maybe not. Who knows? Okay, so today we are talking about the American is it American Medical Association. I should have looked at the Yeah, a medical American Medical Association. They came out with a press release. Talking about BMI. Talking about BMI being problematic. Oh, am glob oh my god, I love it. This is this is something that's happened. And so a lot of people on on the social media channels were like, oh my god, this is amazing. This is so good. Some people were like this is not good. This is bad. So I want to talk about it today. And tell you what I think and I'm going through the press release release and the related blog article rather the related blog blog article from the AMA, line by line and picking it apart and telling you what's the crackers, crackers, crackers, Irish for story or news or good or many different words anyway. So I got a email from Hannah, who is a health reporter from the Pittsburgh Post Gazette. Hannah and I have been in contact before and Hannah is curious, as feels like curious and interested in in fat liberation. Certainly not someone who is spreading misinformation about fat bodies, which is amazing. Love it. And Hannah emailed me saying hi Vinny hope you're well. I'm wondering if you saw the American Medical Association statement that the BMI is an imperfect metric with a problematic history and should be not used. Sit alone to determine overall health. I'm wondering if you have any thoughts on this you'd be willing to share with me for a story that I'm writing. I know that the racist history of the BMI has long been known and the anti fat bias advocates have pushed for doctors to adopt a more comprehensive measure. Do you think this statement from the AMA is enough? What was your reaction? Thanks. And please let me know if you have any thoughts to share. By the way, the spreadsheet you sent me is proven very useful. I'm looking into some of these studies for the story now. Oh, yeah, I sent Hannah a spreadsheet with all the science science, guess what, you can have that spreadsheet with all the fat science, if you become a cofee subscription, I can't remember which level it is five or $10 or something. You get also get the fat resource list mega guide blahblah blueprint. Anyway, I responded to Hannah. But before I tell you how I responded, I want to share with you what the AMA is saying. Okay, so AMA, use of BMI alone is an perfect clinical measure June 14 2023. Four minute read by Sarah Berg, Ms senior news writer. So this is on the AMA website. And so they are telling us about a meeting that they had. And what the boffins an old word. Did you say that word? Resale say that word boffin? It's kind of like a word for nerd or word for someone who's smart. Where we kind of dear or derogatory? It's probably it's probably let me google it, man. It's probably like something. There's probably some problematic history. Let me just make sure I'm not saying something really fucking horrible. Oh no, boffin is a person engaged in scientific or technical research. That word was perfect. A person with knowledge or skill considered to be complex, arcane and difficult. Yes. Okay, good. So the boffins the AMA had a meeting. And so let's go through. Okay, I'm gonna link link to the show notes link for the show notes for everything I'm talking about is in phase. Fatty fatty.com, forward slash 174. Or in the show notes. This is episode 174. Okay, so first sentence from this post is body mass index, BMI is easy to measure and inexpensive. Okay, so first, my thoughts on that. So that first sentence, just because it's easy to measure doesn't mean that there isn't a cost. And that cost is to the physical and mental health of the client. And also, just because it's easy to measure doesn't mean that we should be doing it, right. You could say measuring penis sizes is is easy to measure it and an inexpensive and a great way to tell you about someone's health. Well, no, measuring someone's penis size is not going to be something that you could do it easy. It's not gonna tell you much about health and is going to be harmful to clients. Right, you know. Next, the next sentence is it also has standardized cut off points for Oh word and oh word and is strongly correlated with body fat levels as measured by the most accurate methods. Okay, so that was their sentence. We have standardized cutoff points, and is strongly correlated with body fat levels as measured by the most accurate method. So standardized cut offs arbitrarily created with bogus data. Quote, In 1999 1998, the US National Institute of Health brought us definitions in line with the World Health Organization guidelines, the US definitions of BMI, lowering the normal slash O word cut off from 27 point, whatever. 225 This had the effect of redefining approximately 25 million Americans previously healthy two. Oh, word. So they're saying we have standardized cutoff points. So they're standardized cutoff points just because you have cut off points doesn't mean that a good cut off points, right. They cut off points that were arbitrarily created that the number of 25 for a 35 etc. They're those numbers you know why? Because the science because of research because the data know because they're easy to remember. Fucking believable, and they say it is the most accurate method. It might be. It's not even if it was the most accurate method. It is not an accurate method, you know, going back to say, hey, let's measure someone's penis size for health, they can say that's the most accurate method. Isn't measuring penis size, and correlating it to health is the most accurate method we have? Well, it's just it's not a it's not it's not an accurate method. So but they're not wrong because it's the most accurate method according to them. I mean, they are wrong, but Okay, the next sentence they say, but BMI is an imperfect measure, because it does done does not directly assess body fat when the previous sentence I just said, it's strongly correlated with body fat levels, and is the most accurate, but it's imperfect because it does not directly assess body fat. Okay, so that is not why it's an imperfect measure. We do not have the evidence to show that body fat in and of itself is a thing that causes conditions associated with fatness. What we do know is that anti fatness does contribute to those conditions. And so, why would the BMI be imperfect because it doesn't directly assess body fat. Instead, the BMI is imperfect because it tries to assess body fat. So they're saying it's imperfect because it doesn't directly assess body fat but it's imperfect because it tries to assess body fat and it tries to categorize people. And it tries to say this is who is healthy as unhealthy by this arbitrary measure measure. So in the paper weight science by bacon and Afra more, quote, weight cycling resulted in increased inflammation, which in turn is known to increase risk for many fat Associated Diseases. Other potential mechanisms by which weight cycling contributes to morbidity includes hypertension, insulin recession resistance and this lie premia. Research also indicates that weight fluctuation is associated with poor cardiovascular outcomes and increased mortality risk. weight cycling can account for all of the excess mortality associated with fatness in both the Framingham Heart Study and the National Health and Nutrition exam examination study, it may be therefore, that the association between weight and health risk can be better attributed to weight cycling, then add a positive added positive itself fatness itself. So that is the weight science study that was very influential. Bacon an afro more. And so they're saying what I'm saying here, which is that, you know, BMI is not measuring weight stigma. It's not measuring the thing that actually causes harm to fat bodies. And is that actually contributing towards that stigma and shame in its existence, so next line from the paper on paper blog. On top of this, the current BMI classification system is misleading about the effects of body mass or mortality rates. According to an AMA Council on Science and Public Health report presented at the 2023 ama annual meeting in Chicago. Let me tell you that first line again, the current BMI classic classification system is misleading about the effects of body mass on mortality rates. Yes, correct. The BMI is misleading about body mass on mortality rates. This is called the O word paradox. So study Oh word people live longer. link in the show notes. Basically what it showed is that people who are fat live longer than people who are street sized. And it's called the O word paradox because they're like, hang on a minute, we thought that people were dying left, right and center. And it turns out that that's not what the data is showing us. I don't know if that's what the AMA is saying in that line. I don't know if they're alluding to the fact that we can't tell someone's mortality rate from their BMI classification. I'm gonna say they're probably not saying but let's give them the benefit of the doubt. They continue. Numerous comorbidities, lifestyle issues, gender ethnicities, medically significant familial, determined old, determined mortality. effectors duration of time one spends an uncertain BMI category and the expected accumulation of fat with aging are likely to significantly affect interpretation of BMI data, particularly in regard to morbidity and mortality rates. This is a council Council's report. Okay, well, because that sentence becomes after that, the other sentence, I'm going to say that they are saying that because people are complex, the system is the BMI classification system is misleading. They're saying because people are complex, they're not saying the data shows that fat people live longer than, quote, normal weight people. And what is the huge, huge just thing that they are missing with that list of things, and if I buy is basically the list now out the consequences of fat hates. And then also natural reasons, you know, fat people are fat. And saying, there's an issue with that, you know, like, hey, gender, ethnicity, whatever, you know, reasons why someone is who they are. And then consequences of weight bias, fat hate, but they're not naming it. They're not naming the issue, which is fat, hey, what they're doing is saying and not saying the presumption being that fatness causes those things. They're not saying that it's not fatness at court, this causes those things. Okay, continuing on. Further, the use of BMI is problematic when used to diagnose and treat individuals with eating disorders because it does not capture the full range of abnormal eating disorders. So I'm trying to work out what they're saying here. Let me read it again. Let's see if we can try and work out what they say. Further, the use of BMI is problematic when used to diagnose and treat individuals with eating disorders, because it does not capture the full range of abnormal eating disorders. So are they saying that a typical anorexia that diagnosis is fucked up? So atypical anorexia is anorexia and fat people? And it's far from a typical atypical is not not is meaning not typical? Because most people who have anorexia are in smaller bodies, I think it's something like four or 6%. Yes. 6%. So 6% of people who have eating disorders, not just anorexia. 6% of people who have eating disorders are in lower weights. And with anorexia, the majority of people who have anorexia are not lower weight people. Okay. And so are they saying here that if we are using the BMI, we're not going to capture a typical anorexia, and that diagnosis is fucked up? Are they saying that? Or are they saying fat people have eating disorders, and that's why they're fat, and that their eating disorder is binge eating disorder. And that BDD, binge eating disorder means someone eats too much food, which in reality, is a restrictive eating disorder. Are they saying that the BMI does in some way, capture some range of eating disorders? Because it's they saying because it does not capture the full range of abnormal ink disorders? How can the BMI you be used to capture any eating disorder? How, how can you look at someone's body weight and know if they have an eating disorder? How can you say the BMI is going to tell you that a fat person hasn't? Has any eating disorder presumably be Edie because that's all apparently that fat people can have which is not true. And as well, but it is a restrictive eating disorder. So what are they trying to say? Okay, so next for adults, measuring BMI and waist circumference may be better a better way to predict weight related risk. What? What measuring the BMI and waist circumference? According to who is better, according to what? What science waist circumference? What you know that whole thing like carrying fat in your fat in your belly or in your waist is higher risk? It's all bullshit by the way. But for children, there is no good reference data for waist circumference. There is no good reference that f of for adults, which makes get this guy this because we can't do waist circumference on kids. That means BMI for age is the gold standard? Hang on a minute. They have spent the last few last paragraph saying BMI. Here's the limitations. For kids. They're like, we don't know how to measure kids. So let's just stick with the BMI. In fact, it's the gold standard. I mean, make it make sense. Make it make sense. Why is it they're saying it's not great? We got, we're just gonna find it. We're going to use it on kids because we can't think of anything better. How I mean, it's what like, the waist circumference? How waist circumference? How does that measure fat? Because that's what they say. The BMI is not good at measuring fat. How would an waist circumference measure measure fat? My brain is like what a woman. Also, we don't need to be measuring body size at all. gold standard for children. Why? Okay, they continue. There are numerous concerns of the way the BMI has been used to measure body fat and diagnose Oh word. Yet some fish physicians find it to be a helpful measure in certain scenarios. And then, I mean, they don't they go on to saying how the BMI is, is, is harmful. But in that previous sentence, they're saying, but it's not so harmful, that it's not still the gold standard for children. And we use it with adults alongside waist circumference, which again, doesn't measure fat and not what we need to measure fat, you know, we need to be looking at health indicators. And so Okay, so they're saying that some doctors like it. Past said ama Immediate Past President President Jack Resnick, Jr, MD, quote, it is important for physicians to understand the benefits, what benefits and limitations of using BMI and clinical settings to determine the best care for their patients? I would like to know what circumstances it is a helpful measure, like name them out? Or is it just on the doctors whim when they want to stigmatize the patient? Or is there going to be a standard use usage going to be developed, like you're allowed to use the BMI and this time, this time, it's okay to stigmatize the patient and harm the patient. But in this time, it's not like what is the whole thing is flummoxed in me. So that like BMI is problematic and not useful, but still use it and cause problems and harm people. But at your discretion. Okay, continuing the House of Delegates adopted new policy, recognizing the issues when using BMI, as measured as a measurement because one of the historical harm of BMI of the use of too, I'm putting on putting the numbers into of the use of BMI for racist exclusion. Three, BMI cut offs are based primarily on data collected from previous generations of non Hispanic white populations and does not consider a person's gender or ethnicity. In other news, the sky is blue. Next, we tell they'll be telling us that they discovered the earth is in fact round and not flat, or that gravity exists. Yeah, we know, this is old, old news. them saying the historical harm of the BMI, the BMI being racist, also totally cool that they, they thank the fat and black and other racialized and marginalized groups that taught them these facts. And those of them that have been violently harmed and killed by the AMA decisions and policies. It's like it. Who taught you that? You know, who Where did you learn this stuff from? Don't mention don't mention the people you learn it from? Because then that would have to, you'd have to recognize that you were the ones that were causing the harm, and that you have killed the people who are who have graciously shared that information with you. And I'm coming out now in 2023 when we've known this stuff, for so long. For so long, 200 years, the BMI has been about okay, can they continue? In addition, the policy says there are significant limitations associated with the widespread use of BMI in clinical settings and suggests it's used but use B in conjunction with other valid measures of risk such as but not limited to measurements off okay. Are they going to say measurements or have blood pressure, anything that you you know the things that you can test for the real, valid, reliable data to see if we are healthy. What are they going to say we're going to measure we're going to measure visceral fat, body positivity index, body composition, relative fat mass, waist circumference, genetic and metabolic factors. Wah wah wah. So close yet so far, they could have said BMI is not good. And so we, we are instead going to measure blood pressure, blood panels, do tests to see how the body functions. And instead, we're going to do better at measuring how fat someone is. So they're saying the BMI is flawed. Therefore, we need to be better at measuring fat and stigmatizing Fat people not offering them evidence based care but to categorize them as diseased. Okay, they continue on the newly adopted ama policy also states that BMI is significantly correlated with the amount of fat mass in the general population but loses predictability when applied on the individual level. So do you remember Do you remember, way back 200 years ago, when the BMI wasn't called the BMI then it's called the quitter index. Quest let a Dolph Adelphi adult Kwethluk said Listen up here motherfuckers this is not meant to be used to measure individuals this is I'm just looking at these white European men. And yes, I am trying to find the ideal man. The average man Longwear but we can't use it on individuals. Okay. I'd have quite a lot said that. You didn't say listen up here motherfuckers. But a roundabout way said it is not good to use on individuals an AMA 200 years later like ah, Scripture nah, heads. Maybe listen up here. Listen up here to this. Oh, why Oh, idea. We've got a let's maybe not use BMI on individuals. Actually, no, no, no, no, no. We know is not good to use on individuals. But we're still going to use it in individuals. How do you then restart? Well, I'm going to stop using it. We're going to set a user but we're going to use other things too. But you know, it's not really good for individuals with like it. We're going to use it. Yeah, we came up with that. We came up with that. Yeah, totally. It was totally us. Yeah. Okay, the continue relative body shape and composition. Heterogeneous Jeanne at across race and ethnic groups, sexes, genders and age span is essential to consider when applying BMI as a measure of adiposity. The use of BMI should not be used as a sole criterion to deny appropriate insurance reimbursements. Hold on. Now let's read that last sentence. Again, the use of BMI should not be used as a sole criterion to deny appropriate insurance reimbursement. Let me rewrite that sentence for what it should be. The BMI should never be used as any criterion to deny appropriate insurance reimbursement. They're just saying used to be used to BMI Go girl is used to BMI, but then also use something else their waist circumference totally, totally. Yeah. Like, do they understand what they're saying here Do they do by a BMI should not be used as any criteria to deny reimbursement? And as well, they're saying deny appropriate reimbursement, right? They're saying this person should be appropriately reimbursed. But we're going to use this thing that we're saying as problematic as something to deny them, plus another measure who whatever you think is best. Who knows? Measure the peanuts? Who knows? You know, we're just picking up picking out ship from our brains like, you know, okay, continuing the AMA. We're also will support further research on the application of the extended BMI percentiles, and Zed scores. Zed scores is like the average scores, you know, like I say, in a bell curve, percentiles and XenSource and its associated association with other anthropomorphic measurements, risk factors and health outcomes. So further research, in order to explore In other we should research on the application of BMI. Why? Why? Why? Why do we need further research on the BMI? The BMI is bullshit. And they say as well efforts to educate physicians on the issues with the BMI and alternative measures for diagnosing Oh word diagnosing Oh word. Hmm. Sounds like like they are running into the very issue that their panel of experts pointed out to them in 2013. How can you diagnose someone with fatness? When the only shared characteristic of this disease, quote disease is body weight and nothing else? So how can we diagnose someone with a word when there's only one shared characteristic? And every single person who is fat will have different health outcomes? Their own? Experts told them? We cannot say that fatness is a disease because of that. So in 2013 Here's a quote from a piece of literature it's called is a word a disease or a behavior abnormality. Neither did the AMA get it right. Okay, so quote in June 2013, the AMA house of delegates voted to recognize fatness, as a disease state requiring treatment and prevention efforts. A number of other medical societies had sponsored a resolution to support this idea, including the American Association of clinical endocrinologists, The Endocrine Society, the American College of Cardiology, the American College of Surgeons and the American Heart Association. The National Institute of Health had declare fatness, a disease in 1998. And the American fat Oh word society did so in 2008. As a surprise, they did that huh? Because the AMA is sought as the most influential Medical Association in the country. Their statement is expected to have significant influence on healthcare policy, through effects on insurance, industry and lawmakers. The stated purpose for this decision is to improve research into the causes of fatness leading to improvement in methods to prevent and treat it ultimately improving patient health and outcomes. That is not what what the outcome was the outcome was more money to eradicate fatness. This decision would be expected to improve insurance coverage and reimbursements to provide for treating individuals with fatness. In addition, this change in public policy by the AMA supports the concept that fatness is a serious disease that requires treatment and it also removes the stigma currently associated with fatness i It's not just a poor lifestyle choice it does not remove the stigma. The AMA decision is controversial since the amas own Council on Science and Public Health in 2012 said that there was not sufficient data to support calling fatness, a disease and now here we are 10 years later 10 years later, they're still like how can we diagnose someone with fatness? What are the shared characteristics? What are the outcomes of this disease? What is what is which is common amongst all of these fat people? nothing apart from the fact that they're fat ha okay, well Well fuck it. Let's just make it a disease. Hello. Okay condition can can continuing additionally, delegates modified existing policy on the clinical utility of measuring BMI body composition, add a positive d adiposity. And waist circumference to support quote, general emphasis on physicians educational programs on the risk differences within and between demographic groups have varying levels of adiposity BMI, body composition and waist circumference and the importance of monitoring these individuals. Okay, so what they're saying here is between different groups of people, the risks are different. So basically what's going to happen here is that doctors are going to harass racialized people, mainly more and then other marginalized people even more than they normally do. About being fat, which is quote gonna cause even more harm. So the thing is right, stress is bad for our health, what is a big source of stress, living in a society that marginalizes you and excludes you. People who have more marginalized identities, on a population level experience more stress, fat, black people, they are identifying as higher risk. Therefore, they're adding to the stress by saying we need to measure your BMI and your waist circumference and we need to tell you to not be fat, when the causes of the stress is a thing that's happening in that very moment, which is telling the person not to be fat. It is when they walk out of the office and they experienced racism and exclusion and whatever other identities that they have adding on to that. So it is haunting, frightening that they are saying we need to monitor this more in between demographic groups. Okay, continuing, delicate delegates also modified existing policy on eating disorders calling on the AMA to encourage training of all school based physicians, counselors, coaches, trainers, teachers and nurses to recognize abnormal eating behaviors, dieting and weight restrictive behaviors in children and adolescents and to offer education and appropriate referral of adolescents and their families for evidence based and culturally informed interventional counseling, consulting with appropriate culturally informed educational and counseling materials pertaining to abnormal eating behaviors, dieting, and weight restrictive behaviors. So what now? How the fuck can you tell people to lose weight dieting being the biggest risks risk factor for an eating disorder. And then say, we need to be better at recognizing, quote, dieting and weight restrictive behaviors in children and adolescents. You are causing the issue here. And what about adults? Is it okay for fat adults to engage in quote dieting and weight restrictive behaviors? Presumably so. And I bet you what they're talking about in regards to eating disorders here I bet you they're talking about fat kids having an eating disorder and that's what's might cause them to be fat. That is the end of their, their the end of their bullshit. That's the end of their bullshit. So my response to Hannah, which let's think about some other things as well in regards to this. Like I mentioned some people are celebrating this some like you know, people who are aligned with the fat activist community are celebrating this people who are aligned with the fact of his community are deriving this let me read a post from Mikey Mercedes on Instagram. I'm going to need everyone celebrating this to actually read it because the endeavor to measure fatness more precisely is not compatible with ending medical fat phobia. Be fucking for real, finding more measures and criteria through which to continue systematically marginalizing fat people is not a win the AMA using language that indicates the awareness of fatphobia as anti blackness and deciding that the solution is to expand ways of othering fatness is not a win, making measures of fatness that concretize notions of blackness or non whiteness as being genetically or physiologically different from white bodies is not a win. It is race science efforts to educate this as a quote efforts to educate fishers on the issues with a BMI and alternative measures for diagnosing fatness, quote unquote is not a fucking win. Y'all got me heated right now with this bullshit, quote, fat activist and advocate Stop begging for scraps and the expansion of the fatphobia industrial complex and quote challenge for 2023 Please and then in the caption y'all know I don't even posts like that anymore. But the reactions to this statement from the AMA has me heated the BMI is not bad because it doesn't measure fatness quote good enough or because it didn't include non white people in its development. BMI is bad because it is part of the scientific quest to distinguish non whiteness as inferior and because it is used to ration care. This pivot is not about supporting fat people All providing them the care they deserve. It is very clearly about the expansion of systems, practices and tools to correct categorize, surveil and distinguish fatness as a natural and needing intervention. And it pairs perfectly with the push for weight loss medications and increased targeting of fat kids that has been going on for a hot minute now. This is not good.

So, yeah, absolutely. Mikey saying it much more eloquently than I can. It's race science. It's race science. Yeah. So this is what I said to Hannah. We need to look at the AMA's motivation for this and why now remember, in our last emails, so I was emailing Hannah about I was emailing Hannah about or Hannah emailed me and I responded about pseudo fat activists. They're not real fat activists. They are people who are Oh, word, eradicate us and so astroturf corporations, companies, organizations created by weight loss companies to advocate for the advocate for fatness to be a disease. And so that was what Hannah's article was about. And what I was saying was like, It's bullshit, and they're saying that fatness needs to be eradicated. fatness needs to be classed as a disease so that they can make tons of money from trying to cure the disease. Whereas fat activists real fat activists are saying that we need to end fat stigma because there's nothing wrong with being fat. They say we need to end fat stigma or they don't call it fat stigma. They call it weight stigma. Because it's not the fault fat people are greedy and disgusting. They have a disease. And there's nothing wrong with like, there's nothing wrong with having a disease. But the categorization of of fatness as a disease is harmful in this context. And there's many times that things have been categorized as a disease in history. And it's just been used as a way to try and eradicate that population. Think about queer people. Okay, so we need to look into AMA's motivation for this. Remember the emails remember, remember in our last emails we were talking about the medicalization of fatness the medical medicalization of fatness is that you know making fatness a disease and how purveyors of quote solutions to cure fatness are behind a lot of the push to say that fatness is a disease. The AMA has long gone against via advice from experts and long established available science to declare fatness as an issue. And this sucks sudden milquetoast recognition that BMI isn't the best smells fishy? A quote from Regan Chasteen when I say the AMA is in bed with the weight loss industry that's not just a feeling I have a quick look at the 2022 annual report for the AMA foundation finds that Eli Lilly, who's we go V competitor drug turns turns a peptide is expected to get FDA approval as a weight loss drug this year and has been forecasted by Wall Street analysis to be the most profitable drug of all time, gave donations between 500,999 500,000 A million are all friends at Novo Nordisk moving orders made we go V came in between 102 150,000 and Merck which just announced that they are developing a drug to compete with Wigo V and ptosis. And you need to learn how to say this drug because I'm going to use it probably saying it for a lot of times to Zoo Tez Terzi potatoes it Pattaya Tez, Tassie apartheid, we go into the apartheid also shelled out between 500 and 1,500,000 and million dollars. I continue, how could the weight loss industry benefit from a move away from BMI? Well, if we get rid of categories, and they can get their drugs prescribed to more people, which makes me think this is a catalyst of the amas. This is a catalyst of the AMA statement that they're clearly not being informed by fat liberationists in this decision, because one they vaguely mentioned the BMI is called cause historic harm but failed to recognize any of the work that fat activists have done for decades, talking about this very thing and what that harm has done to populations and individuals. They have not apologized for the harm that they have caused. They never mentioned the problematic history of the beat of the BMI in literally killing Fat people. They say that they're using the bite being BMI for kids, it's still gold standard. They don't want to do away with measuring fatness as a disease state, they just want to do it more effectively so that they can continue to try to erase fat bodies in a more efficient man and man manner. Although they are not successful at this, even though they recognize the BMI is not good at measuring individual health, they still want to use it plus other non evidence based ways of measuring health. Quote, The AMA suggests that it is that it BMI be used in conjunction with other valid measures of risk, such as but not limited to measurements of visual fat body adiposity index body composition, relative map fat mass waist circumference. One thing you mentioned, quote, anti fat bias advocates have pushed for doctors to adopt a more comprehensive measure. This isn't not actually accurate, fat liberationists don't want bodies to be measured in a medical setting at all. There is no quote comprehensive measure of fatness as a disease because fatness is a normal way to have a body. We want health to be looked at with actual health markers. We want the correlations between fatness and health conditions to be clearly seen as a mark of weight stigma. And not that adipose tissue is the cause because it hasn't established to be so we want fat people to be treated as humans are not pathologized just for existing. We want evidence based care, which includes the ending of violent anti fatness. So in conclusion, it's mildly satisfying that the AMA is finally very tardily recognizing what fat liberationists and scientists have known for decades. But their motivations scare me. And I worry that instead of hearing, quote, The BMI isn't great. Let's stop harming fat folks, people here, quote, let's spend more money on research to pathologize and erase fat people more effectively. I am really concerned about the power and money the weight loss industry has and the influence they are wielding at policy levels. It strikes me that the AMA are using in some ways, vaguely liberatory language as a cloak Nundah that cloak is a shit ton of bias and stacks of cash and lobbying from pharmaceutical companies. And because consumers the public are getting smarter, they're not as easily duped. When it comes to the idea of fat people being degenerate pieces of shit. The general public are more apt to hear fat people are degenerate pieces of shit, but it's not their fault. That end of a sentence but it's not their fault. That's the cloak of nicety of we're forward thinking when they aren't. They're talking about these not even talking about them. They drop in a couple of words here in their racist history. Not good at measuring measuring individual health. You know, the couple of things here and there. Crumbs exactly what Mikey said crumbs, morsels, tiny little things to say, Oh, we can let our guard down. We can garden. Okay, well, the AMA gets it now. And I think that's the thing is why Mikey was so frustrated is that we see this little thing, okay, and we're, we're, we're rightly so we see that cloak of cloak of language that we understand, right? Those words those, you know, they ring out, you know, and we say, Oh, they get it, okay, they get the AMA get set. BMI is bad. Holy shit. We've been saying this for decades. Wow, they get it they get it like so the headline is BMI is bad. It's problematic. It causes harm. Right? We could take those those those few sentences from the whole thing. That's why I want you to read the whole frickin thing out go line by line and say, what are they actually saying? And what they're actually saying is we intend to be better at causing harm. Write that down is a good one. We intend to do better at causing harm. That's why these frickin anti Oh word charities and organizations that say they're on the side of fat people are so harmful because they are giving language to the oppressor so that we agree with the continued oppression of those marginalized people. Because they said a few buzzwords are given us a little bit a little crumb. And then we're like, Okay, well, that sounds okay. Yeah, yeah, yeah. But really, when you crack it open just a little bit, just even. I mean, within the first sentence, I was like, No. And near this is not sound sound good. And within the first sentence, the truth, the truth, the truth will out. My comment on Mikey's post is that report literally says, We got to be better at classifying people as fat so we can continue to erase them. So let's try all these other stigmatizing methods as well as a BMI in order to kill more fat people. Yeah, so so this is not a weird this is actually I think, actually quite scary and harmful. But like I said, mildly satisfying, right? These big organizations, it's like they're forced to, right, they're forced to get with the times, but they don't want to let go of the money. You know. So hey, I read a really good book that I really liked. My therapist told me about it. It's got nothing to do with any of this. It's called worry free money. By Shannon Lee Simmons, I got it from Amazon. I bought it from Amazon, or like a second secondhand use book. I paid I don't know, like 20 bucks for it. And then on the front, there's a sticker that says 15 bucks. And on the back, there's a sticker that says 599 from Valley village. And so I'm like rats. Okay, I paid the big bucks for it anyway. It's really good. So I've had a long history of shame around money, obviously bring being poor and being homeless at 17 is gonna do that for y'all. Right? And, you know, my therapist was talking about how families especially poor families, we don't don't talk about money and managing money and like, I'm gonna say, managing money I'm not talking about you know, you've got millions and where to put it into what stocks it's basically like, how to you get your paycheck and how much percentage needs to go where and giving yourself your monthly spending money and you can spend that however the fuck you want. You know, it's not like budgeting, like, oh, we need to spend less on Starbucks. It's like you decide what you'd like to spend money on. If it's Starbucks, if it's eating out, if it's buying, crocheting supplies, whatever it is, it doesn't matter. You've got a monthly budget to spend on whatever the fuck you want. And so you can just not be stressed about like, I feel guilty buying a Starbucks, you can be like, well, you know, I've got X amount of money for the rest of month. And so this is what I'm going to buy. I've paid my bills, I put some into savings. I've you know, these are the fixed expenses and and actually, it's helped me cut down on a couple of expenses, I realized that I was paying too much for this one system. I was paying like double the capacity I needed and so that was able to save me 100 bucks. And other other few things. I was like, oh shit, so I've got extra spending money. So yeah, it was called worry free money. The guilt free approach to managing your money. And your life. Shannon Lee Simmons. Now they need does it have fat phobia in the book? No. It doesn't. Why do you wouldn't Why would a financial book have fat phobia? Because every fucking book does. So where they use AI so where the last book I think I read it was finance book I think it's called rocket fuel. It was about like managing your business money. And I'm pretty sure that there was like a they use weight loss as as an example right? In here someone says that they value buying organic foods that's important for them. That's the only mention of food is someone's some one of our clients says, I like buying organic food and that was it and so certified, bullshit free. No. fatphobia one mention of organic food but no judgments is just someone likes eating that. And she's Canadian. It's really simple. And I like it. If you get it and you like reading it, let me know um, I'm not like, Shannon hasn't sponsored the show. I mean, that'd be good, wouldn't it? It was just really good. I really, really liked it. And it makes me it makes me feel a lot less guilty about spending money and knowing what to do with my money. The money that I do have. Okay, well, thanks for hanging out me too. I guess I'll see you in I think two weeks or something. Who knows? One week, I mean, not one week, two weeks or a month. Unless we get some donations on cofee. Send your donations, get more podcasts, or don't send donations and don't get podcast. You might be saved Vinnie. We don't want no more podcasts. And that's cool. Just don't send the money. And you won't. You will also get one podcast. Yes, they'll get one podcast. Well, thanks for hanging out with me. I hope you have an amazing day. Thanks for being here. fatties and fat allies. I think you're great. Thanks for chilling out what my and I'll see you on the next episode of The phys ed podcast. tatty bye. See it in a while. Crocodile alligator.