So that paper on BMI and “obesity” is finally in proofs stage and I’m already bracing for the reaction in case anyone reads it.

I’m waiting for a zoom meeting to start so let me just tell you a little bit about it.

Here’s a thread from over a year ago in which I optimistically say that I expect the paper to be out in 6 months. Lol.

https://twitter.com/cricketcrocker/status/1114515182812913665?s=21 https://twitter.com/cricketcrocker/status/1114515182812913665

As part of writing this paper, I looked *everywhere* for a definition of obesity, which is named as a serious disease with major health consequences basically every time it’s mentioned.

The CDC says it’s primarily defined by BMI. The NIH funds research using this same heuristic.

Well. The best I can find (still) is “a complex disease involving an excessive amount of body fat to an extent that it may have a negative effect on health”

You read that right:

it *may* have a negative effect on health.

Okay so we have a “disease” primarily diagnosed using a heuristic that has no clinical or population level association with health...

...and the disease itself is the existence of a probability.

Worth noting that it’s a *perceived* probability.

Before everyone gets all “oh so you’re trying to tell us that fat people are perfectly healthy”

What I am saying is that fatness is a *size* not a *disease*.

It’s foolish to conflate those.

Fat people can be unhealthy. Thin people can be unhealthy.

Do older fatter people have higher risk of cardiovascular disease than thinner ones? To some extent, yes.

And older thinner people are more likely to die of upper respiratory infections.

What would be useful socially and scientifically is if we shifted from talking about body fat in the context of judgey moralistic perceived probability...to researching what is the healthy window of body fat to have?

How does it change by individual?

I would like to see work done on this—because once we start to ask questions about that...

We can answer questions like “what can we as a society do to help everyone stay in their window?”

“What social policies will support health in everyone?”

Health is more than body fat—and right now the social animus towards “obesity” hurts health in general.

Health is not a size.
Vice is not a size.

Obesity is not a meaningful paradigm for investigation.

And BMI is useless.

The paper will not read like a twitter thread, and the ideas here are what I built the paper *ON*, not what I wrote in the paper.

But when it is published I’ll tweet about it.

I want to say one more thing about this.

I did not know all of this when I started writing the paper. I thought it would be a good way to measure health, to involve BMI.

I was so wrong.

Luckily for my professional self respect...I spend a lot of my time listening to other people and examining my own thinking, so when I came across fat activism, I listened.

I asked questions and tried to find science that supported what I thought.

I could not find any evidence.

In the end my coauthors were generous with me and let me reframe our discussion of or results in a new way.

A way that while using the same analyses, contributes a different thing to a different conversation.

If you’re not an academic scientist—let me say now that it’s really frowned on to take 2 years to publish a paper that is not going to a very fancy journal.

But this one took me two years because it takes time to untangle how wrong you are. To understand how you can be right.

It takes a lot of time to figure out what the data are actually telling you, when you started out expecting them to tell you totally different things.

And then it takes time to write it all up and discuss it with the 9 (I think?) coauthors.

This paper—about “obesity” and DNA methylation...is not my field.

I learned a ton doing it and I am a better thinker now, too.

But I’d be lying if I said it wasn’t a conventionally bad career move to spend so much time retooling a paper into a thing that isn’t really my field.

But I’m proud of the work.

I‘m glad we (however narrowly) avoided doing harm by perpetuating “obesity”.

But I’ll tell you what, I am not going into “obesity” research.

This was just what I had to do to make sure I was not doing harm.

Not to hold myself up as an example by any means but I wish that slowing down and re evaluating were more normalized in academia.

Because we collectively have some really bad takes.

Ok I think that’s all I have to say for now.

I guess 2 addenda:

1. Fellow postdocs and everyone “above” us: if I can take a strong position against singing along with harm, so can you.

2. Without @Artists_Ali, I would not have avoided doing harm. Follow, listen to, and support her, please.

Ok evidently some of you need a bit of help refocusing on the bad part. (Also I meant to say “mis-served” in this tweet):

https://twitter.com/cricketcrocker/status/1114529536325160961?s=21 https://twitter.com/cricketcrocker/status/1114529536325160961

Well here’s a link to access the paper.

We weren’t able to afford OA fees so it’ll only be available this way for a month. After that please contact me if you want to read it but can’t access.

https://www.nature.com/articles/s41366-020-0646-z.epdf?sharing_token=LoSyrKRjo2_Ecbk28DShKNRgN0jAjWel9jnR3ZoTv0MzfKOTY2jJvLGTyNQkghmm_w9QqyGRZlNAAMV6_OsyrHMPybnnLKzv3WsA3jh8d-JYml6cm5m58xLNLivh8TkFOR95WpwyxPw1jYO-mJ3Vr31Gtd_kkWlEgzbfXqlbsVI%3D

I don’t love the name of the journal that it’s being published in, just for the record.

That said, I think the readership of the journal needs to know that the simple proxies currently used to assess health risk due to body size....

...are not biologically synonymous.

I will probably do a thread in the next few weeks to go through the results but there are so many deadlines happening to me right now...

I just want to emphasize that I’m not the first person to realize all these things.

I was able to find plenty of supporting material to cite, but the literature did not rise up to meet me (great phrase from @TheVelvetDays) but that’s on indexing.

So much work exists on this.

So in recognition of this, I’d really appreciate if you’d go find and commit to learning from and supporting fat activism and the people whose fields this actually is.

Join their patreons, read their work, collect your friends when they do anti-fatness.

People I learn from (non-exhaustive list because my brain is moosh right now):

@DaShaunLH
@Artists_Ali
@yrfatfriend