I’m an adipose tissue biologist. I study sympathetic nerve action on adipocytes. This month is my first committee meeting since beginning to intensely read weight bias literature. I’m nervous to hear a group of old school researchers respond to my new ideas. But it isn’t optional

It’s about responsible conduct of research. it’s also about me. I’ve never been a “normal weight”. Ever. 10 year vegan, 15 year long distance runner. I’m engaged in auto-ethnography deconstructing my own health journey. Decoupling weight and health.

These are the things I know: exercise and healthy, culturally appropriate diet are critical to human health. Large bodied and small bodied people do not consistently differ in these variables. I know this from data. I know this because I am one of these people.

I know that adipose tissue is essential for life. I know that some people at extremes of adiposity distributions have health problems. I know we cannot manipulate adipose tissue directly short of liposuction, and as a result, it is difficult to understand causality.

I know that categories can be very dangerous things. Collapsing all larger bodied people into “an epidemic” of ob*sity defines unalterable human bodies as a problem to be resolved.

I know that dieting is dangerous. I know that the entire association of BMI and cardiovascular health is explained by weight cycling. Meta analyses of 400k participants unequivocally demonstrate this. But still we are desperate to make fat people thin.

I know that fat people are chronically disrespected in life and in healthcare. I know I was hospitalized three years ago and that it hurt me to see “ob*sity” in my chart. Because I knew what they thought of me and how easily I could be written off. I never received a diagnosis.

I also know I used that term for years afterward, despite having felt its stigmatizing aura. I know people feel they earned their metabolic dx and that they have to fix it themselves. That attitude kept my dad off metformin, a lifesaving drug, for years.

I know that all metabolic disease clusters in sites of profound structural violence. We ignore this to our own peril. As researchers and clinicians, we are morally obligated to understand our patients and their experiences, even if they are hard to understand and model.

I experience profound conflict as I grapple with these ideas. But the old ideas didn’t work. They hurt people. I have devoted my life to harm reduction in every domain. And I dedicate myself to that principle here, in this awkward and confusing space.