Not All Bad

00:05:31

Public: You know, your knee wouldn’t hurt so much if you lost some weight.

 

00:05:34

Dr. Kaylee Byers: It made me nauseous. My first thought was, “Ex- squeeze me?” But years of internal monologuing stigma and childhood teasing, were now sitting like a gnashing angry monster in the corner of the room validated by a healthcare provider. I came to that office for my health, but, air quotes, walked away thinking about my weight. And ever since I’ve ruminated about the offhand associations we make about our physical health and what society considers health.

 

Check one, two, this is a challenge I’m not alone with, which is exactly why our producer, Jenny Cunningham went out to ask the people how they wrestle with questions of weight and health.

 

00:06:21

Jenny Cunningham: Do you have any thoughts on how weight affects health?

 

00:06:24

Public Man: I think people get a bit obsessed about weight.

 

00:06:26

Public Man: I think weight really affects health.

 

00:06:29

Public Woman: I know some people, they just tend to have bigger bone in structures.

 

00:06:34

Public Woman: You can’t tell how healthy someone is by judging their weight.

 

00:06:37

Public Woman: Weight affects a lot of everything.

 

00:06:39

Public Man: It’s your choice, it’s your body, it’s your life.

 

00:06:42

Public Man: It’s a complicated relationship.

 

00:06:45

Dr. Kaylee Byers: As you heard. It’s a mixed bag. We each make an assumption around our health and weight between obsession, feeling it’s all superficial or too complex to weigh into. So let’s unravel the scratchy and uncomfortable sweater that binds our societal view on fatness.

 

00:07:04

Shawnta Collette Carter-Williams: I think. So for me, I feel like I was-

 

00:07:09

Dr. Kaylee Byers: Shawnta Collette had difficulties with her health before her stroke in 2019, including another heart attack nine months before.

 

00:07:17

Shawnta Collette Carter-Williams: My doctor, he’s like, “I don’t want to scare you when I tell you this.” And he’s like, “You’re having a heart attack.” I was like, “What? Heart attack?”

 

00:07:26

Dr. Kaylee Byers: Her doctor said, it was brought on by stress.

 

00:07:30

Shawnta Collette Carter-Williams: It almost felt like an attack. “I told you that you were stressed out. I told you you needed to quit your job and find a new job.” It was just kind of devastating. So I’m like, I’ve tried to make all these necessary changes.

 

00:07:40

Dr. Kaylee Byers: But after 2019, they found out her family had a history of high cholesterol, so she became extra cautious with her health, but couldn’t be as active as she used to be.

 

00:07:51

Shawnta Collette Carter-Williams: Once I had the stroke and I became incapacitated, it made it harder for me to exercise. It made me harder to do anything. And so I was at an unhealthy weight.

 

00:08:03

Dr. Kaylee Byers: In that time, her doctor found that she was at risk of developing type two diabetes. That’s when her doctor mentioned Ozempic.

 

00:08:10

Shawnta Collette Carter-Williams: And it would help me lose weight. So I immediately realized that I wasn’t as hungry as I was before. So I wasn’t eating a lot. I didn’t have the urge to eat. I was a little bit more tired than normal. First three or four weeks, I was vomiting, I had diarrhea, all these different things going on with my body.

 

You get on this medication, you’re not going to live a glamorous life. People take the medication, continue to eat bad, not exercise, and solely rely on the drug. And that’s what I was doing.

 

00:08:46

Dr. Kaylee Byers: To get past the initial nausea and side effects.

 

00:08:49

Shawnta Collette Carter-Williams: I was eating greasy foods. I love grapes, I love plums, causing my body to go haywire.

 

00:08:55

Dr. Kaylee Byers: She switched up her diet a little and-

 

00:08:57

Shawnta Collette Carter-Williams: I noticed that the side effects went away. What I realized is that I needed help For me this drug changed my life.

 

00:09:09

Dr. Kaylee Byers: But what the heck is Ozempic anyway?

 

00:09:13

Dr. Michael Lyon: Well, it’s probably the most important breakthrough in the treatment of diabetes and obesity in human history.

 

00:09:20

Dr. Kaylee Byers: That’s me sitting with Dr. Michael Lyon.

 

00:09:22

Dr. Michael Lyon: A medical doctor and medical director of the Obesity Medicine and Diabetes Institute in Vancouver.

 

00:09:29

Dr. Kaylee Byers: And oddly Ozempic has a sort of scaly history. It began with a researcher named Dr. Daniel Drucker.

 

00:09:36

Dr. Michael Lyon: So Ozempic is several generations in 30 or 40 years ago by Daniel Drucker, and it’s the discovery of a hormone that’s produced the intestinal tract. It’s a small fragment of protein, a peptide called GLP- 1 Glucagon like peptide number one. It was clear that this had potent physiological effects on several systems, and interestingly, they couldn’t make the peptide back then where you could extract a gene from the human genome and reproduce a peptide like we do for insulin and so on. So what they had to do is look around in nature for something analogous to GLP-1. And the initial discovery of an analog of GLP- 1 was found in one of my favorite lizards, the Gila monster.

 

00:10:30

Dr. Kaylee Byers: That’s right, Gila monster. Specifically it’s venom. It’s a black and orange spotted lizard the size of your forearm and quite poisonous.

 

00:10:38

Dr. Michael Lyon: Which is a lizard found in the deserts of Southern US and northern Mexico. And in the saliva of that lizard, which has a poisonous bite and the poison is in its saliva, they discovered, strangely enough, an analog of GLP-1. And that became a peptide they could manufacture synthetically before DNA technology or recombinant DNA technology. And they made that hormone and it became something called exenatide, which was the first generation of the GLP- 1 analogs, the injectable drugs that have led to this remarkable breakthrough. And then later we had Saxenda, which was when it was approved for the treatment of obesity at a higher dosage.

 

00:11:23

Dr. Kaylee Byers: According to 2019, statistics from the World Health Organization, 1. 5 million people globally passed away due to type two diabetes. So something like Ozempic could be a lifesaver.

 

00:11:36

Shawnta Collette Carter-Williams: Luckily, I had really great insurance. I wasn’t paying the $1,600 or $1, 500 a month that I know some people were paying. My insurance was covering the medication. And so I was getting ready to get my prescription for my one milligram 1. 0 milligram, and they told me that they were out of stock. And so I was like, okay. And so they’re like, “Call back tomorrow.” And so I called back the next day and then one day led to two weeks, and then two weeks led to three weeks. And so that’s where I went through a period of not having the drug for almost four months, I basically gained all the weight back.

 

00:12:19

Dr. Kaylee Byers: That’s the moment she realized that Ozempic was having a minute in the spotlight.

 

00:12:24

Harriet Brown: People with type two diabetes-

 

00:12:26

Dr. Kaylee Byers: You may have heard about it, headlining with celebrities using it and losing weight really fast.

 

00:12:31

Male TV Host: Demand for Ozempic and Mounjaro exploded as people documented their success stories using the drugs.

 

00:12:36

Female TV Host: It’s too good to be true.

 

00:12:37

Announcer: When I look around this room, I can’t help but wonder is Ozempic right for me?

 

00:12:42

Male TV Host: Kim Kardashian and Real Housewives of Beverly Hills star Kyle Richards, who both lost a lot of weight in just a few months, have denied claims that they used Ozempic.

 

00:12:52

Harriet Brown: Yeah, Mindy Kaling had an Ozempic party. Everybody gave themselves Ozempic injections and they are now being widely prescribed for weight loss. It’s become a very hip fad.

 

00:13:02

Dr. Kaylee Byers: Harriet Brown.

 

00:13:03

Harriet Brown: I am a professor of magazine news and digital journalism.

 

00:13:06

Dr. Kaylee Byers: She’s an author, journalist and professor with Syracuse University.

 

00:13:10

Harriet Brown: I would never criticize anyone for making any choices about their body, but I think it’s deeply problematic.

 

00:13:18

Dr. Kaylee Byers: When she first heard about Ozempic, she was skeptical.

 

00:13:21

Harriet Brown: If you’re looking at financial interests, these are drugs that you have to take for the rest of your life basically because the minute you stop taking them, you will regain weight. So there’s again, a lot of money to be made.

 

00:13:30

Dr. Kaylee Byers: She spent much of her career grappling with the questions we have about our weight and health, and she fears that drugs like this are just another stone that rolls us further down the path of obsessing about our weight.

 

00:13:41

Harriet Brown: The bigger issue I think, is that, I mean, the American Pediatric Association, for instance, is now recommending weight loss treatment for kids as young as two.

They recommend talking about bariatric surgery for kids as young as 13. And I am really afraid that that’s going to be one of the big consequences of this new class of drugs semaglutide, they’re GPL- 1 receptors. So I think again, it’s going to be perceived as well. Now there’s finally a treatment for obesity, and now everyone should be taking it. No. It’s really worrisome.

 

00:14:18

Dr. Kaylee Byers: But for Harriet disentangling our perceptions around weight and health, well, it’s deeply personal.

 

00:14:25

Harriet Brown: First of all, being an American woman, I think, and I grew up in the sixties, thinness was great. My mother had one of those placards up in the kitchen that said, “You can never be too rich or too thin.” And that was kind of-

 

00:14:38

Dr. Kaylee Byers: Good motto.

 

00:14:38

Harriet Brown: Good reminder. Yeah. Yeah. And dieting was like a bonding activity. It was something I did with my mother. It was something women did together. I was really, really messed up about body image and weight and all of that for a long time. But just the overarching assumption is that fatness is a terrible thing and that it’s a fate to be avoided at all costs. And I was kind of outraged to discover that no, the science around weight and health is poor and highly tainted and not at all proving what we all assume to be true. And then I just fell down the rabbit hole with it.

 

00:15:29

Dr. Kaylee Byers: You are listening to Nice Genes, a podcast all about the fascinating world of genomics and the evolving science behind it, brought to you by Genome British Columbia. I’m Dr. Kaylee Byers, your host. We want to get more people to listen to the genomics stories that are shaping our world. So if you like Nice Genes! Hit Follow on Apple Podcasts or wherever you get your shows. Gila monster, your pals, by slithering, your favorite episode into their podcast feed.

 

In this season, we’re tackling some of the big assumptions that hit both society and science. One assumption that has deeply affected my life is the connection we make around our health and our weight. It’s something that Harriett Brown feels is a pain point for us as a society, and we kind of get hung up on it.

 

Assumption space. What are some of the big assumptions you think that we make when it comes to fat, weight and health?

 

00:16:24

Harriet Brown: Oh, boy.

 

00:16:25

Dr. Kaylee Byers: We could talk about this for many, many hours.

 

00:16:29

Harriet Brown: A few of the most common and most deeply held ones are we assume that fatness is unhealthy. We assume that fatness is a matter of choice in the sense that anyone can lose weight. So if you are fat, then you have chosen on some level to not lose weight. I’ve had some really enlightening conversations with people who seemingly, without even knowing what they’re doing, sort of highlight how deeply that bias runs by saying perfectly contradictory things in the same conversation.

 

00:17:08

Dr. Kaylee Byers: The question she had about these judgments became a focal point in her book, Body of Truth.

 

00:17:15

Harriet Brown: My oldest daughter, when she was 14, developed anorexia, and in sort of helping her through that, it kind of showed me the other side. Strangers would walk up to her on the street when she was gaunt and dying and say, “Oh my God, you’re so beautiful. You could model what’s your secret?” Doctors would say things to her like medical people would compliment her, and it was nauseating. And then we’d be shopping for high calorie foods for her, and everyone else in the store was looking for the lowest calorie foods and talking about their diets. And there we were like, “Which ice cream has the most calories per half cup? That’s the one we want.” It just upset me greatly, and it made me as a journalist say, okay, well, I need to get to the bottom of this. I need to understand for myself what is the connection between weight and health? And I kind of expected to find that there were connections and that yes, fatness hurts you in these ways, and that’s why we have these cultural assumptions about them.

 

00:18:26

Dr. Kaylee Byers: So one of the first quagmires for Harriett to wade through was BMI, AKA the body mass index, it’s calculated as how much your weight is in relation to your height. So if you weigh 150 pounds, your BMI will be higher if you are five feet tall versus if you’re six feet tall and those BMIs fall into categories, a “normal” BMI is considered 18.5 to 24. 9. Anything under that is considered underweight. Anything over that is overweight.

 

00:18:58

Harriet Brown: If you look at correlations of various kinds, you’ll notice that we don’t even talk about the underweight part of the chart, right? Or look at its connections with things because again, that assumption runs so deep.

 

00:19:11

Dr. Michael Lyon: It’s far more lethal to have anorexia than to have a BMI very high. We try to use a surrogate marker to determine something else. So terms of weight and health, we use BMI. It’s helpful to give you an initial guidepost. The sensitivity is very poor. BMI is not a very good predictor of health outcomes.

 

00:19:31

Dr. Kaylee Byers: In 2004, an epidemiologist and scientists with the Centers for Disease Control and Preventions National Center for Health Statistics wanted to put the baggage behind BMI to the test. Her name was Dr. Catherine Flegel.

 

00:19:47

Harriet Brown: And she’s like a very no- nonsense straight shooter kind of person. And at some point in the early 2000s, she decided to really bear down on this, what is the relationship between mortality and weight? So what is your risk of dying prematurely at various weights, at various BMI, since that’s the measure that we use, she looked at such huge data sets. I think she expected to find kind of like a linear relationship between weight and health. In other words, the heavier you were, the greater your risk of dying early, but that’s not what she found. What she found is looks more like the Nike swish, like that kind of like little J. So you actually have a much greater chance of premature death if you are “underweight” or if your BMI is over say 40 than you do anywhere else in the middle, and where is it lowest?

 

Where do you have the least chance of dying prematurely? It’s in what we would call overweight to mildly obese. And she didn’t talk about it. She didn’t rationalize it. She just published these findings and wow, there was a firestorm. People protesting people saying, this can’t be true. She did it a couple of times over the space of about 15 years, and she kept finding the same thing, and she was like, “Look, I don’t know what to tell you. This is what the data says. Make of it what you will, that my job isn’t to interpret it. My job is just to put it out there.”

 

00:21:29

Dr. Kaylee Byers: I wonder about weight and health. We often frame it as a very clear line, right? Once you’re above a certain threshold, you are going to not be well if you’re below a certain threshold. That’s the same thing. Even though we don’t talk about that nearly as much, but there doesn’t appear to actually be as much evidence behind that as it might come across in the assumptions that we make about healthiness based off of a number like BMI.

 

00:22:00

Dr. Michael Lyon: Our current estimate going forward into the future is the best marker for a relationship between excess weight and poor health. It’s liver fat. In our clinic, we have a very sophisticated tool called the FibroScan. It uses an ultrasonic wave to measure both liver fat and fibrosis in the liver or scarring. And it’s pretty clear that liver fat is probably the single most easy thing to correlate excess weight with poor health outcomes. Epigenetics plays a huge role here, and if we could map the epigenetics of someone with higher BMI, we would see that those with liver fat are the ones that are going to have all kinds of inflammatory systems turned on. And things like insulin resistance and resistance to GLP-1. Ozempic is really a long lasting form of GLP-1.

 

00:22:56

Harriet Brown: I mean, I’ve delved into some of the big studies that say, look, we have found this cause and effect thing and have big methodological problems. Let’s just put it that way. I mean, I looked at studies during my five years of diving into this. I saw studies that were sample size of 14. Another thing that those studies often do is they only follow people for a very short time, but that’s not actually how people work. And when I sort of got to understand that this relationship between weight and health wasn’t as straightforward as I thought, I was like, “Wow, folks, this is good news. People are going to be happy to hear this because guess what? If you weigh 10 pounds more than your doctor says you should, you’re not going to drop dead of a heart attack. That’s not a thing.” And I was kind of shocked at first that people did not want to hear it.

 

People resisted this mightily, and they still do. And it took me a while to sort of understand we’re so steeped in this relationship between weight and health. Before I wrote the book, I reported some stories for the New York Times about, for example, it was just looking at what are some of the effects of weight stigma on people. They have physical health effects, mental health effects, whatever, and wow. And the New York Times is a reasonably educated audience. I mean, the hate emails that I got, the horrible, nasty comments on every story I wrote, or if you look at reviews of the book on Amazon, you’ll see people writing things like, “Stop eating donuts, you disgusting pig, and go for a walk”, which is rooted in those assumptions. Again, that fat people just are sitting on the couch eating bonbons all the time and lazy.

 

And you know what? If that’s what you chose to do, that would also be your right to do that. But anyway, those assumptions get applied to everyone. So yeah, I honestly sort of stopped writing about this subject because it was so bruising at a certain point.

 

00:25:09

Dr. Kaylee Byers: What was clear from what Dr. Flegel and what Harriet saw was a flawed way our science and experts had provided a framework for health and weight, and in many cases it neglected the genomic component of our weight.

 

00:25:22

Harriet Brown: Genetics plays a huge role. It’s also epigenetics too, right?

 

00:25:26

Dr. Michael Lyon: There’s at least 300 genes that are involved in obesity that are changed epigenetically with lifestyle.

 

00:25:33

Harriet Brown: Like for instance, exposure to endocrine disruptors, environmental toxins, which we are all exposed to constantly that that can shift weight at a cellular level. I think we haven’t really looked at it deeply because we’re so invested in this concept of personal responsibility, but I think there’s a lot to be learned there.

 

00:25:56

Dr. Kaylee Byers: Here’s the deal. There are over 400 genes that we know about associated with becoming overweight or obese. They affect appetite, your sense of fullness, metabolism, what foods you crave, where different fats go on your body, and even whether eating is a way to cope with stress, but those genes aren’t a one size fits all for everybody. Research from Harvard suggests that genes may influence an individual’s disposition to becoming overweight anywhere from 25% to as high as 80%, and having extra stores of fats is sort of the big reason we’re human.

 

00:26:32

Dr. Michael Lyon: For most of human history, if there was abundant food around, it was very important that you ate as much of it as you could, as quickly as you could and gained as much weight as you could because a famine was always going to be around the next corner. When we’re looking for genes that make us vulnerable to obesity, it’s a bit of a futile effort in a sense because we’re all set up for weight gain, essentially.

 

00:26:55

Dr. Kaylee Byers: From an evolutionary perspective, our closest relative is the chimpanzee. We share about 99% of our DNA with them. But one key difference that makes us us is fat and how we store it. Chimps have mostly what’s called brown fat ready to go and burn as calories, but as humans have genes that are locked up, which keeps us from converting white fats into those brown fats, those are what’s stored to keep us warm And protect our organs.

 

So why have the extra white fat? Well, it helps us grow our hungry, hungry brain.

 

00:27:32

Harriet Brown: The actress Joy Nash, I don’t know if you’re familiar with her work, but long ago in the early days of YouTube, you can still find it. It’s called Fat Rant. And one of the things she says in that very amusing video is to be thin, choose two thin parents. I do need four thin grandparents.

 

00:27:56

Dr. Kaylee Byers: Excellent. You know gang, it’s no surprise to me that our genetics play a role in our weight, but I don’t know if it hurts any less with that understanding. Each comment still hits you, whether it’s in a doctor’s office or walking the beach or just existing. Those comments can really add up. It can have a big impact on our mental health.

 

00:28:18

Harriet Brown: Someone, I can’t remember who it was, but someone said in this space, if shame and stigma inspired people toward better health, we wouldn’t have any health problems. We’d all be-

 

00:28:31

Dr. Michael Lyon: I started to get interested in health when I lost weight, when I almost died from pneumonia as a teenager, and that’s why I became a doctor. But now I am 65. I have to keep my BMI under 25 or I have type two diabetes, which has led to most of my family. I have no family left because they all died prematurely from diabetes, and I decided I don’t want to do that if I can help it. So I’m like a health nut.

 

00:28:58

Dr. Kaylee Byers: Talking to Harriet and Dr. Lyon, they underscore a really important point about health and reveal that what’s really going on inside us is complex, physical, mental, the whole shebang.

 

00:29:10

Dr. Michael Lyon: Weight bias, weight bigotry is a very real problem. It’s maybe the most serious problem related to obesity is the bias and bigotry associated with it. That leads to a whole host of problems. But on the other hand, if obesity was invisible, it would be without controversy a disease, but it would be defined a bit differently. It’d be defined by identifying the real weight- related health issues that are there.

 

00:29:38

Harriet Brown: In reality, what we are beginning to know as we begin to study all kinds of stigma right around race, gender, sexual identities of all kinds, is that when you live in a stigmatized body, it takes a toll on your health, the incredible stress, the elevated levels of cortisol, the higher levels of inflammation, all of the things that we know come from living in a stigmatized condition. Can we talk about behaviors that actually improve health, like getting more exercise, like eating in a certain way, like real health behaviors and not just reverting to the knee jerk of lose weight, and that speaks to another assumption, and that assumption is that dieting or weight loss is benign. I’ve actually had scientists say to me like, well, okay, even if you do gain the weight back over five years, at least you’ve been thin for a period of time, and that’s better for you.

 

Actually, no, it’s not better for you. It’s actually better for you to be at a stable weight than it is to go up and down, up and down, has all kinds of metabolic consequences. Inflammatory consequences. It’s not benign to diet. It’s harmful. Any doctor will just matter of factly, recommend lose some weight. Okay, how am I supposed to do that in a way that’s healthy and sustainable and isn’t going to mess up my body? If I could tell people one thing, I would just say, please don’t comment on other people’s bodies. Just stop. Why? Why is that the first thing we say?

 

00:31:19

Shawnta Collette Carter-Williams: Yeah. I’ve recently found out is that, oh, yeah, so that’s what I call it.

 

00:31:27

Dr. Kaylee Byers: Shawnta Collette has a supply of Ozempic again, after going without it for a few months, she nearly gained back all the weight she had lost, but it wasn’t entirely about losing the weight for her to begin with. In her case, it was a matter of living her life, and now she uses her experience in a standup routine as a comedian.

 

00:31:46

Shawnta Collette Carter-Williams: My name Shanti Q. I’m from Denver, Colorado, and before my stroke, I used to take life with a grain of salt, but that’s how I got there. The salt.

 

We all are going to come to that day. We don’t know when, but we all are going to be faced with death at some point in time, and so I had to face that and I had to decide if I was going to die internally or if I was going to live. There was sometimes I was like, “Lord, you could have just took me out child.” I’m like, “What you doing up there? I would’ve loved to see what you was doing up there.” So if I was really going to take this situation and make it something I was going to live my last days, I was going to let my last days bee my greater days. I look in the mirror every day one day, and I say, we the best!

 

00:33:05

Dr. Kaylee Byers: Our guests for today. Were Harriett Brown, author and professor at the SI Newhouse School of Public Communications at Syracuse University, Dr. Michael Lyon, Medical Director of the Obesity Medical and Diabetes Institute, and Shawnta Collette Carter- Williams, heart and health advocate and comedian.

 

You’ve been listening to Nice Genes! A podcast brought to you by Genome British Columbia. If you like this episode, go check out some of our previous ones wherever you listen from, share us with your friends and leave us a review. You can also MD the show on Twitter by going to at GenomeBC, and if you’re listening with kiddos or you’re a teacher looking to spice up your lessons, we have learn along activity sheets added to the show description of each episode.

 

And if you like, Gila monster venom it’s just the tip of the iceberg for powerful poisons. Join us in our next episode for a ghoulish dive into titillating toxins.

I also want to ask, so you were talking about this early mindset about colonialism and toxins. How did that relate back to early pharmacology?

 

00:34:38

Dr. Kimberly Garrett: I think a lot of it was also based on the idea of specifically applied poisons. However, they weren’t very good at it. So we saw things like arsenic used as cure- all we saw patent medicines. We even see now colloidal silver people ingesting colloidal silver, which is really, really dangerous, and people would ingest these dangerous metals because at that time I think there was a lot, again, of this dominion idea of we can conquer illness.

 

00:35:11

Dr. Kaylee Byers: I love creepy crawly season, so we look forward to sharing another spotty tale with you next time.