Welcome to Burnt Toast! This is the podcast about about diet culture, fatphobia, parenting, and health. I’m Virginia Sole-Smith.Today’s conversation is with Gregory Dodell, MD, a weight-inclusive endocrinologist in New York City, better known as @everything_endocrine or “that one good diabetes doctor!” on Instagram. I know so many of you have questions about weight and diabetes, and a newsletter essay on these issues is forthcoming! But in the meantime, I’m delighted to bring you this conversation with Dr. Dodell, which challenges so many of our assumptions about carbs, weight and diabetes risk. If you enjoy this episode, please subscribe, rate and review us in your podcast player! And subscribe to the Burnt Toast newsletter for episode transcripts, reported essays, and more. (Here’s a 20% discount if you’d like to go paid!)VirginiaI am delighted today to be chatting with Dr. Gregory Dodell, who is an endocrinologist in New York City. Welcome!GregThanks for having me on.VirginiaI’m really excited to have you here. I think I get a question about diabetes about once a week. It comes up in a lot of different ways, from parents, from people worried about their own health or a parent’s health. It also comes up a lot from trolls, right? It’s the argument that they think you can’t fight back on. We’ll be having this very nuanced conversation about the relationship between weight and health and why it’s so important to separate weight from health, and someone will throw in, “But what about diabetes?” It feels like this third rail. Like, okay, people can be healthy at any size, but maybe not with diabetes. So, why don’t we start there? Why is diabetes so inextricably linked to weight and our collective understanding of this condition?GregYeah, it’s tough to tease out. It’s tough to answer, just because of what we hear in the media and what a lot of doctors probably say in the office. The first thing is, it’s really important to realize that correlation and causation are not the same things. There’s 40 some-odd things that impact blood sugar, just like there are many, many, many things that determine body weight. You can’t just say one causes the other when you look at weight and diabetes. There’s people across the size spectrum that have diabetes. I see people in my office across the BMI spectrum—of course, BMI is not a useful indicator of health—but just to put it in context. Not everyone who has a higher BMI has diabetes and there are many people with a “normal” BMI that have diabetes. A lot of the research doesn’t control for things like weight stigma, access to healthy food, stress levels, sleep—real behaviors that impact these things. So that’s really what I would say: Let’s focus on the behaviors. Let’s really look at the research critically, like a lot of people in the field are thankfully starting to do, to tease out the relationship and see. There may not be anything there and there may be something there. Even if there is, we need to treat people and focus on behaviors and things that we can do to improve health. Focusing on weight as a main marker of health just isn’t working.VirginiaRight, because we don’t have effective and safe ways for most people to lose weight. So prescribing that and zeroing in on that as the entire treatment plan is underserving people. And I’m glad you highlighted the stigma piece, too, because I think that’s difficult to tease out for folks. It’s not like researchers are acknowledging this bias as they’re doing the studies. Because this has been so baked into our culture for so long, a lot of researchers who are studying these questions are starting from the premise that there’s a causal relationship without the data to support that. GregRight. When you start with a research study and a protocol, you have to look at all the factors that impact all the different variables. I think, if you come into a study with a preconceived notion that weight is what’s gonna cause this, and you’re not controlling