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The stupid explodes: obesity now a disability

I just did a calculation for my mom, who is 70 and 5' zero in height, and 120lbs, her BMR is just over 1100 calories/day, so 1500 calories/day she would gain weight walking a brisk 5 miles a day.

Well... not quite, although I get your point. The BMR is roughly equal to the resting power of the individual, times 24 hours. For most people, resting power is about 1-1.2 W/kg. But, just sit up and that increases to maybe 1.7 W/kg; walking bumps it up to about 4 W/kg, and so on. I think running (sprinting) and intense swimming can get it up to 20 W/kg or so at most.

So you don't need to be that active in order to consume a good few extra hundred calories during the day, as long as you're not completely bedridden.
 
It carries all the hallmarks of a Conservative party policy, aimed at attacking stereotypes maligned in the tabloid press without providing funding to actually deliver effective treatment.

Alcohol, drug and obesity management services are already critically underfunded and stretched, this will only make it worse. A similar proposal by Westminster council a couple of years ago was criticised by the BMA as unworkable. Once again it's typical of this government to fail to get onside those people who are actually supposed to deliver their crackpot ideas.

Then you could make an excellent case for the benefit savings to be passed on the rehab organisations.

Is it the government failing, or the people in the health industry failing to get on board?
 
Then you could make an excellent case for the benefit savings to be passed on the rehab organisations.

Where would savings come from? If people are going into rehab type situations then they are going to continue receiving disability support. That's a net cost to the budget. And even if you DO cut an individual off from assistance and create a 'saving' (a questionable equation anyway because if that person is genuinely unable to work then the costs of supporting them are just going to be transferred to some other sector of the economy), how many people do you need to deny their meagre disability payments to fund one expensive rehab bed/programme? Is a 1:1 ratio? I doubt it. 1:2? 1:10?

Is it the government failing, or the people in the health industry failing to get on board?

I'm not sure I even understand this question? Are you asking whether support service providers are refusing to treat people just because? The point The Don was making was pretty clear, I thought - the government is asking already overstretched providers do more on already inadequate budgets. I don't know about weight loss services but publicly funded drug rehab already has inordinately long waiting lists, certainly that's the case here - it can take 6 months to get a placement. ANd the UK is much the same, from what I understand, I watched a documentary a few months ago that explored drug addiction and that was definitely the sense I got about the system there too.
 
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Where would savings come from? If people are going into rehab type situations then they are going to continue receiving disability support. That's a net cost to the budget. And even if you DO cut an individual off from assistance and create a 'saving' (a questionable equation anyway because if that person is genuinely unable to work then the costs of supporting them are just going to be transferred to some other sector of the economy), how many people do you need to deny their meagre disability payments to fund one expensive rehab bed/programme? Is a 1:1 ratio? I doubt it. 1:2? 1:10?

The cost savings take time, but are guaranteed to be a lot more than benefit payments.

Reduction in health spending.
Reduction in benefit spending as people return to work.
Additional tax income as a result.

There's no reason why the plan should not be win/win/win - except for the fact that humans are involved and one of them will figure a way to screw it up.

I'm not sure I even understand this question? Are you asking whether support service providers are refusing to treat people just because? The point The Don was making was pretty clear, I thought - the government is asking already overstretched providers do more on already inadequate budgets. I don't know about weight loss services but publicly funded drug rehab already has inordinately long waiting lists, certainly that's the case here - it can take 6 months to get a placement. ANd the UK is much the same, from what I understand, I watched a documentary a few months ago that explored drug addiction and that was definitely the sense I got about the system there too.

I asked because I don't know the answer, because I only have local knowledge on that subject.

Yes, current health services here are hopeless, but there are also a large number of independent organisations with capacity and desire to do take people on. Do those private organisations have a better success rate? They swear they do, and the numbers they quote tend to display that but I'm no expert.

I just don't believe it's as cut and dried as Don was making out. I know several cases of people in closely-related industries here who will protect their ivory tower at any cost, including to the cost of the people they're supposed to be helping.
 
Yes, current health services here are hopeless, but there are also a large number of independent organisations with capacity and desire to do take people on. Do those private organisations have a better success rate? They swear they do, and the numbers they quote tend to display that but I'm no expert.

They may have desire but in this case they won't have the funding. Bit Pattern is correct, existing services are already underfunded and heavily over-subscribed. There will be no additional funding available because this is an exercise in saving money.

I can't find evidence that private organisations are more effective, and more importantly are more cost effective.

I just don't believe it's as cut and dried as Don was making out. I know several cases of people in closely-related industries here who will protect their ivory tower at any cost, including to the cost of the people they're supposed to be helping.

The Don thank you.

I'd like some evidence to support your assertion here.
 
I have a general question, hopefully someone more informed on these matters can answer. What if a person is not overeating (meaning, eats 2000 or fewer calories a day), but still wants to lose weight? Is an exercise regimen the best option in that situation? I was under the impression eating significantly less than 1500-2000 calories a day wasn't recommended. But it would it be okay for weight loss?

What are you eating? Something to think about. People are generally told that weight gain and obesity is merely down to overeating and being too sedentary (ie. consuming more calories than they expend) . It is so frustrating to so many people because they do what they are told to do and it just gives them lackluster results they usually can't keep up, ending up tired and sick, or even worse than they were when they started. They are told if they just eat less and exercise more they will loose weight, that if they simply cut the junk food and cakes that will be enough. But they don't realise that many of the "healthy" "diet" foods that don't have sugar in them will still break down into sugar in their gut. Many of these foods have a higher GI than actual sugar, and so technically worse and even more "fattening"! Yet we're told to base most of our diet on carbohydrates, when most of these foods we're told we should eat like pasta, rice, breads and potatoes might as well be sugar we're shoveling into our mouths. It is interesting that we can keep up this idea that "a calorie is a calorie" when we simultaneously seem to think sugar is uniquely fattening and especially bad for us. Or how we can recognise that people have "different metabolisms" enabling some to seemingly be able to "eat as much as they want" or "as much junk food as they want", and not gain weight, while others put on weight very easily with very little. Clearly it can't just be the number of calories we consume. We are to think eating fat makes us fat, when fat does not spike our insulin levels, which is the mechanism which drives energy into our fat cells. Carbs also causes us to be hungry so quickly because the energy isn't being allowed to get to where it needs to be, so we eat more, usually more of the very foods causing the problem in the first place. Exercise itself doesn't really burn a lot of calories and will likely make you very hungry in the process which is why we have the phrase "work up an appetite", which isn't exactly going to help when you're trying to lose weight. This coupled with the cravings for carb/sugar rich foods is a recipe for unhappiness and weight gain.

IOW, if you are eating under the number of calories you expect to lose weight and not losing weight, you are probably consuming too many carbs which is raising your insulin and driving energy into the fat cells. You could already have a degree carb sensitivity making your fat cells greedy, so that they hold on to that energy when the cells that need it starve. Paraphrasing Taubes, you aren't getting fat because you're overeating, you're overeating because you're getting fat. Edit: If people like him are right, and it seems like he is much more right than he is wrong, we've been told the exact opposite advice for losing weight for decades. Telling us to base our entire diet on carbohydrate rich foods like pasta, rice and breads that raise insulin and dramatically cut the fat in our diet, the only macro nutrient that doesn't spike insulin, was probably almost the worst advice they could have given as far as obesity and diabetes is concerned. It all seems to go back to the idea that fat causes heart disease which we now know is false, but if they were going tell people to remove the fat in their diet they had to replace it with something, which was carbs. It seems like the truth is topsy turvy.
 
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What are you eating? Try watching this. People are generally told that weight gain and obesity is merely down to overeating (consuming more calories than they expend) and being too sedentary. It is so frustrating to so many people because they do what they are told to do and it just gives them lackluster results they usually can't keep up, ending up tired and sick, or even worse than they were when they started. They are told if they just eat less and exercise more they will loose weight, that if they simply cut the junk food and cakes that will be enough. But they don't realise that many of the "healthy" foods that don't have sugar in them will still break down into sugar in their gut. Many of these foods have a higher GI than actual sugar, and so technically worse and even more "fattening"! Yet we're told to base most of our diet on carbohydrates, when most of these foods we're told we should eat like pasta, rice, breads and potatoes might as well be sugar we're shoveling into our mouths. They think eating fat makes them fat, when fat isn't spiking their insulin which is the mechanism which is driving energy into their fat cells and which causes them to be hungry again so quickly. Exercise itself doesn't really burn a lot of calories and will likely make you very hungry in the process which is why we have the phrase "work up an appetite". IOW, if you are eating under the number of calories you expect to lose weight, you probably are consuming too many carbs which is raising your insulin and driving fat into the fat cells, and you could already have a insulin resistance issue making your cells greedy that hold on to that energy where the cells that need it starve. Paraphrasing Taubes, you aren't getting fat because you're overeating, you're overeating because you're getting fat.

LOL, well I wouldn't exactly call myself fat. I'm female, 26, 5'2 and currently weigh like 111 pounds. I'd like to weight 105.

I eat 2 hard-boiled eggs for breakfast with black coffee. Then I always eat a healthy dinner, mostly veg, only lean meats. If I ever eat bread, it's wheat. And I don't eat much of it. Maybe once a week, if that. I avoid carbs and excessive salt as much as I can. I don't use condiments. I drink 1% milk for a beverage with meals, and water in between. No soda ever. Alcohol (white wine or vodka) like once a week sometimes. Far from every week. Jeez, do I have to give up everything? :p

I have an evening exercise regimen that involves running on treadmill and some free weights. My vice is I sometimes snack on nuts late at night. I know I need to cut that out, but even when I do it, I should be well within my allotted calories for the day. I just don't get why I'm having so much trouble shedding these last 5-6 pounds. And a lot of the nutritional advice I seek out seems really conflicting. There have been a lot of different views postulated in this very thread, as well as the other (less technical) one in Community.

I used to be able to eat anything I wanted and the only real exercise I got was walking between classes and bus stops. And I never gained an ounce. Suddenly, I hit 25 and my ass started jiggling every time I had a milkshake. So I had to start fighting my metabolism. The battle rages on.

ETA - Watching the video you linked right now. :) Thanks.
 
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What are you eating? Something to think about. People are generally told that weight gain and obesity is merely down to overeating and being too sedentary (ie. consuming more calories than they expend) .

How is that untrue? How else does someone become overweight, besides over eating? It's simply impossible to gain weight while in a calorie deficit.

I didn't feel like watching the hour long lecture, so I looked up Gary Taubes. His opinions seem to be on the edge of woo, at least according to http://www.sciencebasedmedicine.org/why-we-get-fat/

Also, it's "lose," not "loose."
 
How else does someone become overweight, besides over eating? It's simply impossible to gain weight while in a calorie deficit.

Whatever the biological complexities of gut flora, metabolic propensities and so on, this much remains true. Spotting the over-eating when one calculates that you aren't can be tricky though.
 
Whatever the biological complexities of gut flora, metabolic propensities and so on, this much remains true. Spotting the over-eating when one calculates that you aren't can be tricky though.

Absolutely. It's super easy to mis-estimate how much you're consuming, and self-reporting is notoriously unreliable.
 
How is that untrue? How else does someone become overweight, besides over eating? It's simply impossible to gain weight while in a calorie deficit.

I'm not an expert at all, but I have read and watched a fair bit on this recently. I tried to explain a little bit of "why we get fat" to you in the post you quoted. But here's a pretty good animation taken from the anti-Super Size Me documentary "Fat Head" that might help clear up the concept.

The short of it is that not all calories are equal, which is the fatal mistake we make when we merely talk about calories. It is the reason why the "calories in calories out" idea doesn't make sense and definitely doesnt help people that want to lose weight. The fact is the body responds to different kinds of calories in different ways. It is not controversial that there are "good" carbohydrates and "bad" carbohydrates. The bad carbs being things like sugar, better carbs being things like oats. Oats are said to be a lower GI food, and sugar is a high GI food. The gycemic index is to do with how fast the carbohydrates will covert to glucose in the gut. Sugar converts quickly and for that reason can provide a quick burst of energy, while something like oats converts much slower and so the rate of energy provided by the glucose is at a more sustained period of time.

It is well understood that consuming a high GI substance like sugar may give you a burst of energy but you use it up quickly, and so you get hungry again faster. This is why its uncontroversial to say that you should significantly reduce sugar intake if you want significant change in reducing body fat, that you should eat low GI carbohydrates to provide longer lasting energy "so you feel full for longer." We know that the hormone insulin drives fat storage and stimulates fat cells to take in glucose. Insulin is released prominently when we eat carbs, because carbs convert to glucose and that needs to be dealt with. If we eat too many foods that spike our insulin too much for too long our body can't cope and we can become insulin resistant, which can lead to diabetes. All that insulin can lead to obesity/weight gain because insulin causes the fat cells to become greedy and not release their energy easily when you need it like it's meant to. Meanwhile, your body thinks it's starving and it tells your brain to eat more despite having all this stored fat.

So now you've now got a metabolic disorder, and are much more inefficient at fat regulation. Someone that doesn't have this problem can eat much more than you, while you can still put on weight eating less. If someone with a metabolic disorder follows the typical guidelines for a healthy diet, the very diet that may have got them into the situation in the first place, they will continue to base their diet on carbohydrates. Even if they reduce simple sugars, they may consume foods that can have the same or even higher GI than sugar has. We even have the Heart Association saying foods are "heart healthy" that are high GI and significantly spike your insulin levels. They might have some success but only because there's less energy for the insulin to push into the fat cells. They keep their fat levels low since that's what they are told to do, so their body is crying out for energy which is why so many rebound and can't keep the diet up. When it comes to exercise, exercise itself doesn't burn many calories. What it will do is increase the appetite, which will then cause them to want to eat more. So they'll eat the same foods that was causing them to get fatter, except they'll eat more of it. Since they are still eating a high carb diet they will still crave sugar and so also be more prone to cheating. The reduction in appetite alone on a low carb diet is a non-trivial aspect of weight control, even if it really did come down to "calories in calories out" the recommend high carb low fat diet is still a very bad idea.

In regards to losing weight because you're in a calorie deficit diet, I'm going to quote from someone on another forum: 'Taubes often used the example of a growing child. A child grows because of growth hormone, and then eats more to compensate. We could retard this growth by caloric restriction, however it would not stop growth hormone itself. The growth will still be driven by GH, we'd only restrict the materials needed for this growth to be realized. In a similar fashion, we could reduce obesity by caloric restriction, but it wouldn't stop the cause of obesity, we'd simply restrict the materials needed to sustain obesity. On the other hand, if we stopped the cause of obesity directly, the materials needed to sustain obesity would not be needed anymore, and caloric reduction would spontaneously occur.'


I didn't feel like watching the hour long lecture, so I looked up Gary Taubes. His opinions seem to be on the edge of woo, at least according to http://www.sciencebasedmedicine.org/why-we-get-fat/

I recommend you give him more of a shot than this. The person immediately misrepresents him, ironically while also talking about strawmen.

Here is the first few obvious failures on the part of the writer you linked me to:

1. He implies Taubes is saying the laws of physics don't have anything to do with weight gain. That is not what Taubes is saying. He is saying that it is not as simple as "calories in calories out" and the "law of thermodynamics" is not being applied correctly to the human body when people argue against what he is saying. It reminds me of evolution being said to break the law of thermodynamics, which it does, so long as you make false assumptions as to how the earth/universe works.

2. He says Taubes believes reducing calorie intake cannot work. This is also not accurate. As should should be clear from the example I gave earlier, it is not that reducing your calories won't necessarily cause weight loss it's just that it isn't getting to the root cause of why you are putting on weight. When we are growing we have growth hormone flowing through us and we eat more food to compensate for that. We can stunt our growth by reducing our caloric intake, but that doesnt mean eating was the reason for us growing, it was the growth hormone. We ate more because the growth hormone needed us to eat more.

3. He talks about how some people are more efficient at storing calories than others, and even says Taubes is right when he says people get fat due to the way their fat is regulated, but then says that it's all still about how many calories you consume anyway. If you took two people with very similar body types and gave them the same food and they did the same exercise then the assumption of "calories in calories out" means we would have to assume they both get fat, or both lose weight, at more or less the same rate. Why? Because they would both be consuming more or less than the calories they were burning. Yet as this person already recognises some people have bodies that are very efficient at storing calories and handling fat regulation, and some are not. If an obese persons body is inefficient at storing fat and has a metabolic disorder, then telling them they are just eating too much completely misses the point of why it is happening. They may well be eating more, which could be due to their metabolic disorder making them eat more (the same way a growing child filled with growth hormone is driven to eat), or they could be eating the same thing a sedentary slim person eats who has a body that has a healthy metabolism. If it is the former, then just like with a growing child, maybe eating more is the symptom not the cause of their obesity. This is why its absurdity to reduce obesity and gaining fat merely to terms of "calories in calories out", which ends up being practically meaningless and hardly tells you anything.

4. Skipping ahead he seems to be unaware of just how debunked the idea that fat's cause heart disease, especially in recent years.

This article does not seem like it is written by someone who has more than a superficial understanding of what Taubes is saying, or there is some intentional or subconscious tendency to misunderstand him.

Also, it's "lose," not "loose."

I know, its a bad typo habbit.
 
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The cost savings take time, but are guaranteed to be a lot more than benefit payments.

Reduction in health spending.
Reduction in benefit spending as people return to work.
Additional tax income as a result.

There's no reason why the plan should not be win/win/win - except for the fact that humans are involved and one of them will figure a way to screw it up.

Oh, right, I misunderstood what you were construing as savings. If a scheme like this was fully funded and resulted in rehab sectors getting the resources they need then I'd be all for it.

Yes, current health services here are hopeless, but there are also a large number of independent organisations with capacity and desire to do take people on. Do those private organisations have a better success rate? They swear they do, and the numbers they quote tend to display that but I'm no expert.

Whether they do or not, they still cost money - whether the state pays or the individual pays, and in the scenario of someone being on welfare being forced into treatment on the threat of losing their benefits then one would assume they're not going to be able to pick up the tab for a private provider.
 
How is that untrue? How else does someone become overweight, besides over eating? It's simply impossible to gain weight while in a calorie deficit.

I didn't feel like watching the hour long lecture, so I looked up Gary Taubes. His opinions seem to be on the edge of woo, at least according to http://www.sciencebasedmedicine.org/why-we-get-fat/

Also, it's "lose," not "loose."

Can I just quote that to re-state the case?

It is absurd to suggest that one will not lose weight in a calorie-deficit diet.

Excellent response. (and +1 on the grammar work!)
 
Whether they do or not, they still cost money - whether the state pays or the individual pays, and in the scenario of someone being on welfare being forced into treatment on the threat of losing their benefits then one would assume they're not going to be able to pick up the tab for a private provider.

Correct, but given the cost savings, even a tenth-decent government would direct some of those savings to be diverted to contract private providers to fill the gap.

Now all we need is a tenth-decent government.
 
Correct, but given the cost savings, even a tenth-decent government would direct some of those savings to be diverted to contract private providers to fill the gap.

Except for a couple of things.....

Firstly, the cost savings (a few tens of pounds a week) wouldn't come anywhere near the costs of an effective rehab.

Secondly, we have no evidence that private services will be any more effective than NHS services (about a 10% success rate) but we have plenty of experience and evidence of the ineffectiveness and greed of private suppliers in the NHS.
 
Firstly, the cost savings (a few tens of pounds a week) wouldn't come anywhere near the costs of an effective rehab.

Either deliberately or inadvertently, you're missing the billions of pounds saved by not having to pay benefits when they return to work. It is bleeding obvious that if you can even get 1000 people off a benefit and paying tax that the savings will be in the tens of millions annually.

Nice to see you asking for evidence and giving none yourself.

Doesn't bother me a bit.
 
How is that untrue? How else does someone become overweight, besides over eating? It's simply impossible to gain weight while in a calorie deficit.

I didn't feel like watching the hour long lecture, so I looked up Gary Taubes. His opinions seem to be on the edge of woo, at least according to http://www.sciencebasedmedicine.org/why-we-get-fat/

Also, it's "lose," not "loose."

It's not that it's untrue its that its more complicated than that. For a variety of reasons, low-carb diets work better than low-fat diets. Carbs, especially simple ones, cause a wide variety of hormonal responses that change metabolism. And exercise is not enough by itself to create a big enough deficit plus it also creates metabolic changes that work against weight loss.

So while it's true to say that a net calorie deficit is the goal in order to achieve permanent weight loss, it's also true that what you eat is equally important.
 
It's not that it's untrue its that its more complicated than that. For a variety of reasons, low-carb diets work better than low-fat diets. Carbs, especially simple ones, cause a wide variety of hormonal responses that change metabolism. And exercise is not enough by itself to create a big enough deficit plus it also creates metabolic changes that work against weight loss.

So while it's true to say that a net calorie deficit is the goal in order to achieve permanent weight loss, it's also true that what you eat is equally important.

It's not equally important, unfortunately. At least not macronutrient ratios. For starters, I challenge the statement that that low-carb diets "work better than" low-fat diets. (at least not for endpoints I think most people consider the definition of "work").

In particular, in the few good quality longitudinals available (and there are not very many) low-carb diets have just as bad a 12mo weight loss outcome as any other diet. It's just like any other fad diet: some people lose weight; most don't. The ones who do swear it's the Second Coming.

There is no proven 'best diet'. This is why I am not a big fan of 'dieting' per se: the evidence is that this is not a practical solution to individual or population obesity. There are special exceptions (ie: diabetics, hypertension... there are specialized diets for these conditions that are proven to be adhereable and effective)

Diets in isolation are just difficult to 'stick to', which makes them more or less an academic exercise rather than good advice.

Taubes has recently gone what I call 'full Duesberg' - undaunted by being unable to collect scientific support for his hypothesis, he has doubled down. He's set up his own research to crank out the results he wished he could find in the literature.

I was talking to my wife the other day, and came up with another analogy: I referred to Taubes as the 'L Ron Hubbard of diets'. An outsider who published best selling books, tons of references that look impressive to people new to the subject matter, iconoclastic "the experts are all fools and killing innocent people" mythology, and a very dedicated Following that You Don't Want To Mess With.
 

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