The stupid explodes: obesity now a disability

[Minoosh]

The stupid thing is if you make your own. Burgers, tacos and pizza etc can actually be tastier and better for you

There are lots of small dietary changes that can help. Less mayo, ice tea vs. soda, slightly thinner layering of cheese and dough re: pizza.

A teaspoonful of sugar in your coffee or tea adds 1.7 pounds a year. There are delicious creamers that would add 5.2 pounds a year if you put 50 calories' worth in your coffee. Anything around 10 calories a day, surplus or deficit, adds or claims a pound. In the U.S., the surplus side usually wins out. I'm actually a little surprised Americans aren't fatter. It varies by state.

I have recently heard boys praising "thick" figures, women of "traditional build" in Alexander McCall Smith's Botswana series.

 

[Skeptical Greg]

If a girl becomes anorexic, is it her fault?
....

The bottom line would be, yes.. Which would be the answer for most addictive behavior..

If you are talking about some kind of captive, brainwashing therapy, then we are talking about something that goes beyond self inflicted medical conditions..

The overwhelming majority of overweight people have simply eaten too much, and had too little exercise. Their justification or rationalization for doing so doesn't change that..

 

[Minoosh]

The overwhelming majority of overweight people have simply eaten too much, and had too little exercise. Their justification or rationalization for doing so doesn't change that..

The math is simple. Addressing the issue on a public-health scale isn't. Mitigating/arresting compulsive behavior is incredibly difficult - that's why it's called compulsive - and a tendency toward compulsive behavior is not necessarily an individual's fault. There are significant genetic and environmental factors at play. Americans started getting fatter about 30 years ago, for a lot of reasons, including snack foods designed to induce over-consumption. I don't think it was a general implosion of willpower. There was simply far more opportunity to overeat and under-exercise.

From what I have read about anorexia, it doesn't generally start as a decision to starve to death. It just feels right; the sufferer feels more in control, the control is experienced as reassuring. Once the reward system is fired up the behavior is encouraged. Food is like that for a lot of people. It's comfort. I heard an obese coworker say, "I'm starving." I thought, "No, you're not." So I can be judgmental, but I didn't doubt she was feeling genuine hunger. Bad eating habits can become self-perpetuating. Too much sugar promotes brain impairment, according to a Harvard Health Publications.

This might all sound like justification and rationalization to you, but I think it's important to look at the biology of obesity rather than framing it mostly as a failure of will.

 

[casebro]

The math is simple. Addressing the issue on a public-health scale isn't. Mitigating/arresting compulsive behavior is incredibly difficult - that's why it's called compulsive - and a tendency toward compulsive behavior is not necessarily an individual's fault. ...

From what I have read about anorexia, it doesn't generally start as a decision to starve to death. It just feels right; the sufferer feels more in control, the control is experienced as reassuring. Once the reward system is fired up the behavior is encouraged. Food is like that for a lot of people. It's comfort....
This might all sound like justification and rationalization to you, but I think it's important to look at the biology of obesity rather than framing it mostly as a failure of will.

A friend is a psychologist, we talk. OCD happens because the subject feels out of control of their life, that they CAN control ummm- how clean their house is. So OCD house it is. Or OCD weight loss. Or more pertinent, I can eat lots, just to feel in control of...what? that facet of my image? Hmm, that is food for thought.

I kniw it's poson. But I can corntol the tyope. I can contriol the dose, because

 

[casebro]

The math is simple. Addressing the issue on a public-health scale isn't. Mitigating/arresting compulsive behavior is incredibly difficult - that's why it's called compulsive - and a tendency toward compulsive behavior is not necessarily an individual's fault. ...

From what I have read about anorexia, it doesn't generally start as a decision to starve to death. It just feels right; the sufferer feels more in control, the control is experienced as reassuring. Once the reward system is fired up the behavior is encouraged. Food is like that for a lot of people. It's comfort....
This might all sound like justification and rationalization to you, but I think it's important to look at the biology of obesity rather than framing it mostly as a failure of will.

A feind is a psychologist, we talk. OCD hapens because the subject feels out of control of their life, that they CAN control ummm- how clean their house is. So OCD house it is. Or OCD weight loss. Or more pertinant, I can eat lots, just to feel in control of... that facet of my image? Hmm, that is food for thought.

Hmm, how about "I know it's poison. But I can control which poison, I can control the dose. Because I AM IN CONTROL!!!

 

[Skeptical Greg]

...

This might all sound like justification and rationalization to you, but I think it's important to look at the biology of obesity rather than framing it mostly as a failure of will.

Sure we can look at those things.. And I'm sure looking at it goes a long way in funding grants and all kinds of research..

Meanwhile, obesity is on the rise, and nothing anyone is doing is helping.

When will over-processed fat and sugar laden food and drinks start getting the same warning labels that alcohol and tobacco products have?

 

[blutoski]

http://m.nzherald.co.nz/nz/news/article.cfm?c_id=1&objectid=10809145

Hm. It doesn't have any actual numbers, so still doesn't help with the question of whether the sin tax on tobacco is sufficient to cover costs associated with use.

They're saying smokers are less expensive for a mix of reasons, one of which is early death. These are always questionable estimates and the analysts tend to make a lot of assumptions (eg: did they include missed future income and consumption tax revenues, or just medical costs?)

 

[blutoski]

The poster above was talking about tobacco and not alcohol. I'd suggest that there's a difference in that there is a healthy level of alcohol intake (a glass of wine with dinner may be better than none), but the same isn't true of tobacco.

As far as I know, there is no credible research showing any benefits from alcohol. Most credible research shows a dose response curve. However, this is a good illustration of my point: there is an industry out there whose job is to vindicate these toxins as part of a healthy lifestyle, typically funded by the manufacturers.

Further you seem to be making a distinction between those who increase their risk of requiring medical treatment by engaging in a particular habit (smoking here), and those who end up requiring said treatment. I doubt anyone would suggest that the treatment of the individuals who end up sick is payed for by their extra taxes, but whether it's paid for by all the taxes paid for by the group who put themselves at greater risk is a different, and I'd suggest more relevant, question.

The point seems to be that those who don't engage in risky behaviour shouldn't, or at least don't want to, pay for the consequences of that risk. Whereas it seems entirely reasonable that all those who engage in said behaviour share the cost of it's outcome.

Agreed, but we cherry pick our risks based on morality, is the concern. For example, getting pregnant is a health risk, but everybody seems happy to subsidize medical complications. For example, would we refuse treatment for post partem depression since the mother "chose to accept the risk of this condition"?

 

[Tsukasa Buddha]

Some people don't... that's the genetic lottery.

Huh? I could force this into a CICO-compliant interpretation, but people say this all the time as an unscientific excuse.

 

[Tsukasa Buddha]

According to a recent New Yorker article, "Diet and exercise alone rarely help people lose weight and keep it off." Is that their "fault"? Maybe. I find it more helpful to think in terms of responsibility: Anyone can be predisposed to putting on weight or getting addicted to substances. There are huge industries devoted to making people overeat and use addictive substances. I don't think shaming people helps. You want to empower them. I do, anyway. Can't speak for you.

This New Yorker article looks at it from a practical angle:
Bariatric Surgery: The Solution to Obesity?

Bariatric surgery is a very strange thing. There are additional caveats depending on the type, but it is essentially just CICO and restricting food intake, but having your body "enforce" these behavior changes. As such I am certain it has higher compliance, though many people will find ways to "cheat" their new GI tract, but some people seem to promote it as accomplishing something other than what diet restriction would.

From the article:

There is strong consensus that bariatric surgery is effective, and Medicaid now covers it in forty-eight states. At the same time, research into conventional weight-loss methods has repeatedly pointed to an overwhelmingly dispiriting conclusion—that diet and exercise alone, no matter how disciplined the individual, fail overwhelmingly often. This makes for an unsettling and consequential revolution in our understanding of our bodies. Still, only about one per cent of those who medically qualify for bariatric surgery get it. Advice about diet and exercise often has a moral undertone; surgery has a mechanistic one.

But really in both the only thing "failing" is the person sticking to the diet. This is more difficult when your stomach is smaller, but still entirely possible. The "moral" or "mechanical" explanations are the same for both.

Incidentally, I have seen far too many medical sources reaffirming the "99% of diets fail" myth. Here is a particularly disturbing one I just read, which describes anti-obesity medications as a growing trend.

Maybe both doctors and patients need to reduce their expectations. Dr. Pieter Cohen, general internist at Cambridge Health Alliance, counsels patients that intense lifestyle changes can lead to modest, but important, results. “I am often talking to patients about making aggressive lifestyle changes today so that when we meet in two to four years, they might be 1 to 5 pounds lighter," he said. "But if you did nothing you might be 10 to 20 pounds heavier.”

Linky.

Is this where we have come? These medical professionals cannot explain CICO and TDEE to patients who are underestimating their caloric intake and overestimating their energy expenditure? They could healthily lose 5 pounds in a month, not years.

 

[xjx388]

As far as I know, there is no credible research showing any benefits from alcohol. Most credible research shows a dose response curve. However, this is a good illustration of my point: there is an industry out there whose job is to vindicate these toxins as part of a healthy lifestyle, typically funded by the manufacturers.





Agreed, but we cherry pick our risks based on morality, is the concern. For example, getting pregnant is a health risk, but everybody seems happy to subsidize medical complications. For example, would we refuse treatment for post partem depression since the mother "chose to accept the risk of this condition"?

I think the argument is that people should pay for the coverage their life -style/-stage indicates. If you want to have children, then you can pay more. Smoke? Pay more. Have a bad diet which leads to the risks of obesity, diabetes, hypertension...? Pay more. Incentivize people to improve the choices that lead to higher health costs.

 

[The Atheist]

They're saying smokers are less expensive for a mix of reasons, one of which is early death. These are always questionable estimates and the analysts tend to make a lot of assumptions (eg: did they include missed future income and consumption tax revenues, or just medical costs?)

*Shhh!*

It's an economic fact that smokers' early death is extremely cost-effective for governments. Have a look at the costs of years & years of diabetic treatment vs the quick, painful death cigarettes usually result in.

The average is stated at -15 years of life, and all of that is on a pension, so the savings are astronomical for a country with gov't-funded superannuation.

 

[blutoski]

*Shhh!*

It's an economic fact that smokers' early death is extremely cost-effective for governments. Have a look at the costs of years & years of diabetic treatment vs the quick, painful death cigarettes usually result in.

The average is stated at -15 years of life, and all of that is on a pension, so the savings are astronomical for a country with gov't-funded superannuation.

Actually I'm not sure it is... My exploration of this was that it's cost effective for their health budgets, but not for their national budgets. ie: they don't include missed future income taxes (ie: what's the scope of the budgetary analysis?).

One problem that large organizations (such as governments) have is that their silo'd budgets can put departments into conflict with each other (cost shifting). The health ministry's budget would be in surplus if we all keeled over dead this afternoon, but that would end on January 1st when the budget shrinks to $0 due to no taxable income.

 

[blutoski]

I think the argument is that people should pay for the coverage their life -style/-stage indicates. If you want to have children, then you can pay more. Smoke? Pay more. Have a bad diet which leads to the risks of obesity, diabetes, hypertension...? Pay more. Incentivize people to improve the choices that lead to higher health costs.

It's been proposed, for sure, and I'm actually an advocate about managing the behavior rather than the person's current condition, because you don't know how a person got where they are. There are many causes of obesity that do not reflect individual choices (genetics, drug side effects, tumours).

And there are people who make all the wrong choices but dodged the health effects, mostly this is lucky genetics. We all hear those centenarians talking about their secret to longevity being a shot of vodka and a pack of smokes with every meal. So: restaurant taxes, sugar taxes, red meat taxes, added sugar taxes, in addition to our existing palette of sin taxes. The other nice thing about these approaches is that they're proven effective. But for some people, no, that's Nanny State Talk, and this is because there's more than one conversation happening, unfortunately.


And here's the problem: how we slice and dice it is somewhat arbitrary, and this is why it gets political. Just as an example, actuaries can show us that people who take the bus are healthier than those who drive. Should drivers (90% of the population) "pay more" ? Likewise, eating red meat vs white meat; eating meat vs vegetarianism; vegetarianism vs veganism. Even if a red meat tax is demonstrated to reduce bowel cancer, try to get "make the beef eaters pay for it" past the Beef lobby.

What we've done is decree that these choices aren't "worth mentioning" because they're not visibly unattractive at a human emotional level. This is why there's a reasonable suspicion that the actual motive to vilify certain people is plain old prejudice, but we manage the cognitive dissonance ("I'm not a fat basher, I'm just worried about his health/my costs.") by backfilling some story that makes us sound objective.

 

[blutoski]

Huh? I could force this into a CICO-compliant interpretation, but people say this all the time as an unscientific excuse.

No, CICO is still applied, but the genetics are about differential difficulty of managing it. That can include alleles that influence impulse control, for example.

My opinion is that if you survey a person with BMI=30 and compare to a person with BMI=20 and ask them what their weight management strategy is, both would say "I don't have one. I eat when I'm hungry, stop when I'm done the meal."

It's just that the thin person lucked out, her autopilot eating habits in this environment do not lead to obesity. The BMI=30 person has to do something more than our 19th century pre-massmedia ancestors did, has to do something more than the genetically advantaged peer. This sucks, but it's the reality we live in.

As a comparison, I'm short. That's mostly genetics in this day and age. I had many swimming competitors who could whip my ass even though they didn't train anywhere near as hard as I did. They grew bigger muscles simply because they had bigger skeletons. I had to do more strength training than they did to get the same results. I had to think about my approach to competitiveness: I ended up gravitating toward events that did not depend on pure musclepower (endurance and technical events, such as open water). Nothing about this breaks the laws of physics. It just means we're given different cards to play, we need to understand what it means for strategy. Some people have been given alleles that predispose them to obesity, which means that if they want a lean body, they have to pay more attention to what they're eating than somebody without those alleles. I consider myself one of these people, BTW.

We've seen this unfold sometimes in a person who 'used to be thin'. I have a colleague who is not athletic, but maintained a BMI of about 20 throughout college and medical school and his residency. Ate anything he wanted. Suddenly a few years ago, he looked like he was pregnant - the type specimen for android distribution. No change to his eating habits... just hit middle age and his endocrine situation shifted, because that's his genetic predisposition. Now he's struggling to learn techniques he never used before, because he used to be enviously thin without having to dedicate attention to it. (my wife - who has been envious of his leanness since they met in highschool went from schadenfreude to concern over the last five years, as he's not getting the weight off).

 

[Tsukasa Buddha]

No, CICO is still applied, but the genetics are about differential difficulty of managing it. That can include alleles that influence impulse control, for example.

My opinion is that if you survey a person with BMI=30 and compare to a person with BMI=20 and ask them what their weight management strategy is, both would say "I don't have one. I eat when I'm hungry, stop when I'm done the meal."

It's just that the thin person lucked out, her autopilot eating habits in this environment do not lead to obesity. The BMI=30 person has to do something more than our 19th century pre-massmedia ancestors did, has to do something more than the genetically advantaged peer. This sucks, but it's the reality we live in.

As a comparison, I'm short. That's mostly genetics in this day and age. I had many swimming competitors who could whip my ass even though they didn't train anywhere near as hard as I did. They grew bigger muscles simply because they had bigger skeletons. I had to do more strength training than they did to get the same results. I had to think about my approach to competitiveness: I ended up gravitating toward events that did not depend on pure musclepower (endurance and technical events, such as open water). Nothing about this breaks the laws of physics. It just means we're given different cards to play, we need to understand what it means for strategy. Some people have been given alleles that predispose them to obesity, which means that if they want a lean body, they have to pay more attention to what they're eating than somebody without those alleles. I consider myself one of these people, BTW.

We've seen this unfold sometimes in a person who 'used to be thin'. I have a colleague who is not athletic, but maintained a BMI of about 20 throughout college and medical school and his residency. Ate anything he wanted. Suddenly a few years ago, he looked like he was pregnant - the type specimen for android distribution. No change to his eating habits... just hit middle age and his endocrine situation shifted, because that's his genetic predisposition. Now he's struggling to learn techniques he never used before, because he used to be enviously thin without having to dedicate attention to it. (my wife - who has been envious of his leanness since they met in highschool went from schadenfreude to concern over the last five years, as he's not getting the weight off).

Makes more sense, but I think you are siding with genetics to the exclusion of environment, behavior, and how body signals can change over time. Middle-age weight gain is most likely due to the decline in energy expenditure due to lower activity and muscle mass, not genetics. Many people report feeling full and hungry differently when they have lost weight than when they were obese. And so on.

 

[blutoski]

Makes more sense, but I think you are siding with genetics to the exclusion of environment, behavior, and how body signals can change over time.

Hopefully I'm not 'siding' with anything... I'm a big advocate of the phrase 'obesigenic environment' and often the first to point out that we're not genetically different than our grandparents, who were demonstrably thinner. The environment changed, and the genes interact differently.


I was probably also lumping 'body signals change over time' into the 'partly genetics' bucket, since that will vary from individual to individual. Specifically, endocrine management of appetite.

Middle-age weight gain is most likely due to the decline in energy expenditure due to lower activity and muscle mass, not genetics. Many people report feeling full and hungry differently when they have lost weight than when they were obese. And so on.

Yep. Lots of factors interacting, but I would say that our genetics is the platform upon which we experience a decision landscape. Extracting 'blame' and 'accountability' gets complicated when we see how, for example, identical twins separated at birth are almost always within 1.0 BMI decades later.

Here in 2016 we need new skills that our grandparents didn't have, they weren't battling sophisticated marketing departments pushing calories. We need to make different decisions, and in an environment where our genes have much more degrees of freedom to fulfil their programming, we need to be aware of them if we want to 'fight' them.

Here's an example from last month. Marketing departments have learned that there are two times of year where there's an exaggerated opportunity to create bad eating habits: January (because of New Years' Resolutions) and September (because families are under a lot of time stress with school starting). So, this is when you can expect those A&W, Subway, McDonald's, KFC, and Church's Fried Chicken coupons to start fluttering in the mail slot.

There's a psychological principle nicknamed the "what the hell effect" (Janet Polivy's work, eg: [Getting a bigger slice of the pie. Effects on eating and emotion in restrained and unrestrained eaters]). Basically, if you break your commitment to yourself ("I won't drink this year") then for some reason we decide the whole deal is shot, and our discipline is weakened. If I have one drink, I might as well get hammered. If I get takeout one night this month, I might as well do it every night. They want to break our resolve as soon as possible after these typical commitment start dates, it increases sales until the next cultural timeframe commitment start date. (at which point they do it again)



ETA: I forgot to make my point about our grandparents and coupons. Our grandparents would say use the coupons, because cheap food was rare. We should throw away the coupons, because food is so cheap now we don't need to risk obesity to save nickels. Our grandparents said "Always finish your dinner, there's people starving in Japan" - we should not finish our dinner, if we're not hungry. Somebody put too much food on the plate, use smaller portions next time. If you don't like waste, save the leftovers for lunch - don't shove it down.

 

[marplots]

The environment did change. Specifically, the environment of the typical mouth which changed from not having food in it all the time to being constantly stuffed with food. But, "obesogenic" is also a good term.

 

[The Atheist]

Actually I'm not sure it is... My exploration of this was that it's cost effective for their health budgets, but not for their national budgets. ie: they don't include missed future income taxes (ie: what's the scope of the budgetary analysis?).

One problem that large organizations (such as governments) have is that their silo'd budgets can put departments into conflict with each other (cost shifting). The health ministry's budget would be in surplus if we all keeled over dead this afternoon, but that would end on January 1st when the budget shrinks to $0 due to no taxable income.

You can trust me it's correct. The small amount of lost productivity and tax is overwhelmed by the huge deficit in pension payments made. Smokers tend to die more at or after retirement age than 20 or 30 years before it.

 

[cullennz]

While lardy, diabetic, alchys live longer, pay less tax, cause more social harm and cost a fortune