The stupid explodes: obesity now a disability

[Jono]

No.

I repeat - I have no interest in what size someone is. It's only when their weight becomes an issue that someone else is expected to pay for I give a damn.

Kind of like people sporting and the many, many costly injures that result thereof ye? No, I actually doubt your concern on this is only (if, at all) about the matter of dispersed money for the ol' "they did it to themselves" thingy.

With the swedish system, you pay very little money either way for your own individual ailments (regardless of how you aquired them). As it happens, I heard something similar from a co-worker not long ago. Naturally, he's really careful about what he eats and his fit physique (all well and good so far). Subsequently, I guess that is what, in part, made him even moreso an emotionally judgemental fat-shamer and prone to discus the morality of those who are overweight etc etc and etc. Just as naturally and expectedly, he and I have had our disagreements. He was on sick-leave for a couple of months late last year because he had "accidentally" broken his thumb. I learned he was engaged in a "how far can you bend it" thingy with his friend during a less than sober situation, and something in the bone snapped. When he brought up the same argument again, i.e that his criticism of those overweight has "nothing" to do with how he personally feels about them as people, but about the fact that they cost society money for something they "did to themselves" I asked him...; so, did you pay for that thumb-operation and the subsequent sick-leave out of your own savings? No, of course he didn't.

 

[rustypouch]

Kind of like people sporting and the many, many costly injures that result thereof ye? No, I actually doubt your concern on this is only (if, at all) about the matter of dispersed money for the ol' "they did it to themselves" thingy.

With the swedish system, you pay very little money either way for your own individual ailments (regardless of how you aquired them). As it happens, I heard something similar from a co-worker not long ago. Naturally, he's really careful about what he eats and his fit physique (all well and good so far). Subsequently, I guess that is what, in part, made him even moreso an emotionally judgemental fat-shamer and prone to discus the morality of those who are overweight etc etc and etc. Just as naturally and expectedly, he and I have had our disagreements. He was on sick-leave for a couple of months late last year because he had "accidentally" broken his thumb. I learned he was engaged in a "how far can you bend it" thingy with his friend during a less than sober situation, and something in the bone snapped. When he brought up the same argument again, i.e that his criticism of those overweight has "nothing" to do with how he personally feels about them as people, but about the fact that they cost society money for something they "did to themselves" I asked him...; so, did you pay for that thumb-operation and the subsequent sick-leave out of your own savings? No, of course he didn't.

While your cow-orker might be hypocritical, I'm still not convinced that accidents are equivalent to complications from obesity.

With accidents, it just takes one moment of inattention or foolishness, and the damage is done, there's no going back.

Obesity to the point of disability, or where major complications arise, takes years of effort. There's all sorts of warning signs along and indications along the way. It's mostly reversible with some simple changes, especially if they're made early. Yet for some reason, there are people who would rather eat large amounts of fast food every day, washed down with litres of cola, than have feet.

 

[The Atheist]

Obesity to the point of disability, or where major complications arise, takes years of effort. There's all sorts of warning signs along and indications along the way. It's mostly reversible with some simple changes, especially if they're made early. Yet for some reason, there are people who would rather eat large amounts of fast food every day, washed down with litres of cola, than have feet.

Brilliantly put.

 

[Jono]

While your cow-orker might be hypocritical, I'm still not convinced that accidents are equivalent to complications from obesity.

With accidents, it just takes one moment of inattention or foolishness, and the damage is done, there's no going back.

Well, the formentioned situation wasn't really an accident imo, which is why I put it in quotes. He, indeed foolishly, did something that is demonstrably risky, in an intoxicated state. I think the point follows that if you're arguing that overweight people ought to pay, themselves, for any subsequently linked ailments of that overweight because they did it to themselves, then... you'd have accept that the same argument is appliable to many a misadventurous stunts, hobbies, sports et al that are saddled with high frequencies of costly injuries etc.

 

[Jono]

Obesity to the point of disability, or where major complications arise, takes years of effort. There's all sorts of warning signs along and indications along the way. It's mostly reversible with some simple changes, especially if they're made early. Yet for some reason, there are people who would rather eat large amounts of fast food every day, washed down with litres of cola, than have feet.

I'm gonna disagree with 'The Atheist' here as I don't regard the above statement as brilliantly put. Simple changes you said? Well, for some maybe, for a whole lot of others not so simple. E.g, for someone on psycho-pharmaca, with accompanied disabilities, the reality of gaining 4-8 pounds a year is not an uncommon theme. Give it fifteen years and you've got a weight that isn't, by any measure, easily regressed by just excercise. So, your idea that many/most aquire their overweight by sitting like a plant on the couch, washing down fast food with litres of cola, is a bit of a fat-shaming stereotype, prejudiced as a generalisation and as such not alltogether representative. Here's an article that addressed the kind of, as it is sometimes, misconceptions about obesity that you touched on there. Excerpt:

Obesity is primarily caused by a lack of physical activity or by unhealthy dietary habits

The positive energy balance underlying obesity is generally attributed to chronic excess energy intake or reduced physical activity. Unhealthy diet and physical inactivity are the “big 2” on which almost all preventive and therapeutic programs for obesity are focused, thereby neglecting other possible contributors to excess body weight. Although intuitively appealing, clear evidence (eg, individual-level epidemiologic data and randomized experiments) beyond ecological correlations is lacking for the big 2.2 Many other putative contributors to the increase in obesity (eg, insufficient sleep, psychological stress, endocrine disruptors, medications, intrauterine and intergenerational effects, etc) have supportive evidence that is as compelling as, if not more compelling than, the evidence for the big 2.
...

Obese individuals are less active than their normal-weight counterparts

It is very common to hear that obese people are lazy and should get off the couch. [My edit: sound familiar ye?] This discriminatory bias against those with excess weight is not only widespread among the lay public but also among health professionals, even those in regular contact with patients with obesity.7 Yet, the most recent data from the Canadian Health Measures Survey, a study of a nationally representative sample that used accelerometers to measure physical activity, suggest otherwise.
...

Everyone can lose weight with enough willpower

It is common to hear that weight loss is a matter of willpower and compliance with the weight-reducing program. However, the magnitude of weight loss is very different among individuals with the same weight-loss intervention and prescription, and the same compliance to the program—one size does not fit all. Thus, for some people (especially those who have already lost some weight), simply putting more effort into a weight-loss program will not always result in additional weight loss given the different compensatory adaptations to weight loss. For example, the decrease in energy expenditure that occurs during weight loss is highly variable between people and might dampen efforts to lose additional body fat. Such compensatory mechanisms might sometimes fully counteract the 500 kcal per day decrease recommended in most dietary interventions, making it very difficult for such “poor responders” to lose weight.

Physicians should remember that obesity is not a choice and weight-loss success is different for every patient. Success can be defined as better quality of life, greater self-esteem, higher energy levels, improved overall health, or the prevention of further weight gain.

Fortunately, here in Sweden, many have begun to seek aid in getting a gastric-bypass. It's not for everyone, but according to the studies I was shown when I took part in such a trial-meeting (I wasn't looking for a gastric-bypass, just wanted to educate myself on it), they pointed to the next-to-near futility of trying to get notably overweight people to go out and excercise their harmful state down. Partly, that's because they have other psychological ailments as well. So, all in all, if the given data and studies were properly done, the option to have a gastric-bypass can be a lifesaver if you're severely overweight, or obese as is frequently used as a term.

 

[The Atheist]

I'm gonna disagree with 'The Atheist' here as I don't regard the above statement as brilliantly put. Simple changes you said? Well, for some maybe, for a whole lot of others not so simple. E.g, for someone on psycho-pharmaca, with accompanied disabilities, the reality of gaining 4-8 pounds a year is not an uncommon theme.

What percentage of obese people do you think fall into that category? 2%? 3%? I'll be astonished if it's more.

Medical issues have already been discussed and aren't included in the discussion because it's an entirely different issue. The issue here is people without medical reasons for being obese.

 

[casebro]

What percentage of obese people do you think fall into that category? 2%? 3%? I'll be astonished if it's more.

Medical issues have already been discussed and aren't included in the discussion because it's an entirely different issue. The issue here is people without medical reasons for being obese.

My guess would be ten times as high as yours. Ya know, depression over their obesity. Or visa-verse.

 

[Ron Swanson]

All weight loss takes is eating less food ... lost 100 pounds in three years by simply eating less no excursive not fad diets (that was almost 6 years ago) ... mind you I gained back 12 15 pounds, but I'm working on it

 

[The Atheist]

My guess would be ten times as high as yours. Ya know, depression over their obesity. Or visa-verse.

Everyone who gets depression gains weight?

You're claiming mental illness is responsible for a large amount (20-30%) of obesity.

I only have one thing to say to that:

Evidence?

 

[rustypouch]

I'm gonna disagree with 'The Atheist' here as I don't regard the above statement as brilliantly put. Simple changes you said? Well, for some maybe, for a whole lot of others not so simple. E.g, for someone on psycho-pharmaca, with accompanied disabilities, the reality of gaining 4-8 pounds a year is not an uncommon theme. Give it fifteen years and you've got a weight that isn't, by any measure, easily regressed by just excercise. So, your idea that many/most aquire their overweight by sitting like a plant on the couch, washing down fast food with litres of cola, is a bit of a fat-shaming stereotype, prejudiced as a generalisation and as such not alltogether representative. Here's an article that addressed the kind of, as it is sometimes, misconceptions about obesity that you touched on there. Excerpt:


Fortunately, here in Sweden, many have begun to seek aid in getting a gastric-bypass. It's not for everyone, but according to the studies I was shown when I took part in such a trial-meeting (I wasn't looking for a gastric-bypass, just wanted to educate myself on it), they pointed to the next-to-near futility of trying to get notably overweight people to go out and excercise their harmful state down. Partly, that's because they have other psychological ailments as well. So, all in all, if the given data and studies were properly done, the option to have a gastric-bypass can be a lifesaver if you're severely overweight, or obese as is frequently used as a term.

Yes, the changes are simple. Whether or not it's easy for someone is a different matter entirely. Your body weight and composition is determined by your diet and activity levels, with diet being the most important for excess fat. It's an indication of how someone lives their life, of day to day habits. I don't think anyone will debate that there are numerous factors which can affect appetite, satiety response, and energy levels.

We seem to agree that changes in weight are not an instantaneous process. It takes months, and sometimes years, for any substantial change, whether it be fat gain or loss, a change in muscle mass and strength, or a change in cardiovascular capacity.

The fact remains that the only way to gain weight is by overeating, regardless of the source or reason.

In regards to the article you posted, it seems to be flirting with woo, as it hints that some people can gain weight regardless of consumption. Also, citing Linda Bacon makes my skepti-sense tingle (is that a thing?), just like if someone cites Ken Ham on a biology related paper.

Although I would agree with it that the root causes of overeating need to be examined, and that there's an argument to be made for treating the morbidly obese as addicts.

 

[blutoski]

He has not given an explanation for how we can hold the view that fat, low GI foods, or high fiber foods are more satiating than refined carbs like sugar, but that someone's appetite and cravings will have no effect on someone's ability to stick to a diet.

I think this is referring to me. I'm having trouble parsing that sentence, but I think you're asking for me to elaborate on what appears to be a contradiction: that some elements of foods are associated with higher and lower satiety, but that simultaneously it probably doesn't have a big impact on obesity rates? I'm pretty sure I explained that: it has to do with which components, and what quantities.

The macronutrients that are best associated with satiety in the real world are roughage and water, but the effect competes with external factors that influence satiety, such as simply seeing the bottom of the bag or having less variety.

Just to back up a bit: I use the model of 6 macronutrients as follows:

• fats: 9cal/g
• ethanol: 7cal/g
• non-fiber carbs: 4cal/g (eg: sugar)
• protein: 4cal/g
• fiber carbs: 2cal/g
• water: 0cal/g

Primarily, we should look at the 'g' side of the equation. People appear eat mass, not calories or macronutrients. That is: people are primarily satiated by eating X grams, plus or minus a bit. The plus or minus a bit is influenced by macronutrient mix and external cues.

The volumetrics diet is one of the most successful, because it focuses on boosting the grams of fiber carbs and water in a meal. Adjusting sugar/fat/protein percentages just doesn't have very much effect on how many grams we eat, so these intense and time consuming discussions about it are what my dad calls 'tripping over dollars to pick up pennies'.

There is also an interesting thing about protein in particular - satiety appears to have a strong cognitive component. That is: when subjects don't know the percentage of protein in the meal, the benefit diminishes. Expectation is a strong influencer of satiety, just like deciding we're 'full' when the plate is empty. This finding was groundbreaking in the 1990s, and it has taken a long time for the professionals to incorporate it into weight loss strategies. I don't think it's really resonated with the public, but that's true for most of the external factors. Nobody thinks they're influenced by menu wording or colour choices, either. We all think we're too smart.

So anyway, if I'm eating X grams per day consistently, and shift my food choices to lower calorie density as much as possible, I should see weight loss for awhile, until I level off with a lower BMR. If I'm at a good weight then, I can maintain eating that original number of grams per day. Unfortunately, a lot of people will still be overweight, and the body has to be trained to eat fewer grams per day. This is where stomach surgery or lap bands function, but the stomach can also 'learn' to expect less food, given enough time (stomachs don't actually shrink though.)

Here's the challenge, then: evolution shaped us to seek out calories. So it's not surprising that those low energy density macronutrients - fiber and water - are also not very tasty. My thinking these days is that we need to firstly build up a practical real world recipe base for foods that have dominant water and fiber, and secondly, desensitize the population's assumptions about what percentages of fats, sugars, and proteins constitute a 'real meal' to address the satiety influence from expectations. Salt is another substance that functions by expectation and escalating thresholds, we need to look at that too.

We already know appetite suppressing drugs can cause weight loss because people eat less. The most dramatic weight loss treatment is physically reducing someones appetite with surgery by restricting or cutting away their stomach. For certain it is harder to stick to a diet if you are surrounded by people eating badly, but in the same way it is hard to quit taking heroin if you are surrounded by heroin addicts in your personal life. It is still asinine to suggest that it is just as difficult for someone to stop taking those drugs if you have significantly reduced their cravings for it. We perform surgeries like gastric bypass precisely on the logic that this will dramatically increase their satiety with very little food, if someones appetite and ability to feel satiated had no effect, why on earth would we be performing such invasive risky surgeries?

I think this is consistent with the model I endorse, which is that satiety is not significantly influenced by macronutrient percentages. Contents stretching the stomach wall is a different and well understood and proven mechanism for signalling end of a meal than the hypothetical models that involve GI.

I talked about studies he referred to. They did not study the behavior of obese people.

True, and I appreciate that you can only address the studies that are presented, but please understand that they're provided as examples rather than definitive. Contrary to Taubes, human eating has decades of good studies, it has taken me a decade to read perhaps 10% of them.

[edit for brevity]

If Taubes is wrong then fine, but at least criticise what he is actually saying and not such basic misrepresentations, otherwise it does make it seem like you feel you have to. The word strawmen is so overused I get tired of seeing the word, but that is what we are talking about here.

To be honest, I disagree that these quotes are out of context. Like yourself, I've read his books, many articles, and try to stay current with his foundation's research, and the problem is that he seems to frequently contradict himself. It could be because he says certain things to certain audiences based on what he thinks they will accept.

But he's not really influential in the community, since all he has published are essentially op/ed pieces. Looking forward to his results, just like I look forward to other researchers' results. Lots of pet theories out there. He's just one with publishing power.

Regarding his research: I would be doing a disservice to represent the foundation's work as 'his' research - to his credit he has partnered with Peter Attia, who has appropriate expertise to review the research proposals.

 

[blutoski]

While your cow-orker might be hypocritical, I'm still not convinced that accidents are equivalent to complications from obesity.

With accidents, it just takes one moment of inattention or foolishness, and the damage is done, there's no going back.

Obesity to the point of disability, or where major complications arise, takes years of effort. There's all sorts of warning signs along and indications along the way. It's mostly reversible with some simple changes, especially if they're made early. Yet for some reason, there are people who would rather eat large amounts of fast food every day, washed down with litres of cola, than have feet.

There are certainly people like that, but you can't identify them with a scale. There are people who eat nothing but mcflurries but are underweight. They just don't eat more calories than they expend.

So this is the primary problem, unfortunately. There is a cultural prejudice that connects a person's appearance with an unjustified assumption about their character, and it's unfair.

The other thing is that, as you say, it can take a long time to become so obese... a person who gains an excess 100lbs over 20 years of adulthood has averaged a 'gluttony' of 47 extra calories per day. About four peanuts. Hardly a sign of poor character.

 

[GlennB]

The other thing is that, as you say, it can take a long time to become so obese... a person who gains an excess 100lbs over 20 years of adulthood has averaged a 'gluttony' of 47 extra calories per day. About four peanuts. Hardly a sign of poor character.

The 4 peanuts a day, sure. But the 100lbs over 20 years seems like poor judgement. At what point should someone wonder whether it's time to act?

 

[blutoski]

Oh and btw, as with the Freedhof link it doesn't fit what Blutoski is claiming. (In the case of Freedhof's article, he contradicts Harriet Hall's criticism of Taubes also linked by Blutoski.) If you the read blog above, while the person obviously does not agree with Taubes they too recognise the importance of satiety and how different diet's actually do have different success rates. That doesn't mean I agree with this persons reasoning but it definitely doesn't match what Blutoski is saying either, who is saying that it doesn't matter what diet you are on or what the macronutrient composition of the diet is. Instead, he says this has no bearing on how successful or unsuccessful someone's ability to lose weight will be. The take home message you'd get from Blutoski is that no studies show the macronutriant composition of foods on a diet show different success rates, but you'd be wrong. The only things that tie these people that keep being linked to and what Blutoski is saying together is that they don't agree with Taubes, but it seems kind of silly to keep linking to people to back you up when they don't, and even disagree with each other. I recommend you fully read this article by Taubes and then consider how it matches up with the representation you have read from his critics.

There's a lot here, but I'd like to focus on the 'different diets have different success rates' - this is a great example of what I was referring to as the 'rearranging the deckchairs on the titanic' thing.



This type of 'head to head' comparison is very popular. Anybody promoting their diet will hunt around for the one that shows their diet is 'best'. There are comparisons that show low fat is best. There are comparisons that show low carb is best. There are studies that show it doesn't matter. I have observed a few valid criticisms of these studies.

• Firstly, I think I've already said I have a couple of favourite diets that show superiority: Weight Watchers (which is a low calorie diet) and Volumetrics (which is a low calorie density diet). Observe that these perennial winners were absent from the results you linked to. The macronutrient idealogues are very focussed on a narrow discussion of low fat versus low carb, and miss the fact that they're just not that different.
• they don't have a long timeframe, but everybody sees that initial weight loss is undone pretty quickly... it's not unreasonable to forecast that all the weight will be gained back on most of these diets - this is why a very important property of dieting that I consider is the likelihood of adherence... yo-yo dieting is a property of choosing a diet that's hard to stick to, and neither the low fat nor low carb approach seems to have special adherability
• the 'significant' differences are a joke - just look at the link you provided... low fat 2 year weight loss is 3lb, low carb 2 year weight loss is 5lb. They're calling that difference 'significan't - are they ******** me? So this is what I was trying to say when I said they're all about the same. There's some static, but this one pound a year difference is not an explanation for childhood obesity rates.
  
  Back when I was doing research medicine, I was working in the field of antiretrovirals. There was a pharmaceutical doing a presentation in a convention that showed a 10% reduction in HIV viral load. This was statistically significant. It was medically irrelevant. These diet comparisons are the same. I see no reason to change my view that the difference among the macronutrient diet results is 'practically irrelevant'.
• added later: there's also definitional problems... a lot of the 'low fat' diets aren't, a lot of the 'low carb' diets aren't... it's one of the ways the researchers manipulate results to show their diet is champion... if the study does not explain what proportions are involved and how they verified it, I think we should just ignore it

 

[blutoski]

The 4 peanuts a day, sure. But the 100lbs over 20 years seems like poor judgement. At what point should someone wonder whether it's time to act?

Yes, there's a long runway on that... what I was responding to was the judgement of character. Obesity is not evidence of gluttony.

 

[blutoski]

The take home message you'd get from Blutoski is that no studies show the macronutriant composition of foods on a diet show different success rates, but you'd be wrong.

Firstly, I'm pretty sure I merely said that the differences were just not meaningful - not that they were zero. Other terms that come to mind: 'practically meaningless' 'irrelevant' 'distinction without a difference' 'missing the forest for the trees' 'rearranging the deck chairs on the titanic'.

And this reference in the passage above is worth mentioning as well as the one in my previous post... as mentioned above, I consider adherence to be critically important in a diet strategy (this includes the exercise portion - if you hate exercise, don't use expect to stick with that as a compensatory strategy... you will abandon it eventually).

Here's the conclusion of that study you linked to:

CONCLUSIONS:

Regardless of assigned diet groups, 12-month weight change was greater in the most adherent compared to the least adherent tertiles. These results suggest that strategies to increase adherence may deserve more emphasis than the specific macronutrient composition of the weight loss diet itself in supporting successful weight loss.

Also worth noting this was a 12mo study. There is a reason these comparison studies frequently chop off at 12mo. As we saw in the other link, there's a bounceback as subjects get bored with their diets and abandon them. This affects all diets, but the low carb diets have the biggest dip and bounceback. That chart does not actually show us which diet had the best adherence. I read the study, so spoiler alert: they were about the same abandonment rate at the 12mo mark. Probably the same at the 24mo mark. This is what we see in the real world, so no surprise.

For me, this is the 'real world' practicality I consider when reading these studies. Taubes is putting people in solitary confinement to see what macronutrient proportions cause the most weight loss. The results will be academically interesting (although we already know what will happen - contrary to his claim, these studies have been done), but probably has little practical application for what dieticians should advise the public to do in the real world where we see food commercials all day and decide what a portion is based on the size of our plate.

 

[rustypouch]

Yes, there's a long runway on that... what I was responding to was the judgement of character. Obesity is not evidence of gluttony.

I find your example slightly disingenuous. Obesity may not be evidence of gluttony, but it is evidence of overeating.

Yes, it only takes a small daily surplus, over a long period to gain weight, and it can add up.

But when someone gains weight, the new tissue needs energy to maintain. That 47, or however many, extra calories a day will, at some point, go towards supporting the new weight, and the weight gain will slow and eventually stop, assuming they haven't changed eating habits. To keep gaining over an extended period requires ever increasing amounts of food.

 

[blutoski]

I find your example slightly disingenuous. Obesity may not be evidence of gluttony, but it is evidence of overeating..

Overeating, or under exercising. Or a combination of both.

Overeating or underactivity. I was explicitly responding to:

there are people who would rather eat large amounts of fast food every day, washed down with litres of cola, than have feet.

Obesity is not evidence of this type of eating pattern or a general character flaw.

 

[bit_pattern]

Framing obesity as a failing of moral character certainly provides a sense of moral superiority, which I'm sure certain people find very comforting.

 

[bit_pattern]

Would be interested in hearing Blutoski's thoughts on this

http://www.salon.com/2015/04/12/you_should_never_diet_again_the_science_and_genetics_of_weight_loss/

In particular the prison experiment and the conclusions the author draws from it.