This is probably as good of a space as any, what do you guys see as politically feasible solutions to our obesity problem? Politically feasible would probably entail not angering food lobbies. Or is taxing corn/soda/meat really the only way?
Oh, and the government should STFU about what it thinks is healthy. The last time it tried to interfere with the market it told generations of kids to eat a pound of bread every day. Don't tax anything you think is "bad" and don't subsidize what you think is "good."
If you absolutely must do something bring home-ec back to public schools. Teach kids how to cook. Then let them figure out on their own what they want to eat.
OTOH, the first few times it interfered with the market they solved widespread nutritional deficiencies that were killing, crippling, and otherwise substantially harming hundreds of thousands of people every year. I'm speaking of the fortification programs:
https://www.nal.usda.gov/sites/default/files/fnic_uploads//45-55.pdf
If you have a beef, it's with he medical and nutritional sciences, which invested too much confidence in what should have been recognized as problematic research results.
No it absolutely wasn't. It was echoing the advice of the agriculture lobby. The medical establishment sent its information in and the FDA altered it. And guess what? The food guidelines from this year were manipulated by the agriculture lobby too. http://time.com/4130043/lobbying-politics-dietary-guidelines...
I only skimmed your article, but it appears those instances were almost entirely labeling guidelines. Example: What constitutes "enriched" flour? I can see the value in that, but I hope it's clear that's very different from marketing enriched flour via the government provided education system.
Yes, the USDA is responsive to the agricultural lobby. So what? At the end of the day it doesn't matter how or why they make their recommendations, but the substance and effect of those recommendations. And my point is that in the long-term the general guidance of the USDA has reflected, more than anything else, the medical consensus. Obviously it doesn't only reflect that, but everything is effected by lobbying, even the medical consensus.
And my larger argument is that if you examine its long-term track record, on the whole it has been positive, at least in the context of nutritional policy. Yes, the USDA's fortification program was largely voluntary. So were its more modern recommendations. Sometimes their recommendations weren't voluntary, like guidelines for federally funded school lunch programs. But the same applies to their fortification programs--those school lunch guidelines also mandate fortified foodstuffs. Also, the fortification programs involved direct and indirect subsidies, which is why most basic foodstuffs (grains, salt) at retail were fortified, at least until the organic craze.
I respond because I'm tired of the narrative that when government does something stupid the answer should just be to remove government from the equation. That's not rational. In every context we should endeavor to make informed and well-reasoned judgments based on a) context, b) facts, and c) some rough assessment of our priorities. Unfortunately we've forgotten how to incorporate those three things into our discourse. We don't understand context because we reframe every issue as some ideological battle about government. We don't understand facts because we're too lazy to root them out, and too lazy to assess their relevance and strength. And we suck at agreeing on priorities because, similar to context, we confuse the means with the end--that is, we seem to think our ultimate goal is to refashion government to fit some conceptual model, rather than to refashion particular laws and agencies to best meet some quantifiable goal, like a lower incidence of diabetes.
This retreat and resort to ideology and abstract modeling is not only a political pathology, but arguably it has been the problem with nutritional science. For example, when I mention "epidemiological methodologies" above I'm implying, among other things, that we committed a category error: too much salt might be "causative" of high blood pressure on a population wide scale, but on an individual scale it doesn't cause anything in most people, and the particular issue in the subset of the population responsive to high salt intake wasn't something you'd expect given the large population studies. The population-wide mechanism was empirically sound (lower average salt consumption, improve average outcomes) but not reflective of the underlying pathologies at the micro-scale and ultimately suboptimal.
IOW, yes, if _everybody_ reduced salt consumption to some common recommended level then population-wide health could improve. But there's a better equilibrium to be found by understanding the details and taking a more nuanced approach, allowing us to improve health even more. Likewise, maybe we might all be better off on average if the USDA disappeared overnight. But perhaps there's a better equilibrium where the USDA still has a role. We can't know without making a careful assessment, and continually re-making that assessment.
Let's stop being lazy. Let's dig into the details. It's difficult and frustrating but there's really no better way. At the end of the day, government will never go away. Somebody will always rebuild the bureaucracy. The only sane long-term strategy is to stay engaged.
>I respond because I'm tired of the narrative that when government does something stupid the answer should just be to remove government from the equation.
Don't pretend like you're presenting anything but an equal and opposite narrative. This government program, which is nothing more than bought and paid for marketing by lobbyists, has literally killed millions of people. How many people need to die before you'll say enough is enough?
If the government got out of the way then people would seek out the information they need and they would get it from a variety of sources such as books, their personal physicians (probably the best choice), or other sources. Unreliable sources would relatively quickly fall by the wayside. But the government voice is a foghorn which cannot be ignored, especially when you put it in the school curriculum.
>Let's stop being lazy. Let's dig into the details.
I'm right here with you. One-size fits all nutrition recommendations from the government is a disaster. When the government becomes a voice for nutrition recommendations its scope makes it, in effect, the only voice. That makes the government voice the ripest target for manipulation. Instead, the voice of the scientific community at large should be out there. It's there today, but it's drowned out by the government fog horn. If you want nutrition information, the best person to talk to is probably your doctor because they will know pretty near the latest medical information and be able to adjust it for you as an individual.
I think the only thing you two actually disagree about (because I certainly agree with most of what both of you said) is the medical consensus at the time of the food pyramid, and the only thing that has been contributed to that is a Wikipedia link. Now I have a high degree of faith in Wikipedia and also fully expect the food pyramid was bought and paid for, but following through on Wikipedia to the links supporting this brings 2 book links and a USDA.gov page. Perhaps reading the books would provide a high degree of good explanation, but I still don't know what the medical consensus at the time was. My contribution is a crappy link ( http://www.nytimes.com/2007/10/09/science/09tier.html ) that suggests the medical consensus indeed thought fat was a greater enemy and am left with no solid belief of the central issue. Stuff is hard.
Exercise is costly in time, and, therefore, money.
As a sort of self-performed experiment, I've exercised regularly for the last 2 years, on average of 3.5 times a week (every other day).
This required 1.25 hrs for the workout itself, another .25 hrs for the added commute, $60 for the gym membership per month, an increase in calorie consumption to compensate of about 30%, hence additional food costs of around $100/month.
That's a total of 273 hours in a year in opportunity cost and $1920 in various expenses.
Assuming a semi-skilled wage of $15/hr, that's $4095 + $1920 ~ $6000 opportunity cost per year to exercise and stay healthy.
$6000 is a make or break amount of money for poor people. I can afford it relatively easily, considering how much health benefits I receive from it, but living paycheck to paycheck, most of them likely can't.
Assuming exercise isn't fun. Physical therapy is supposed to be a brutally painful and exhausting way to repair damage that you'll feel better about in the distant future. Exercise should be fun. If you're not having fun, with fun people, you're probably doing it wrong.
There are people who genuinely don't enjoy exercise, despite no indication that they would somehow not benefit from the effects.
(I include myself in the set of people who don't know the solution, though I've never had this problem. My very naive intuition is that http://slatestarcodex.com/2017/04/25/book-review-the-hungry-... is a... reasonable jumping-off point?)
Another issue is it's expensive to eat healthier foods. Addressing income inequality feels like one aspect that could help as well. It's much harder to come up with a good, politically feasible solution to that.
Still, as bad as it is, it's better than nothing - I grew up in a pretty depressed, white-trash area where better than 50% of kids were on free-and-reduced lunch subsidies, and for not a few, breakfast and lunch at school might be the only meals they got some days. But for god's sake, we can do much better than we're doing, and it shouldn't cost any more than the sugar-blasted packaged garbage we're shoveling at kids today. Make a big batch of scrambled eggs, give them a piece of toast with peanut butter (although I supposed peanut allergies have ruined that), oatmeal, something with a little protein or complex carbohydrates in it, a piece of fruit. It's not rocket science.
Let people eat what they want to eat. Quit trying to micromanage other people's lives.
But the right fix is definitely the food situation. Everybody already eats.
A person who eats healthy, exercises and takes care of themself ends up paying for those who don't.
On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people.
Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on.
The cost of care for obese people was $371,000, and for smokers, about $326,000.
http://www.nytimes.com/2008/02/05/health/05iht-obese.1.97488... (numbers from 2008)
The main factor as to why this is the case is important though. The longer you live the more costs you incur on the system because you end up getting another sickness which costs a lot more to treat, they specifically quote Alzheimers, than obesity and lung cancer.
One thing they did not take into account though is the lack of productivity i.e. the costs of being disabled (possibly b/c it is a dutch study using dutch data and parameters), in the USA diabetes is a disability and incurs significant other costs on the system which were not taken into account. It would be interesting to see what the comparisons would look like once that is taken into account.
But its certainly the case that smoking is much cheaper overall. It doesn't lead to disabilities and people die younger and incur far less costs.
[1] http://journals.plos.org/plosmedicine/article?id=10.1371/jou...
Even without a national health care system, taxpayers are paying for those who don't take care of themselves.
I would imagine if 320 million people are going to be measured for financial punishment purposes, there would be a startup opportunity in some kind of 3-d scanning appliance that could auto-generate circumference measurements.
Of course where money is involved corruption will develop and inevitably there will be clinics where patients are asked politely to measure themselves and record their own numbers, such that the promised savings will never occur.
We already have a 2D scanning appliance which can measure body fat to 1% accuracy, even for weightlifters. It's called a DEXA scan. Currently scans cost about $50 and take several minutes, so not really practical for screening millions of people every year. But I'm sure engineers are working on improving cost and speed.
https://www.theguardian.com/society/2017/may/17/obesity-heal...
Gym memberships are at a high. The amount of time and money people invest purely in their fitness is at a high. Yet so is obesity. The behavioural forces making people fat are stronger even than the social, sexual and economic pressures driving people to be thin.
You aren't going to put on weight or maintain an unhealthy weight if you aren't eating excess calories.
As far as eating goes, you can't really dictate quantity but I think one thing you can do is subsidize healthy foods and make them cheap and affordable so everyone can have access to them. I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive.
As far as physical activity is concerned, we've had unhealthy foods for a long time and people have eaten unhealthily since the 50s. Look at this chart: http://wellandtrue.com/the-world-has-changed-so-have-our-wai... and you'll see that we only start getting a big spike after the 1980s when everyone basically started moving to fulltime desk jobs in front of a PC all day. So I think some kind of nationally mandated PE routine kids had to do M-F would be a start even though it'd probably never get support.
I feel that's a common misconception. Sure, you can't buy fresh, organic foods but I'm able to build muscle on about ~$10/day and stay healthy as a horse.
Frozen peas (most frozen veggies) are $1 for 4 servings; canned black beans and chickpeas are $0.89 for 4 servings; whole-wheat bread is $3-4 for 18 pieces; 1 gallon of water is $0.89 (if you faucet water isn't drinkable); etc.
You certainly can eat healthy on the cheap. It's just that most people don't want to make the sacrifice.
I don't know. It would be interesting to know what the research says. I lived in poverty for much of my younger life and we wouldn't buy a lot of health foods because they were expensive. I remember fruits and meat were a rarety you got exited about. And I was lucky because my parents still tried to feed us healthily - we had a garden and chickens.
Its also probably true that you don't need as much variation and nutritionists say - you could probably live healthily off of potatoes and eggs.
I've also lived off of what you suggest and its not that pleasant. If you want fresh salads and vegetables the price starts going through the roof, so you're basically stuck with the cheapest canned/frozen stuff. Sure you can do it and I have but its not surprising people don't stick to it long when most of the tasty alternatives are either too expensive or just plain junk food.
Yeah, I've felt the same, and that's why I put it to the test. I can't necessarily extrapolate. All I can say is for the better part of 2.5ish years I've been eating the same thing everyday and my health (according to my yearly checkups) has been stellar.
Of course, you have to hit your macro- and micro-nutrient requirements in your daily regimen.
> I've also lived off of what you suggest and its not that pleasant.
It's a matter of perspective, I guess. I look forward to peanut butter peas or greek yogurt with honey roasted peanuts mixed in or overnight oats made with frozen blueberries and soymilk.
I guess I was just trying to offer up that there is a way to eat healthy, cheaply. Because I certainly didn't know about it until later in life.
They are harvested closer to the ideal time and don't degrade during shipping and so on.
Of course not all vegetables, but there are many that stand up well to freezing. Just don't leave them in an auto defrosting freezer for a long time.
You can eat on $200 a month without much problem. I received max SNAP benefits for several months and I spent about $120 a month on food, so I had money left over at the end (being a vegetarian helps).
This really isn't relevant to the point at hand (or maybe it is, who knows?) but I think poor people would have an easier time if the means testing for food stamps were looser. The benefits fall off steeply. If someone is making a thousand dollars a months and working full-time or close to it, the government can chip in more than $10-20 to give them access to healthier food.
If necessary, like when you're in a maintenance phase, you could get it to $5/day.
I hear you and agree. I think the means testing for food stamps should be looser too. It's funny, I know a couple people on food stamps and I know a few vegans. What you say is true.
Also works for saving: earn more and spend less, duh!
Making friends: be nice more and mean less, duh!
Stress: sleep and relax more and worry less, duh!
Marriage: communicate and date more and fight less, duh!
Fat people want to be thinner. There are plenty of negative incentives to being fat. There's something subtler and more complex going on here.
You can try complicate the explanations to account for this but the fact is that it shows that the 'obvious' reasons most people surmise are not so clear cut and need to be tested like any hypothesis. It's a hard problem to test and there are several other competing hypothesis. The best I can say for my own beliefs is that we need to have more studies that need to be done before I'm convinced of any of them.
I explain this here:
https://news.ycombinator.com/item?id=14353914
It's cheaper to not exercise.
Also exercise is not for weight loss, it's for exercise.
Not too surprising that being immune or actively avoiding that toxic culture, results in both wealth and fitness.
Advertising Kills.
Not saying something like that might not be a good idea from a public health perspective. I'm not educated enough on those issues to have an opinion.
From a public health perspective yes that absolutely matters, but all I'm saying is this narrow claim: You will not save money on medical costs if you get your population to act healthier and they die of unpreventable diseases instead of preventable ones.
Yet here you are, posting things like this:
> The problem with that logic is that people with unhealthy behavior actually cost the system less.
Without any data.
I posted what I am educated about, and did not post an opinion about what I am not educated about.
> Without any data.
Apologies. I posted a nytimes story that links to a study in another comment in this thread: https://news.ycombinator.com/item?id=14353347
Nobody? Really?
What you're proposing is to pile additional hardship on people who are likely already unhappy with their current situation, and may also feel powerless to fix that part of their lives. On its face, your proposal lacks both compassion and efficacy.
It's also horribly authoritarian, and would likely discourage people from seeking preventative health care, just because the nurses weigh you at your office visit. Think about the potential unintended consequences before firing off a glib, "fix it with market incentives" proposal, paired with reasoning by [car] analogy.