Obesity Trends in the U.S.
hsph.harvard.edu
hsph.harvard.edu
It's really shocking how quickly Americans' weights increased. The map also shows the increases are usually more pronounced in the South and Midwest first, then spread to the coasts (skipping over Colorado, of course)
A poor diet over a year or two will do it without trying.
We can see this clearly in China. The older generation seems to have some resistance to junk food in terms of weight gain: this is why asians have a reputation for remaining slim, even if they eat junk food. But, it's not due to their genes: they were simply lucky enough to not be introduced to those bad foods until their adulthood.
If you look at the newest generation in China in the cities, their obesity rate is skyrocketing at an extremely high rate.
How so? Growing children can probably handle a lot more junk food and sugar without any consequences than adults.
I know some people who just hate exercise. I think they has no habit of movement of any sort. Likewise, people who were fat or weak as a child have no baseline sense of what it feels to be healthy - and neither do their bodies cells.
So kids can handle more sugar, but if messed up the consequences are worse.
Focusing on kids, because that's where I've got the clearest reference for making my own comparisons: 30 years ago, kids in my neighborhood spent most their time running around outdoors. I'm not even sure everyone's parents knew where they were half the time, and it was fine as long as you made it home for dinner. Nowadays, kids seem to spend most their time playing Minecraft or Fortnite or whatever. I don't see them often on the sidewalk unless they're headed to or from school, and the playgrounds are generally pretty quiet. Over the same time period, hours of TV watched per household is up by about 2 hours per day, and consumption of the Internet has gone from zero to whatever it is right now, so that's where I'm guessing all the kids have gone.
Definitely watched a lot of Nickelodeon and Cartoon Network too.
I really wouldn't point to modern video games as the blame, look more toward how the food has changed.
Anetdotal, but the majority of people I know eat like shit.
> The amount of fructose in the Standard American Diet (SAD) is a major culprit in obesity and obesity related diseases.
> The body metabolizes fructose differently than other carbohydrates. Fructose has become the default cheap carbohydrate additive for food, and it is found in nearly every packaged food in America. Human bodies have not evolved to handle these levels of fructose.
> The first corn syrup in the United States was produced in Buffalo, New York, in 1866. A major breakthrough occurred in 1967 with the patenting of an enzymatic process to convert dextrose to fructose, a 6 carbon sugar that is sweeter tasting than sucrose.
High fructose corn syrups was developed in the 1970s. Americans began producing starch sugar from cornstarch instead of potato starch. Its cheaper than table sugar.
In 1971, food scientist in Japan found a way to produce a cheaper sweetener from corn. HFCS began to appear in frozen foods to protect against freezer burn and in vending machine products to preserve taste.
In the 1980s, both Coke and Pepsi switched from a fifty-fifty blend of sugar and corn syrup to 100 percent high fructose corn syrup, saving them 20 percent in sweetener costs. [0]
[0] https://www.world-foodhistory.com/2011/04/history-of-high-fr...
I'm going to guess the "throwback" soda that came out a few years ago was probably almost entirely the result of corn prices rising due to ethanol production. (itself the result of government policy)
High fructose corn syrup is, from a nutritional standpoint, pretty much equivalent to table sugar. The most substantive difference between the two is a hydrogen bond that is easily broken by even fairly weak acids - it doesn't last long at all once it hits your stomach, so what actually hits your bloodstream is (typically) a 42/58 fructose/glucose mix for solid foods with HFCS, a 50/50 mix for table sugar, and a 55/45 mix for HFCS-sweetened beverages. Those numbers also imply that, unless you just guzzle soft drinks, the industry replacing sucrose with HFCS presumably actually tilts the fructose/glucose mix in your sugar intake away from fructose. And if you do guzzle soft drinks, blaming HFCS for your metabolic situation seems just a bit dissonant.
I think we should be looking first at the big picture: Overall calorie consumption over the past 50 years is way up. If you break that down, fat, having nearly doubled, comes in first, followed by complex carbohydrates (up by about 1/3), and sugar is comparatively a quite small portion of what's changed.
Over the same time period, caloric expenditure from physical activity has gone way down, too.
To me, that picture doesn't imply, "Nabisco changing the sugar they put in my Wheat Thins is ruining my health." It implies, "Driving my car to the supermarket and coming home with a back seat full of Wheat Thins is ruining my health."
FWIW, the word "additive" also has a tendency to be a bit of a weasel word in this context. The glycemic index for starches and sugars is typically about the same, and your metabolism doesn't care that the starches are typically considered the food itself while the little bit of sweetener that's added for flavor is just an additive.
Also the amount of glucose in you blood is highly regulated and the amount is 'less than you would assume'. Least as I understand. Probably consuming even moderate amounts of sugar sets off a desperate attempt by the body to stash glucose as fat to keep glucose blood levels normal.
My first would be that a lot of it is that increases in the availability of vegetable fats that are solid at room temperature (originally thanks to hydrogenation, now thanks to more refined palm and coconut oils) means that it's easy for food manufacturers to add more fat to packaged foods without them seeming greasy.
There's also the whole "Mediterranean diet" thing fueling the perception that olive oil is a health food and making us feel comfortable drizzling it all over everything we eat. It's perhaps relatively healthy compared to other fats, but it's still darn near the most calorie-dense food possible.
I wouldn't be at all surprised if the amount of french fries that get piled on one's plate as a side at restaurants has doubled over the past 50 years.
Heck, even avocado toast. Avocados are way more available than they used to be. Everyone thinks of them as a healthy food, but they're chock full of fat.
The glycemic index is problematic for lots of reasons. If by "a little bit of sweetener" you're referring to HFCS in packaged foods, I disagree. HFCS prevalence seems much much larger than that.
You're right on that sucrose (table sugar) is not much different than HFCS.
Fructose != starches. The body metabolizes the two differently (See below).
A bit of knowledge about fructose rumbling around my brain...
1) Fructose is metabolized differently than glucose. All fructose has to be metabolized by the liver and go through the portal vein. This is not the case for glucose or other non-fructose carbohydrates.
2) Metabolizing fructose via the liver, especially in excess leads to fatty liver. Think foie gras but in humans. Non-alocholic fatty liver disease is now a huge thing, happening even in children. In prior decades if you saw a fatty liver it was because the person was an alcoholic.
3) Fructose is unique in that it short-circuits your bodies methods of letting you know you are full and to stop eating.
Human bodies, metabolism, and our food supplies are all complex dynamic systems so, it's unlikely that one single thing can answer the obesity epidemic.
Nonetheless, if I had to pick one place to start, I'd begin at fructose and see what kind of web is woven around it.
Two places to check out if you're interested in some of what has informed my thinking.
1) Dr. Rick Johnson--seems to know more about fructose than anyone else https://peterattiamd.com/rickjohnson/
2) Dr. Robert Lustig--sees himself as a public advocate so have to wade through some of that to get to his ideas: http://sugarscience.ucsf.edu/robert-h.-lustig.html https://robertlustig.com/ https://peterattiamd.com/roblustig/
Here's a good satirical paper aimed at illustrating the dangers of trying to extrapolate large-scale effects from a constellation of individual metabolic effects: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001541/
A++ exchange, would converse with again.
Our World in Data can show the change from 1975 to today.
https://ourworldindata.org/obesity
So it's more than just a US thing attributable to any particular US policies.
> Of all high income countries, the United States has the highest rates of overweight and obesity, with fully a third of the population obese-a rate projected to rise to around 50 percent by 2030.
https://www.hsph.harvard.edu/obesity-prevention-source/obesi...
It talks about unhealthy food habits, lack of exercise etc. There is probably solid science behind it, but my gut feeling is that there is something missing. I mean people have been eating beef steaks and gobbled sweets in front of TVs for ages now haven't they?
I could be wrong.
I suppose a good example of this is to look at asians who have a traditional diet - they sit around as much as the westerners but are still predominantly thin, though you can tell who's adopted a western diet.
For example, we do not really fully understand the role of biochemical stress hormones, and weight gain. Or how exactly insulin, leptin, cortisol, inflammation markers (eg: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155060/) all interact. Note that leptin is created in adipose tissue, potentially suggesting a cycle - and this is something borne out in experience, it is harder to lose weight the more you have to lose. Definitely an area of research to learn more.
The epidemiological approaches reveal interesting things, but there are a lot of variables, hidden and not, that is pointing that the advice accumulated from these studies is not really having the impact we want.
After all, the current advice is "hey do this thing that is very hard for you to commit to, and has uneven outcomes". Some research even references 'the big loser' because of the inability of people to maintain weight losses.
Typically discussions about this devolve very quickly into coded (and not so coded!) shaming. "unhealthy food habits"? How about "unaffordable healthy food" or "habit forming unhealthy food"? Why not that framing? Go to any average 7-11 and enumerate the list of products that aren't designed to generate "repeat customers". Bananas (in-so-far as they are sold) and water are the only ones I can come up with. Non-edible items not eligible.
For me, the local 7-11 and/or liquor store is enemy number one, lately Starbucks is number two, and it's taken long term thinking about habit manipulation to fight it off. And it's something you have to fight, or just be lucky enough to avoid -- in the modern world you might be default alive but you're not default healthy.
Depressed people eat less; people with anxiety have higher metabolisms due to constant adrenal activation; people with ADD fidget more (= non-exercise activity thermogenesis). People treated for these conditions all gain weight as a result. It's enough to create a pretty big statistical bump.
Everyone who quit smoking in my family replaced it with food (except for one, who replaced it with alcohol, and then later replaced alcohol with food when they realized they were becoming an alcoholic). Instead of reaching for a cigarette they reached for a snack.
It hit my grandparents the hardest because they quit smoking in the late 80s when there was also a war on coffee/caffeine with wild studies blaming it for a ton of health problems.
Boom - they lost two appetite suppressants in one fell swoop.
I am not advocating for smoking, which has worse or comparable health effects to obesity, but I do think it is a factor in a multi-factor phenomena.
https://www.pewresearch.org/wp-content/uploads/2014/04/FT_14...
https://youtube.com/watch?v=tAAAbwEtZRo
/s
> I belong here completely. In our time, I was a freak. Today, I'm an amateur.
[1] Briefly, in the movie H.G. Wells actually builds the time machine. Jack steals it to escape capture coming to our time. Wells, fearing he was unleashed a monster on what he expects to be utopia follows (the machine had been set to automatically return when Jack stole it).
Almost everyone over 30 has some level of gut now, even those considered comparatively fit and thin. This wasn’t normal decades ago, but is normal now.
How often do you see people shirtless? Clothes hide a lot of bellies. Having muscles, being a jogger, eating salads or riding s bicycle is completely consistent with abdominal fat.
So, what standard are you using when you say urban people now are likely thinner than rural people in 1990?
When you sit 9 hours a day you need to hit the gym or diet. When I was waiting tables and bartending in college (and a lil after) I didn't need to workout -- a doubleshift on my feet kept me very lean.
When you have money and a real need for activity then yeah the gym lifestyle becomes a thing.
Clearly 20-30 years is not enough for genetics to play in so what is going on? I know we blame fast food and sugars or possibly even fats a lot, but I feel like a lot of those have existed.
Unless it's some sort of epigenetic factors changing genetic expression?
It's a possibility considering our animals are also getting fatter [1], including lab animals, whose diet is controlled and has not changed.
[1] https://www.theatlantic.com/national/archive/2013/10/its-not...
In recent years, he's suddenly treating hypertension, high cholesterol, and type 2 diabetes in his pediatric patients. With few exceptions, these kids are morbidly obese. He says these things were unheard of fifteen years ago.
Let that sink in. High blood pressure, cholesterol, T2 diabetes in teens, pre-teens, and in some cases even younger. This. is. fucked. up.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2127317/pdf/928...
[1] https://www.nbcnews.com/politics/justice-department/californ...
[2] https://www.theguardian.com/commentisfree/2019/aug/08/monsan...
> There are a number of ways to measure body fat. Some are well suited to the doctor’s office, such as calculating a person’s BMI.
That seems to suggest a simple calculation given height and weight. That is not a proper way to measure BMI. BMI must be measured. Otherwise it simply is not a reflection of anything but an inaccurate calculation that doesn't apply to most people and overestimates the number of overweight and obese people. Yes there are a lot of overweight and obese people, but exaggerating the numbers by using inaccurate formulas and pretending like the numbers were measured instead of calculated doesn't do anyone any good.
Yes, body fat % might be a better metric to use, but BMI is fine for population-level statistics, which is what they're taking about here.
Now, many people argue that BMI is not a good measure of obesity, or health, since it does not account for percent body fat or other health metrics. That’s totally true. But BMI is BMI.
Yes, there are individuals for whom the BMI metric is spectacularly bad, a modest percentage for whom it is simply poor, but those people already know they aren't obese. At a population level, the BMI metric is just fine.