Researchers fear that vaccines might not be as effective in people who are obese | Hacker News Reader

Researchers fear that vaccines might not be as effective in people who are obese

nature.com

57 pointsfortran7768 comments

Even without COVID obese people are disadvantaged in about every aspect of life.

They die much younger than otherwise fit & healthy people. The extra layers of fat mean that their heart has to pump much harder than for a healthy person, essentially putting fat people at a much higher risk of several heart diseases as the heart muscle gets weaker much faster with age.

The extra layers of fat also have other negative side effects like putting more strain on blood vessels and increasing the risk of blood clots, strokes and many other secondary issues. There are literally so many health issues directly linked to obesity that I can't understand why so many people in developed countries care so little about their weight.

It's particularly surprising because physical exercise doesn't cost anything and healthy food is extremely cheap if one can be bothered to learn how to cook. I've been raised on extremely cheap but healthy food. We would buy 10kg of rice which was cheaper than a single Big Mac menu and cheap vegetables which could be cooked up with rice and a sauce. People claim that eating healthy is difficult when you're not rich but I can say from 1st hand experience that this is an ignorant statement to make. Buying prime grass fed beef is expensive, but that is not healthy. Eating beef or lamb 5x a week is actually unhealthy. Vegetables and rice is cheap everywhere.

If you think people don't care about their weight, you are misinformed. Different people gain and lose weight differently. It's that simple. If someone was bad at math, would you say "I don't understand why people care so little about learning math"? Of course not. And, the same with obesity, there are a lot of factors. I'm not saying that it is out of an individual's control, just that it is MUCH harder for some people than others. Some thin people may never give a second thought to how much they eat, while some overweight people may think about it constantly and struggle. Also, please keep in mind that the biggest problem obese face is the attitudes of others.

I will be shocked if we don't (soon) discover that there are environmental/chemical factors causing obesity beyond just food choice. For example: https://www.vox.com/2015/8/24/9194579/obesity-animals

One anecdata point in support of this: I've known more than a few trans people who started losing weight as soon as they got on HRT. Dysphoria causes a lot of stress and anxiety.

> I can't understand why so many people in developed countries care so little about their weight.

It's not about caring - almost nobody wants to be obese.

Most such people are in pain or depressed - usually both.

Also being overworked and thus sleep deprived is a major factor.

Food helps them cope.

Exercise boosts mental well-being as well though so food doesn’t have to be the only comfort that depressed people seek.

It does for some people, not for others.

I took up exercise during the pandemic shut in and I gotta say: I've heard enough people report that it vastly improved their mood that I believe them. But me? Nope. It's a chore every single time. Never gets easier; I just get better at dealing with the physical stress of it. Same pain and same exhaustion every time; none of that reported "runner's high" or "feeling of euphoria" other people seem to experience, and no particular change in mood week-to-week. The pain curve is flatter the more I do it (so I can go for longer periods of time before will gives out and I give a hearty "fuuuuuck THIS" to further running that day), but I still feel like crap every time I finish. I keep telling myself "It's not about feeling good; it's about being better."

The pain won't stop me, but it means it doesn't come for free.

That was also my experience until I mixed in THC and heroic amounts of mountain biking and racquetball.

For me, the conditioning had to be broken. I knew that other people enjoy working out. It didn’t make sense that I couldn’t. I came to feel that my body was lying to me, and it pissed me off.

Maybe it’s hard to boot up the endorphin process, or something. I don’t have a good explanation, but pure rage and good weed powered me through the barrier.

Absolutely. Exercise is also an activity you need to voluntarily commit to doing. The effects of mild/moderate/severe depression can make keeping up this commitment a challenge.

I know it's in my best interests to exercise and I know it makes me feel better when I do it, but when I'm feeling low it's also one of the last things I want to do.

I use the five minutes trick: "just five minutes on the treadmill", "just five minutes bench pressing, you can do it laying down!"

Usually I end up going for longer than five minutes and enjoying every one.

Not a real option for someone who's in pain.

> It's particularly surprising because physical exercise doesn't cost anything and healthy food is extremely cheap if one can be bothered to learn how to cook. I've been raised on extremely cheap but healthy food. We would buy 10kg of rice which was cheaper than a single Big Mac menu and cheap vegetables which could be cooked up with rice and a sauce. People claim that eating healthy is difficult when you're not rich but I can say from 1st hand experience that this is an ignorant statement to make. Buying prime grass fed beef is expensive, but that is not healthy. Eating beef or lamb 5x a week is actually unhealthy. Vegetables and rice is cheap everywhere.

Time is money.

The issue really isn't that you can't live for cheap. The issue is that living for cheap takes time.

It takes prep work to turn cheap vegetables into something edible. On the flip side, a can of spaghetti-os just requires reheating. A box of mac and cheese requires milk and butter and 15 minutes. A bag of potato chips takes 0 time to open. Most microwave dinners are similarly unhealthy but convenient.

Then there is also the problem with culture. If you are poor and spent your whole life raised on mac and cheese + hamburger helper, guess what you are likely to reach for when it comes time to feed yourself in the future? It takes active work to move from an unhealthy diet to a healthy one.

Then comes the education problem. It's hard enough figuring out what a "healthy" diet is even with internet access. You'll find a bunch of fad diets which push for, frankly, super unhealthy foods based on pseudo-science. Sure, the healthiest diet is a vegetarian diet based primarily on vegetables. Good luck convincing people of that. Especially when their reiki master is telling them that banana and pineapple smoothies will unblock their chakras.

In short, health eating requires that you. A) know what it is B) have the time to do it and C) you know how to prep it. Poor folk are often disadvantaged in all these categories.

https://healthyeating.sfgate.com/eating-habits-lowincome-pop...

You can get a bag of pre-cut frozen vegetables for a dollar or so, and rice takes about as long as mac and cheese to cook. Eating microwave frozen foods is far more expensive than eating rice and vegetables. I'd say your education and habit arguments are more compelling explanations.

Many fruits can be eaten without preparation. You can buy a bag of frozen sliced veggies that just needs frying. Lettuce can be prepared by ripping handfuls straight from the head onto your plate.

On the other hand, eating less saves time. For example, skipping lunch saves time on shopping, preparing and eating. It requires no skill or knowledge to skip lunch. Skipping lunch saves money.

>Time is money.

>The issue really isn't that you can't live for cheap. The issue is that living for cheap takes time.

>It takes prep work to turn cheap vegetables into something edible

The thing is, it saves money and time. I've been working late so I started getting into the habit of ordering food most nights for the last month or so. It was costing me $30-40/night.

The last couple weekends I actually put the effort in to make some things that'll last the week.

For $40 worth of vegetables and meat I made meals that lasted me most of the week, that were by far healthier than what I was ordering and cost me significantly less.

Learning to cook well does take time. But it's easier than ever to learn now. Anything you ever want to make has a recipe available online somewhere and I have to say, if you can program a computer, you can learn to follow a recipe.

Once you can follow recipes well and make them taste good, you start to learn what flavours different ingredients add to food and how things cook you can start to step away from the recipes.

Most cooking really just comes down to using the correct heat and putting things in in the correct order at the right time. Once you get that down, you can make anything.

>Then comes the education problem. It's hard enough figuring out what a "healthy" diet is even with internet access

Forget that shit, healthy diets blah blah. You need some protein, you need some fats, the vitamins and minerals and stuff in vegetables, some fiber.

Basically, you want to eat the stuff our bodies are made of and avoid things it's not made of. If it doesn't have some function in our cellular processes, it's garbage. Avoid processed stuff, stuff full of chemicals and additives.

Obviously, it's tough to avoid all stuff like that, but minimizing that stuff and eating things that come directly from plants or animals goes a long way to improving your health.

> Basically, you want to eat the stuff our bodies are made of and avoid things it's not made of. If it doesn't have some function in our cellular processes, it's garbage. Avoid processed stuff, stuff full of chemicals and additives.

Avoiding "chemicals" is impossible and needs to be stricken from nutritional parlance. It's a useless statement. Everything is "chemicals".

Beyond that, the fact is that your body can process a BUNCH of stuff. A bunch of stuff has function in our cellular processes. For example, Sucrose is used all over the place in our bodies. It is even highly biologically available. That doesn't mean that drinking pure sugar water is healthy.

In fact, one thing that our body can't process or use at the cellular level is fiber, yet you advocate that we consume it.

This is exactly the sort of statement I'm talking about when I talk about it being hard for people to grasp dietary health guidelines. It is filled with pseudo-scientific nonsense.

Sorry to come down harshly. If you want to disprove it, then fill free to give me a definition of "chemicals" or "cellular processes" that doesn't make sugar water a health drink. Please link to any sort of scientific study that uses the terms you just used. Please avoid linking to blog posts or youtube videos of quacks.

You grew up eating healthy food. If left to your own devices you probably maintain a healthy diet, regular exercise, and stay at a healthy weight. Whether it's a condition of genetics, environment, or both you're privileged to have an easy time maintaining your weight; it's not that simple for many people. Especially in first world countries where unhealthy food is cheap, fast, widely available, and tastes better. Cooking veggies and rice requires a trip to the grocery store and cooking time and doesn't taste nearly as good as that Big Mac.

I lost about 70 pounds (~32kg) in 2 years through only diet. At the start when I just catalogued what I was eating I was eating about 4k calories a day. I ate more than the people around me, but not a huge amount and I rarely had stomach problems or felt "stuffed". That's just how much food my body wants to eat in a day. When I tried to eat less than that I would feel hungry. Religiously recording what I ate and planning ahead I managed to lose a lot of weight by staying to ~2k calories a day.

But if I stop recording food everyday? Within 2 months I'm at about 3k calories a day. At ~2k calories per day I spend most of my day feeling hungry. I have tried 1-2 large meals a day, or 5-6 small "snack" sized meals a day with no change. My natural preference is to eat a lot of high-fat and high-carb food that is calorically dense and if I don't actively work to curb that tendency then I start putting on weight. For me to be healthy requires constant, daily, effort on my part. It will never be easy. I can never relax on my diet.

Everyone is different, but it is not that we don't care or that we don't try, it's that it takes a lot of concerted effort to be healthy for some people. Like anything that requires willpower (quitting cigarettes, cutting back on booze or weed, quitting video games or porn or really any unhealthy mental addiction, going to work everyday, staying in a committed relationship, etc.) for some people it's trivial and for other's it requires concentration, motivation, and hard work and despite all of that we still fail much of the time. Controlling your weight means controlling those urges forever for some people.

I lack the willpower myself. If I have a bag of chips, I gonna empty that in 5 minutes. Was rapidly climbing weight 7 years ago.

What helped me stay lean without the need of willpower are these rules:

* just drink water, tee, coffee without sugar

* max 2 meals a day

* 2 meals a week have to be salad (lettuce , eggs, tomatoes; dressing just oil, vinegar, mustard)

* 1 meal a day has to contain veggies (I often just add frozen carrots or broccoli)

* don't buy any snacks

Helped me stay at 25 bmi for the last 5 years without ever feeling like I have to starve or needing to count calories.

It is essentially a mental issue.

Food is addictive. It is the mother of all addictive substances, for good reasons. Refined sugar and rich food particularly so, pure energy, exactly what our body needs to stay alive.

What changed is that what was originally rare, high value food sources are now abundant, and we didn't have time to adapt.

The same could be said about alcohol and tobacco. Why do so many people in developed countries drink and smoke when we all know it is bad?

People care, they just can't help it.

>They die much younger than otherwise fit & healthy people

Not really. Life expectancy is only diminished by a few years for obesity. Much less than smoking.

https://www.theglobeandmail.com/life/obesity-cuts-life-span-...

>For example, a 20-year-old white male who, at age 20, weighs 200 pounds (90 kilograms), can expect to live one year less than if he weighed 185 pounds (83 kilograms). At 250 pounds (113 kilograms), his life expectancy falls by three years, and at 300 pounds (135 kilograms) by seven years.

250-pound person is not small by any stretch yet a 3-year reduction of life expectancy is just 3.7% reduction of an 80-year lifespan. I would not consider a 4% reduction to be much.

It only becomes dramatic if we're talking BMIs above 45.

Obesity is a spectrum. Belly fat is obesity but so is being so overweight that you cannot move. We cannot just lump it all together.

The thing is, a 3-year life expectancy loss doesn't usually mean "you just cut off the last 3 years of your life." In many (or most) cases, your years of healthy life adjust downward accordingly.

At 27, you have the same medical problems and quality-of-life degradations a healthy person gets at 30. At 55, you're a 58 year old.

It's really easy to look at a number like that and think "Yeah, I'd be happy to lose the 80-83 bracket". But effectively it's the 20-23 range of healthy, happy life you've cut out. And that IS a big difference.

But this is sorta moving goalposts. We're talking about years of life, not quality of life. That is important too but the claim that obese people die at a significantly earlier age than non-obese people is not supported by evidence.

I would argue that "Quality Years of Life" is what 80% of people (both as individuals and as policymakers) would optimize for, if given a good metric and perfect information, and that "crude life expectancy" is only commonly used because it is so easy to non-controversially measure.

So IMO it's not really moving the goalposts as much as "reminding us of what the actual goalposts are."

I think it is even worse than that! A healthy 30 year old is going to have a much better quality of life than an obese 20 year old. They will be able to climb stairs, walk without getting winded, have more energy, look better ect.

You should be looking at this lifespan reduction in terms of mortality rate. It is not a median three years’ reduction so much as a small, significant chance of life ending decades early.

3 year lifespan reduction is very significant.

Especially if you extrapolate and assume that there would be, on average, more health problems to accompany those later years of life.

>It's particularly surprising because physical exercise doesn't cost anything and healthy food is extremely cheap if one can be bothered to learn how to cook.

Time and energy are finite resources and an abundance of them correlates with an abundance of other resources like money. Being healthy is certainly possible without money, but it tends to be more difficult to achieve.

> It's particularly surprising because physical exercise doesn't cost anything and healthy food is extremely cheap if one can be bothered to learn how to cook.

It is conceptually easy, but I can assure you from personal experience that losing and keeping off significant weight is extremely difficult for some of us. I feel like I am in a state of constant war against my body and the part of my mind that thinks it is going to starve to death. I'm sure a dozen diet-cult people will come out of the woodwork to explain to me how I just need to never eat carbs or only eat within an 8 hour window and all my problems will be solved as though I never tried any of those things in the decade or so I've been doing this, but it isn't true.

> the part of my mind that thinks it is going to starve to death.

That's not your mind, it's your expanded stomach, and the extra space sends a signal that you're not full. If you allow your stomach to contract, you will feel full from less food. Some people accomplish this by mechanically shrinking their stomach (gastric bypass surgery) but it is a natural process.

Basically, eat enough food to provide the energy you need. Nothing more. It's far less than you think, especially with fat reserves. Your stomach will adjust.

Competitive eaters do the opposite: They deliberately expand their stomachs to fit more (of course), and so that they don't feel full when competing.

Downvoter person, read more about stomach elasticity if you don't believe me.

I'm really sick of people on the internet with no expertise whatsoever in a related field trying to tell me, a man who's lost >150lbs, how to do weight loss. If my stomach was going to shrink, and if that process was going to have any significant effect on my desire to eat, wouldn't it have done so by now?

Your first-hand experience isn't universally applicable. Many people live in food deserts or don't have access to reliable cooking facilities. And physical exercise costs time, which for many is lost to long commutes.

As you indicate, though, healthy food isn't intrinsically expensive. That means it shouldn't be an intractable problem.

This factual news story, from the very respected _Nature_, is such a taboo subject that it was quickly flagged and kicked off the front page.

Your advice doesn't work for everyone. For example, I cut out red meat from my diet and ended up gaining weight. Later, I brought back meat and cut out rice (and other carbs). I got back down to ideal weight, while improving my cholesterol and triglycerides.

From a societal level I agree that there are a lot of reasons why obesity has exploded and these are not the fault of individuals.

From an individual perspective, I encourage people to find out what works for them to maintain a healthy weight. From a high level calories in vs calories out. It is difficult with our sedentary lifestyles and processed food but it can be done! Personally exercising portion control and tracking what I eat is difficult for me. I found that doing a lot of aerobic exercise is my best strategy. If you run for 20 miles a week, you have to try to gain weight! Also not keeping unhealthy food in the house is huge. For most people though, portion control is more important than exercise. Family members who have lost weight don't exercise as much as me, but they weigh and watch what they eat very carefully.

One thing I was surprised with during this pandemic is how much weight I lost from not eating processed food. I ate the same amount of food but cooked myself and healthier. I lost almost 10 lbs just by not eating processed food. It's quite scary to think how our diet in America leans so heavy to processed food (deli meat, our bread has sugar, etc). I highly recommend what others are mentioning to eat frozen veggies and chicken breast that are super easy to meal prep and cost effective (Costco sell these at ridiculously low price). It won't be as fast as calorie counting but cutting 50 calories a day for two years can cut 15 lbs.

Sucks for gluttons like me, but I only have myself to blame.

> I only have myself to blame.

I disagree. I think it's safe to say that food producers who make the highly processed addictive crap that passes for food today bear some responsibility. And the people who willingly peddled bad science or 'facts' to try and make things such as sugar look healthy and fat look bad. Personal responsibility only gets you so far when you have limited choices and bad information.

I think I'd know better than you. Huge bowls of pasta I made myself, for myself, are undoubtedly the problem, as is my delusion that a large pizza is a personal sized pizza. Would you have me blame Barilla for making perfectly ordinary pasta, which I choose to over-consume? If barilla didn't make it, I'd make it for myself. An egg and 100 grams of flour, or in my case, more like 4 eggs and 400 grams of flour.

You might think you're doing me a favor by trying to offer me scape goats, but you're not. If there is any chance of me ever losing the weight, it will be through my acknowledgement of my behavior, not blaming others for my personal problems.

You do you. But if you think your own willpower is the sole problem, you're just going to stay fat the rest of your life. Knowing the game being played with food is really important to winning the war.

Just like I replied to the other guy, I didn't say your own choices weren't partly responsible, but I heartily disagree that it's solely your own fault. The corporations designing food these days are using science to ensure you stay fat. We should push back against that.

Well I've lost 30lbs in the past two years, but I don't think blaming others will help with the remaining 35 it would take to get me under 25 BMI (I'm presently a hair over 30.) Cajoling myself to reign in on my portion size seems more likely to continue working than adopting a victim mentality, but you do you I guess.

I think it's great to lose weight. I'm down 43 since the start of lockdown, and I'd like to lose a few more. So I know what a pain in the ass it is. I'm also not under any illusion that my own choices aren't huge factors in the weight gain to begin with. But man, the way food is constructed today is practically criminal. You can get fat off apples now. The amount of sugar in everything is absurd.

Yes, people still put that in their mouth and therefore bear some responsibility, but I think it's fair to say that the industry tries to obfuscate it so people can't really understand what they're eating. How many different ingredient names are there for sugar? A dozen?

I do firmly believe relying on willpower is a unlikely strategy to win. Something like 95% of all people who try it that way gain it all back in less than 5 years. Habit is my best weapon. But finding foods that aren't constructed from terrible ingredients is super important, because I don't make all my meals from scratch.

Good luck, in any case.

> Cajoling myself to reign in on my portion size seems more likely to continue working than adopting a victim mentality, but you do you I guess.

This is the first step, and I commend you! Yes, there are some things outside one's control - genetics guarantees we'll never be as tall as a giraffe, and fast/processed food (plus the advertising for such) is suffused throughout our society. You can still get to a healthy weight. I know, because I used to be fat, but I lost the weight and I feel better than ever.

I disagree with this and tend to agree with OP. Yes, food companies make crap food, but you don’t have to eat it. You don’t need to eat the volume of it most people do. We’ve known it’s crap food for years now. However, you can have 1 cupcake or 1 pizza every now and then and be a healthy weight. You can’t have 10 cupcakes a day and be a healthy weight.

Let’s not discount exercise as well - a bad diet can partly be overcome with an active lifestyle.

I didn't say personal responsibility didn't play any part, just that it's not the only part. Obesity is not a simple moral failing, we could hold our own society to better standards and everybody would be healthier. Half the population didn't get fat just because they're all lazy.

It might surprise people that in the last 150 years people are actually doing more exercise than they ever have before with a lot more science behind what they do for better results. Even with that as the backdrop obesity has shot up. It is not just lazy people, it is bad food and the science that says its great that underpins it all.

> You don’t need to eat the volume of it most people do

The push for food companies to remove fat and replace with sugar would contribute. Fat will make you feel full. Everything is low fat and uses high fructose corn syrup to make it taste good.

> Everything is low fat and uses high fructose corn syrup to make it taste good.

No, all the crap food fits that description. A chicken breast and some broccoli does not.

Again, it’s a decision that must be made - eat crap food and struggle with a healthy weight, eat healthy real food and proper portions and (usually) be a healthy weight.

I don't think it's so simple. No one gorges on broccoli. It's filled with fiber, another thing that will fill you up.

Sugar in foods also trigger a feel good response from dopamine. It's addictive.

Education about healthy eating is important, but sugar is a problem.

If you are trying to lose it, getting past the leptin response is the hardest part, but it can also be a turning point.

Yeah as much as an alcoholic or other addict. There are definitely genetic predispositions to overeating as well.

Definitely. And it's not just overeating. There are a range of processes that vary between people. Like ability to store fat, ability to burn that fat, feeling hungry or full, etc.

I absolutely don't mean this in a snide way, but given your username, it seems like you've totally internalized that as your identity. Do you feel there's opportunities to change that first? (Perhaps I'm being overly presumptuous, and if so, my apologies)

I anticipated somebody would mention this, it's a fair point and I don't mind you asking. Mild self-deprecation is a tool I use to combat self-delusion. I've lost some weight but still have more to lose. The name also somewhat reflects the way I perceive myself as an outsider in this industry; 'big bubba' sounds like a nickname for a long-haul trucker, not a west coast programmer (which I am, but have never really felt comfortable as.)

It is not entirely the fault of each overweight individual, as genetics and gut microbiome play a role too.

Anecdote: My eating habits are significantly worse than those of an overweight friend of mine and I'm of slim/average built.

My hypothesis is that it's people not cooking their own meals. I call it the Two-income Diet (or Elizabeth Warren Diet, if I want to impress people).

Fallacy #1: America has shitty food.

America had god-tier shitty food in the 70s and 80s, to the points where immigrants here with means baked their own bread and everything because it was so bad. Fast forward to the 80s and 90s and you had the beginnings of the farmers markets across the west coast, and now you can buy high quality food for not that much money. Sure, people eat badly, but people don't realize how shitty food used to be. If American food was so much worse then, one would expect people to have been fatter.

Fallacy #2: It's all about portion size.

Portion sizes are large, yes, but they were already big. I remember going to Red Robin in the 90s in high school and having eating competitions, and even then our champions could only do 20 or so coke refills and 5 burgers.

Fallacy #3: Americans don't know how to cook now.

This assumes Americans knew how to cook at some point in the past. Not true. Besides horrific ingredients, people were literally just tossing together cans of shit when my mother moved to the US, much to her horror.

My hypothesis: People don't prepare their own food.

I don't have any data for this, but I think that people are basically not preparing their own food. No matter how bad the shit in can is, it's better than the same shit plus 20mg sodium plus 4 tsp butter in a restaurant. And takeout food looks even worse, literally swimming in oil. Or at a fast food place.

Furthermore, I bet that one could directly tie this into the 1) entry of women in the workforce and 2) more people living alone, where there is less time to prepare a meal that even in the worst case is twice as healthy as prepared food from an external source.

The can matters to. A can of Tomatoes is different from a can of Spaghetti-Os. A can of beans is different from a can of bean soup.

I want to highlight that in the comments so far, every-time someone mentions what it takes to avoid obesity or how they themselves are responsible for their own obesity a large group of people come out and explain how obesity is unavoidable and you don't have control over what you put in your mouth and swallow.

It takes zero effort to explain why you can't do something. There are no shortages of people telling us every day why everything sucks. It's the cheap answer.

If you are still reading, how about taking the tact that if you are going to tell someone why their idea doesn't work you are obligated to provide some solutions as well?

Obesity affects a lot of pharmacological responses. A list can be found here:

https://derangedphysiology.com/main/cicm-primary-exam/requir...

Obesity is a triple whammy when it comes to COVID-19. Besides the vaccine impacts, it also directly increases the risk of a bad outcome and it contributes to other chronic diseases that are also risk factors.

https://doi.org/10.1016/j.metabol.2020.154373

It was also identified very early on in the pandemic as a risk factor. It would be interesting to see if the negative effects are mitigated once a person loses the weight.

Trump had all the risk factors but recovered quickly, although this is just a single datapoint and he had the best care in the world.

He shows some breathing struggle in his last videos and is not still fully orange [1]. I would not say that is recovered yet.

[1] This seems silly but it has a logical explanation. You can't spot symptoms of liver failure (yellow skin) in people while they wear orange make-up. The make-up would mask it. I bet that his physicians forbid him to use yellow dyes for a while so they can check early for changes in the skin color.

We don’t know for sure if he had it in the first place

Since the comments here seem to have taken a turn of "How to fix obesity"; for anyone reading this article who wants to lose weight I would strongly recommend The Hacker's Diet. Especially if you're a developer or in IT the book may appeal to you as it's written by an IT person who approached weight loss as a technical problem. I lost 70lb in 2 years thanks to this book. The fulltext can be found here:

https://www.fourmilab.ch/hackdiet/

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