More than 73% of American adults are overweight or obese | Hacker News Reader

More than 73% of American adults are overweight or obese

diabetes.co.uk

I mean, duh?

Eating makes you feel good. It releases all kinds of feel-good chemicals in your body, and it just feels good to be, if not full, satiated. It's an activity chock-full of positive reinforcements.

Exercise, in contrast, is filled with various forms of pain (short and long term) and lots of tedium. If you're lucky, you get an endorphin rush to help offset these, but not everybody (and not every exercise regimen) provides these. It's an activity with lots of built-in negative reinforcements.

And dieting? Dieting is constantly saying "No" to the positive feelings associated with eating. A piece of Christmas fudge? No. A side of fries with your hamburger? No. A full rack of sauced BBQ ribs? No. Creamy dressing for your salad? No. Seconds? A whole lot of No.

It takes a lot of willpower and a long term goal to maintain a certain body shape to consistently - over the course of your entire lifetime - exercise more and eat less. And any mistake, any injury or illness which pushes you into obesity, and you're having to go even further into the "this doesn't make me feel good" category.

Throw in a continuing shift towards jobs which don’t burn thousands of calories every day (e.g. forced exercise, overhead for increased caloric intake), and the availability of cheap meals with lots of calories, and boom. Obesity.

Everything you said it true, but why isn't it such a big percentage in other developed countries?

As pointed out by others, this is happening in other developed countries as well, it’s just lagging behind the US.

Personally, I largely blame our learned culture of referencing “children in Africa”. Want to fuck up a child’s eating patterns for life? Force them to clean their plate.

Hu?

I grew up in France and I have always cleaned my plate as my mother told me. In my familly, it's the polite and sensitive way to eat. Same expectation when visiting friends. Really few are overweight.

Since I moved to Japan, I learned that here too food is treated with the same deference : "you shall not let a grain of rice left in your bowl" is basic table decency. Few overweigh people here either.

Both France and Japan have their food recognized as UNESCO cultural world heritages. In both countries people LOVE to eat and hate to waste.

Maybe people should treat their food and themselves with respect and only put on the plate what they should and can eat?

Cleaning your plate when you decide how much to put on it is one thing, cleaning it when your parents decide is quite another and IMO harmful.

I've told my children that they should usually clean their plate. Not always, because noone's perfect, but if they make a mistake often it's time to think about what they put on that plate.

My grandfather would say "take all you'd like, but eat all you take" which had a similar "plate clearing" idea, but was also more responsible (likely due to growing up during the great depression).

The issue with the "children in africa" thing is that someone else is setting the portions for you, I think. Everywhere I go, meals are just too big! I feel silly only eating half of a meal, especially if I don't have the ability to save the rest for later.

Portion sizes, like everything else in America, are just bigger.

In this respect, Covid has been good for my family.

We wanted to try to help local restaurants, so we get take-out food 2 or 3 times a week. Since we're not eating in the restaurant, all the food stays at the house-- we get lots of leftovers!

I frequently tell the kids to order what they want, but eat all of it. (If not today, finish it tomorrow.)

The ironic thing is, the genetics that are making us unhealthy, are the exacts ones that made us healthy and able to survive when calories were scarce and intermittent.

Not everyone has that same feeling about food. And It's not something everyone's addicted to. I've mostly stopped consuming "regular food" in favor of Huel. Funnily enough it has made me appreciate the few meals i eat way more, since the rest of the meals are literally the same Huel Vanilla flavor.

Exercise makes you feel better long-term, even light exercise such as walking helps, where I would argue the negative reinforcement is low. People are just too busy "being controlled" by corporations feeding them the next dopamine kick. NFLX and FB mostly is my understanding.

I understand that It's easy to become obese in 2020 where you barely have to get out of the couch to get food, but i find it arcane how people can let it get so out of hand. It's happening slowly but steadily in Sweden too, my understanding is that bad food is cheaper in the US than here though, which makes us cook more overall.

Dieting doesn't necessarily have to mean saying no to tasty food, just eat a bit less of the bad stuff.

When i was a little kid my mother would give me 100$ a year if I didn't eat candy (what a deal!?). So i withheld completely (except on my Birthday and xmas) for ~5 years. Since then I don't have the craving for any candy or sweets. Takeaway being it is probably important how you're brought up. I find it exhausting to get my 2.2kcal that I'm supposed to consume daily.

> Exercise, in contrast, is filled with various forms of pain (short and long term) and lots of tedium.

No, I wholeheartedly disagree. I strive for some exercise, daily. I really really long for those hours of solitude into the mountain, the physical exertion too. The sweaty and cold days. What you are referring to is mechanical repetition inside a gym or something, because one can feel forced to "work out". Exercise can have any form and location. You can run, walk, swim, paddle a kayak or bike your way into nature and reap every benefit exercise has to give without feeling pain or tedium.

Sorry but you speak like someone who does not exercise a lot and thus perceives movement as a chore.

This.

I'm about to go out bicycling for about four hours. Have been looking forward to it all week. It's a bit of a chore until I get into the flow, or perhaps until the traffic light density recedes as I leave the city, then it's so good.

Yeah, he literally mentioned what you said in the comment:

> If you're lucky, you get an endorphin rush to help offset these

And if you're not, you don't get it no matter how hard you try. Did hardcore biking for the last two years (2+ hours every single day, 9-hour bike rides on some weekends), took a break, probably will continue in 2021, but not even once got any good feelings from it, just an endless chore.

A friend doesn't, from biking. He swims instead. Another friend plays a team sport, one which is utterly incomprehensible to me.

That was my point, sort of. One size does not fit all, but different forms of bodily exercise exist. I believe GP did not try to say so.

This varies by individual. For me, almost the only form of exercise that doesn’t induce lots of suffering is lindy hop. And that’s only when there’s an extremely cute gal on the other end. Otherwise, I’m like, “yeah, I’m good. Next song please be slower. I don’t need to sweat through my third shirt tonight.”

I’ve done the multi-hour bike rides. (Road and mountain) The ten hour long hikes in beautiful scenery. Kayaking from one beautiful island to another in Thailand. Didn’t like it. Never have. Likely never will. Unless there’s a hot girl I’m focused on, I will be focused on the pain.

If you’re arguing you need to be an iron man athlete to get to some magical point where you start enjoying exercise, maybe consider that that pool of people is self-selected. Those who enjoy exercise probably do it a lot and those who don’t enjoy it... might not.

It's short term culture at play.

Good diet and sport have non linear curves. It's bad the first 3 weeks, then suddenly it's "so" great.

I'm in a special situation but I couldn't eat fat/sugar/salt for a while. Forced me to eat veggies.. if you don't eat burgers or pringles and soda your tastes becomes finer. Diets are full of pleasure but they're subtle. And the food industry got away by saturating all the key sensors to make sure whatever you ingest will feel amazingly better.

These days I can eat more stuff but I almost don't feel the need, I know it's mostly artificial and very detrimental to my health long term (if you believe nutrition and medicine, they seem to hint at less is more)

The point that it's far worse in north America went literally over your head.

It's not out of reach to stay in shape and even have en entire population be mostly in shape. You don't even need discipline, what you need is an overall culture that it's "good" to be in shape, "bad" to eat crappy food (basically the opposite of the US), and people will naturally and almost unconsciously pay attention to the food they it all their life, starting by taking good habits when they are young.

Of course if your first thoughts are to look for "explanations" and "excuses" (which btw are the most bullshit I have ever seen on that subject, you could have at least talked at least about stress as an actual obesity factor in people's life) you will never get there..

If you're inclined to think of this as just an American problem, keep in mind that most western nations are following the same trajectory as the US -- they're just 10 to 15 years behind.

https://ourworldindata.org/grapher/share-of-adults-who-are-o...

Thank you! Here's a few more data points that I found useful:

Adult obesity by state over time: https://stateofchildhoodobesity.org/adult-obesity/ . MA, WA, and IL seem to have uniquely flatlined in the last 4 years. Most states have not.

Obesity in the US: https://en.wikipedia.org/wiki/Obesity_in_the_United_States#P...

Colorado, which has consistently had the lowest obesity rate of any state going back to 1990 (6.9%): https://www.denverpost.com/2018/09/12/colorado-least-obese-s...

This isn't surprising. We're conditioned to eat great tasting food and lots of it. Most American cities have a car-oriented culture, along with sedentary lifestyles; therefore, not much walking or NEAT (Non-exercise activity thermogenesis). It seems over the years, Americans are burning less calories, but consuming more.

I usually cook at home now, thanks to the Pandemic. Looking at all the recipes I found online, I realized how much high-calorie ingredients you have to add to make the food taste delicious. I try to limit those ingredient or use lower-calorie substitutes, but it is challenging. I can't imagine how much fats and sugars restaurants put in their foods to make it tasty for the general population.

Also, food portions have gotten bigger. We're used to eating more. Having a great tasting food filled with sugar or fats is not bad by itself, but eating a small portion of it won't be satisfying or satiating enough for most people.

There's a Youtube home cook named Ethan Chlebowski who sometimes does low-calorie versions of certain foods. I think more people need to do that--give great recipes that can taste almost as good as the high-calorie versions.

> I realized how much high-calorie ingredients you have to add to make the food taste delicious.

Is that not a trap? Most professional cooks who want to stand out use lots of salt and sugar, sometimes up to a point that I find it disgusting. I can imagine if you are used to that much salt and sugar, you need it again to taste anything. But believe me, you can unlearn it and start to taste the food itself, instead of the added salt and sugar.

I learned the rule that a cook that uses lots of salt and sugar is a bad cook.

I agree on the sugar aspect, but having been brought up firmly in the "salt is the devil" camp by my parents, it was an absolute revelation for me that the way you get rid of that hollow taste in food is by adding salt.

I used to always make dishes that had all the right ingredients to taste good, but just didn't. The thing they were missing was salt.

Sadly there are numerous substitutes for sugar but haven't found anything for salt.

> I realized how much high-calorie ingredients you have to add to make the food taste delicious

What are these ingredients? When I'm cooking the ingredients I tend to overuse to make things taste good are garlic, ginger, chilis, and sesame oil. I suppose sesame oil is high in calories, but you don't use much of it. Deliciousness can come from lots of places!

Mostly fats and carbs (sugars). A teaspoon of olive oil is about 40 calories. And most people use a lot more than they realize, especially when it requires sauteing. That can add up quick.

Also, using fattier cuts of meat compared to leaner cuts (chicken thighs vs breasts). Of course that's part of the "fat" equation.

Besides flavor, mouthfeel is part of what makes a food taste good. Fats usually provide good mouthfeel for the average people.

What I do to minimize the amount of calories I need to use is use non stick spray (near 0 calories for a splash of oil), leaner cuts of meat, and sugar substitutes like stevia.

If you give people a meatloaf using turkey, sugar free ketchup, no breadcrumbs, and minimal use of oil OR a meatloaf using 80/20 ground beef with bread crumbs and real ketchup, they'll probably pick the "unhealthier" meatloaf if the seasonings are equal.

I don't have evidence for this but my gut tells me that people are not getting fat off of olive oil, and in fact if they used more it would tend to offset a larger number of calories from other sources.

Olive oil is a fat. There is 120 calories for 1 tablespoon. Sure it’s healthy fat, but it still has a lot of calories. Butter actually has less calories per tablespoon than olive oil.

Nobody disputes olive oil's caloric content. It does seem like a stretch though to imply it has anything to do with the obesity crisis in the western world. Olive oil is not a recent introduction to our diets. Perhaps people are using much, much more - but that seems somewhat implausible, it doesn't actually taste that good by itself and I'd like to see something showing that the amount use to sauté the average unit of food has increased significantly in the past few decades. Either way, having tried/trying to gain weight I can confirm that olive oil is not particularly useful in that respect, it's easy to get ~80 calories with it but difficult to go beyond that. In a lot of cases you will not consume all the oil you used for frying or whatever anyway - so it is also misleading to imply that the volume used in cooking equals calories ingested, and unless you're cooking for yourself only, the amount needed to sauté e.g. onions is basically constant for 1-5 people, so you'd likely be consuming only a fraction.

Part of the issue is in training your taste. Yes, the super high calorie foods are always going to taste good. But that does not mean that the less caloric foods will not also taste just as good. My SO has a super restrictive diet (due to some pretty bad health reasons). My SO's taste has changed dramatically since being on the diet for some time. In that my SO can taste a single 'no-no' ingredient in just about any food item. I'm talking a single pepper-flake in ~4 hour roast. Things you may not think of as 'sweet', like broccoli or cabbage, are reported as near candy. It's taken a while, but the effects are real.

I think that issue is a big deal with the obese: taste. Their tastes have become so desensitized that only the umami bombs of Doritos will elicit a response. Similarly with fats and sugars, only the largest signals are now received.

Perhaps a way to deal with this is to just have the obese eat more, but of the 'good' stuff. To retrain their taste. Have a salad, a good one, and then eat dinner. Have an apple with breakfast, and then all the eggs and butter. Etc.

Fringeing overweight, it has taken me years to remove 10kg and keeping it off is a constant battle. I used to be as thin as a rake.

Folks, its a mostly one-way ratchet. If you put a one-way walk into any system, and let it run free, what direction do you think things will trend, even if the pace of movement is a crawl?

You can lose 10 kg in 20 days of not eating anything but electrolytes, so it's definitely not one-way ratchet. It's just difficult to do so. Once you eat anything with calories, you disrupt your 100% fat burn and it makes you totally miserable as the body switches over to energy preservation, while with 100% fat burn you feel plenty of energy.

When I weigh myself daily, I realize I can fluctuate over 5kg just depending on if I've shat, been fasting for 24 hours, and/or consumed much water that day.

I wouldn't start counting score until you have a few months of data to average.

All of those "lose 10 pounds in two weeks!" magazine programs just have you emptying your poop chute where you get immediate results. Because they never try to scale to 20 pounds in four weeks or 30 pounds in six weeks.

Those +/- 5kg are coming from the water inside, that's normal. I am talking about real fat burning. Think about it - if you don't eat at all, aren't you going to lose weight? Our ancestors often went through feast-famine cycles and survived, likely because they accumulated fat during feast periods and then spent it during famine periods. Our issue is that we are always in the feast period and can't allow body to enter the famine one. The first three days are usually the worst, then it feels normal (assuming you take your electrolytes).

I still remember driving through some small town in Arizona 10 years ago, and I couldn't find a single non-obese person there. Not just overweight, full on obese. Parents, kids, everyone. It was the one of the most bizarre experiences I've had, as a visitor. Cities are not that bad though, but I'm sure many rural parts are close to 100%.

I've only ever visited San Francisco in the US, and the first time I was there I was slightly surprised that in terms of obesity it seemed pretty similar to Dublin (which wouldn't be the thinnest city around, but is middle of the road European). Then I flew back via O'Hare, and really saw the difference when waiting for the transfer; quite dramatic levels of obesity.

I wonder how much of it is just down to urban Americans walking places, and rural and suburban Americans less so.

I did also notice that there was added sugar in virtually _everything_.

There are probably multiple factors, walking more and fewer time sitting in cars is quite possibly one of them. Urban areas also have more young people.

The added sugar in the US is a shame. Just this year, the nutritional labels are mandated to show added sugars in products now. I hope that helps.

Would showing added lead in baby formula help?

Kind of shocked how in the US an issue that is obviously a health issue is treated as a personal failing.

If you want sugar in your food you're free to add some after the fact, or buy it from a non-food store. Warning people that all the food they have access to is poison is not a solution to anything.

> Warning people that all the food they have access to is poison is not a solution to anything.

It sounds like you are suggesting all food in American grocery stores is equally bad when it comes to sugar. Perhaps I misunderstood you, as that is obviously absurd. While I do wish there were more healthy options, I can assure you that the mainstream grocery stores (Ralph's, Safeway, etc) contain many products with low or no sugar.

Empowering people to make better decisions is actually one of the best things we can do. What is your alternative proposal?

I read nutrition labels, looking at the sugar content. I eagerly await the requirement to list the amount of added sugar, as it will inform my food purchases.

>What is your alternative proposal?

Ban over the counter sale of processed food, the same way heroin stopped being sold as Mr. Jims Magical Cure All.

It's not like banning additives that have proven detrimental to health is a radical new idea. We have killed hundreds of industries that killed people before, most of them in much smaller numbers than the food industrial complex.

>Empowering people to make better decisions is actually one of the best things we can do.

Looking at the state of the US, it really isn't. Taking advice from Americans on food is like taking bathing advice from Catholics in 900AD.

What's the definition of processed food?

I think most people will think your proposal is very extreme.

>I think most people will think your proposal is very extreme.

As would most heroin addicts in 1890.

When 73% of your country is losing between 5 and 20 years of life expectancy drastic measures are in order.

We force people to wear seatbelts. We don't let them buy some drugs. We can make certain food illegal.

Post stomach cancer, I can't eat sugar without becoming ill. So I stopped. Regular fruits are now very sweet, and a chocolate bar is inedible.

> While I do wish there were more healthy options, I can assure you that the mainstream grocery stores (Ralph's, Safeway, etc) contain many products with low or no sugar.

What struck me as weird was the sugar in products where I'd never have expected to find it in the first place. In particular bread (most non-absurdly-expensive brands seemed to have added sugar, which would not normally be the case here).

In fact, an Irish court recently ruled that Subway 'bread' wasn't actually bread at all (important for VAT purposes here); too much added sugar.

I'm sure it is _possible_ to get food that doesn't have added sugar in the US, but it does seem to be the default to add sugar in some quite weird places.

Edit: One way to regulate this, less draconian than actually banning added sugar, would be to regulate naming (for instance, banning sale of a bread-like product with added sugar as bread).

> walking more

I remember how much everyone has to do some (or a lot) of walking in London, New York, and other cities where you use public transport to get around.

I suspect that daily walking makes a huge difference.

It’s all diet. I visited Nashville a couple of years ago and everything on the menu was fried or just terrible for you.

Most of weight is diet. Exercise helps a tiny amount but is more for your cardiovascular health and strength. Running for an hour burns far fewer calories than half of a muffin.

> running for an hour burns far fewer calories than in half a muffin

As a guy who runs pretty hard and weighs over 200 lbs, I burn nearly 1000 calories in an hour of running (~11km distance). I've tried a few different models to estimate this and they all more or less agree.

A lightweight person jogging at low intensity for an hour, maybe.

A Burger King Whopper with cheese, for example, has 710 calories. You would need to run 10km. Running and exercise is worthless. Don't eat the Whopper. Cancel the gym membership. Workouts cause calorie cravings - and most Americans will just eat processed garbage [ or unless you are super healthy - then you drink the "Mocha Mojo" from jamba juice 680 calories ].

> running and exercise is worthless

A bold claim indeed.

Not everyone who exercises is trying to lose weight.

It's a discussion about weight, so in context, that statement is completely valid.

Use an elliptical and it will show you exactly how many calories per minute you can burn.

For reference, Olympic athletes only manage to burn 30 calories per minutes at their best. I would put most people’s capacity at 10 to 15 calories per minute sustained.

https://www.nytimes.com/2018/02/23/sports/olympics/cross-cou...

> I burn nearly 1000 calories in an hour of running (~12km distance).

You get a lot more calories than you can physically burn in one day. A donut can be something like 500 kcal. Skipping on snacks is more much effective than exercising no matter how you look at it.

For losing weight, yes.

However AFAIK fit and moderately overweight is better for your health than unfit and skinny.

It's a thread about people being overweight. We are not talking about other benefits here.

> you get a lot more calories than you can physically burn in one day.

I don't know if I do, since my weight has been pretty constant for a few years. But I'm sure some people do. Are most people in a state of constantly increasing weight?

Exercise is certainly helpful once you start getting close to your ideal caloric intake. If at rest you'd burn ~2000 cal/day, and you're consuming ~2300 cal/day, then exercising for one hour, three days a week can certainly make a difference.

Most people that are actually overweight though, have a much higher surplus in their caloric intake. Strenuous exercise like running over 10km isn't possible for many of these folks... and even if it were, it certainly wouldn't be possible every day. Cutting out the 600cal breakfast sandwich in the morning or the 200cal soda every day at lunch will have a bigger impact for most folks and is a lot more feasible.

Yeah, eating less is probably the most important thing for people who want to lose weight. Not going to dispute that.

Just wanted to address the exaggeration/overgeneralization in GP comment.

Diet is the biggest part of it, no question, but calories are misleading. The number of calories you burn by running for an hour doesn't take into consideration the increase in metabolism that will follow for up to 48 hours or the calories that will be burned in the future by the extra muscle you build even while at rest.

I agree it is diet, I disagree that it "fried foods" that are the source

High Fructose based drinks like Soda, Mass produced Tea's, etc combined with decades of government "education" around the high carb diet is the main source of the Mid Wests Obesity problem

When you are drinking 1500-2000 calories a day, and eating mainly pasta / potato heavy meals that is going to kill your weight.

Fried Chicken is not the problem...

That's a good callout. The prevalence of sugar in the American diet is pretty insane.

Fried food doesn't help either ...

It's always 'diet' in a first order sense. The interesting question is why all the mechanisms broke that prevent diets from looking like this at a social level.

Input into the system is a big factor, but to maximize fat loss you also have to induce the system into expending prioritized fuel sources before it saps into fat reserves. And exercise probably induces that during but also after exercise too.

We stopped for burgers in a Texas McDonalds in a tiny town off the beaten path.

Every single person inside was obese. It was actually embarrassing trying to squeeze by people on my way to find the end of the line, and we decided to just have one person order the food instead of all three of us contributing to the awkwardness of the human body version of bumper cars. I'd never seen anything like it in my life.

Living in Austin, I would wonder where exactly this 73% of the population lived. But after that rest stop in McDonalds, it was obvious that they simply live everywhere between the urban centers.

Our society is failing its people tremendously and on so many levels.

That last sentence doesn't seem to follow. Why do you place the blame on "the society"?

Unhealthy food can be hard to avoid.

Sort of conflicts with the narrative that urban centers are being victimized by Dollar General and the like, contributing to ill-health for city dwellers.

IMHO, the problem is wide-spread. (No pun intended.)

Cities not being that overweight just means that rural areas are more than 73% overweight. That's the craziest thing to me. Low urban overweight numbers require the overweight areas to be 80+% to catch up.

I had spent some time in South America and flew back into the US via Miami. We were a red-eye and so got in pretty early in the morning for Miami. The part of South America we were in is somewhat known as a fit place as well.

That said, it was shocking coming back to the US to see how fat and tired everyone was. I remember one of the TSA people who was just enormous. Literally wider than tall. Having been out of the culture for so long, I was a bit stunned at the size of that person and most of my countrymen too. I remember think to myself: how did this happen, how did we allow it to get so bad? That, and for being on a red-eye, most of the people in the US were more tired looking than the people that just got off the plane.

The combination of fatness and exhaustion was, obviously, quite memorable.

My big question is then: What is this doing to our society? Sure these changes must reflect in our education system just as they are reflected in our food system. Where else do they reflect? How have our politics been effected?

I think everyone working in tech knows that sometimes simplistic solutions handle the vast majority of cases. The people who are muscular athletes are probably not worried about their BMI, but if they are, they can discuss with their doctors.

Is "healthy at every size" still a fringe movement, or is it gaining more social acceptance?

"Body positivity" is -- inadvertently for the most part -- insidious. Of course, don't make fun of overweight people for being overweight, don't be an asshole. However, making people people believe that they can eat whatever they want, can be obese and still healthy doesn't help at all. It might make you feel nice, but it is very destructive and unhelpful in the long run.

> but it is very destructive and unhelpful in the long run.

If the United States ever moves to a public-funded healthcare regime, it will also be more expensive and destructive to care for from a government budget perspective.

False!

Unhealthy people are great for saving money. Health care costs are disproportionately skewed towards end of life care. People who are unhealthy die younger and more quickly.

Edit: Here you go. https://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748...

Assuming the healthcare issues resulting from being overweight result in a sudden death.

Considering they result in chronic conditions such as diabetes and hypertension and require things like heart bypass surgeries, I doubt it.

After 20 years of avoidable diabetes.

Obesity is strongly correlated with chronic healthcare issues (stroke, coronary artery disease, cardiac issues, diabetes, cancer, etc) and poor health outcomes overall. This has partially been directly linked back to signaling from adipose tissue. Being fat is unhealthy; this has been known for awhile; full stop. We can absolutely expect an aging, obese population to contribute to increased healthcare costs.

Additionally, while end of life care for the elderly is one significant contributor to health care costs, managing patients with multiple chronic healthcare conditions actually is the single largest cause of healthcare spend. If we want to be blunt, your assumptions are wrong: Fat people typically don't die suddenly while young, they die slowly after battling chronic disease, and they rack up costs while doing so.

Nonsense. You just move the years of suffering and high health care expenses to a younger age.

But you still have less years overall of high health care expenses, don't you?

I’m sorry but you can’t just make broad sweeping claims like this with literally zero supporting logic or evidence:

> However, making people people believe that they can eat whatever they want, can be obese and still healthy doesn't help at all... it is very destructive and unhelpful in the long run.

First of all, I can’t think of a single body positivity activist who says “you can eat whatever and you’ll still be healthy.” It doesn’t really help your argument when the first target is a preposterous strawman!

More to the point: body positive ideologies might be damaging in the long run. But it might not be! You have absolutely no evidence either way - nor could you, even in principle! - and it’s extremely irritating to see such strongly-stated ignorance.

One of the major impetuses for the body positivity movement is the incredible danger of anorexia nervosa, which is the most lethal mental illness and has been spiking dramatically since the 80s. And as an unambiguously psychological disorder, nervosa rates are much more easily understood as a consequence of societal views of body image than obesity rates.

To be blunt: although there isn’t extant data, I strongly suspect that body positivity saves more lives than it loses. There will be many more women discouraged from starving themselves than women discouraged from moderate exercise and reasonable diets.

Regardless, obviously the body positivity movement has nothing to do with the 21st century rise in US obesity rates (not to mention Mexico). The problem in both countries is much more agricultural/economic. And it strikes me as a bit ridiculous (or dishonest) to suggest that marginalizing body-positive ideologies can reduce the obesity rate.

It depends what people mean by body positivity. If it's "you're not a bad or less worthy person if you're of weight X, and it's ok to accept some realistic compromises" that's one thing. If it's "people only tell you to not be fat to comply with society stereotypes and you can be healthy at any weight", that's something completely different. I've seen both and people don't often clarify their position.

To add: Shaming people about their bodies is not the way to help them loose weight.

Well there is data on the impact of obesity [1].

Prevalence:

* There are 2 biillion people overweight and 650 million obese globally [2]

* There are only about 3 million people with anorexia nervosa [3].

Nevertheless, people should not be treated like children. You can be positivie and empowering without telling them that they shouldn't even bother to try. Help people change their life and get healthy, that is how you build self esteem.

[1]: https://en.wikipedia.org/wiki/Obesity#Effects_on_health [2]: https://www.who.int/news-room/fact-sheets/detail/obesity-and... [3]: https://www.thelancet.com/journals/lancet/article/PIIS0140-6...

There's some social acceptance definitely recently. But that doesn't avoid the fact some things just scale with size/weight. Like the wear on joints or the amount of blood you need to pump. But the movement I've seen was more about acceptance than offsetting those issues.

For those interested in a different measure that is much more suited to athletes:

A body fat calculator that requires just a tape measure.

You measure your height, waist and neck (as a man).

http://fitness.bizcalcs.com/Calculator.asp?Calc=Body-Fat-Nav...

The site is in 90's retro style. You can click on the question mark at the bottom left to see an explanation of all fields.

Someone with BMI of 27 ("overweight") and 16% body fat ("fit") and no belly (but no six-pack either)

I was happy to close the tab once "Fit" popped up until I saw the waist measurement is to be done "at navel".

But can I inhale sharply and hold while measuring?

Sure, if you breathe properly[1]

1. https://www.health.harvard.edu/staying-healthy/take-a-deep-b...

It's impressive, because it's as if in America, we've figured out how to design a system that gets 73% of us to agree to do whatever we are doing to be overweight. That's really something when you think of it in terms of a population that is otherwise divided and polarized.

Our firmware back from the ape era contains instructions to enjoy anything sweet and/or fatty.

Of course, this worked back in the Paleolithic, when you found something sweet and/or fatty several times a year.

It becomes a bad loophole for metabolic diseases when sweet and fatty things are everywhere and cheap.

There are plenty of other countries where sweet and fatty things are cheap, yet they don't have the same obesity rate as the US.

Everyone is slowly getting there, some countries (UK, Arab countries) faster, but the development seems to be unstoppable.

In my country, never particularly known for being thin, I can see a definitive negative development since the 1990s. Morbidly fat teenagers were basically nonexistent then. Now you meet them all the time.

IMHO the worst offenders are soft drinks, which have zero satiating effect and consist of a mass of liquid sugar. Coca-cola used to be expensive here in the 1990s (compared to a median wage), now it is cheaper than beer, our typical lower class drink.

In the last few years, a number of countries have brought in sugar taxes that have in many cases caused soft drink manufacturers to push the zero calorie versions of their products, or reduce sugar in their normal ones (particularly common where there's a two-tier tax; I think about the only soft drink that's still in the top tier here is Coca Cola, but even they have been heavily pushing their Coke Zero product), or both. Will be interesting to see what impact this has.

>Morbidly fat teenagers were basically nonexistent then.

This is always striking to see in movies with the "fat" kid. As an example, look at Willy Wonka from 1971 and 2005

https://www.bbc.com/news/entertainment-arts-37220788 ['71 on the left]

https://www.digitalspy.com/movies/a798428/what-tim-burton-ch... [2005 on the left]

The fat gluttonous kid from 1971 barely looks abnormal today. While the one from 2005 is morbidly obese.

Just watch some home movies or look at pictures from the 60s or 70s and see how skinny most people were back then. It’s pretty amazing how the country got fat in such a short time. Having lived only on the coasts I noticed that Americans are a little chubbier than what I was used from Germany but the extent of the crisis became only clear when I did a cross country trip. Going to a Walmart in Indiana or Oklahoma you basically see only very fat or morbidly obese people. Even children are huge.

In the US there are many highly processed foods with little fiber and added sugar.

Nutrition fact labels can be very misleading. e.g.: showing nutrition facts per certain some arbitrary amount of weight, or having multiple servings per container, which is misleading if it's an individual serving container.

e.g.: Oreo serving size is 2 cookies. Who opens a pack of oreos only to eat 2 of them? nobody.

Many occupations do not involve physical activity, and nowadays many day to day activities also do not involve physical activity.

Something I've realized in recent months is that restaurant portions are insane.

Even if you're not eating a cheeseburger - heck, even if you're eating a salad (assuming it has more than just lettuce) - the sheer amount of food you get in a single entree at most restaurants means that even a reasonable type of meal will end up being two or three times the calories it would be if you made it at home. The alternative of course is to stop halfway (or earlier), but that's really hard to do when it's right in front of you.

The only workaround I know of (beyond just not eating out) is to order it to go, and then immediately put half in the refrigerator.

"Clean plate mentality" is also a big part of the problem. We should not indoctrinate kids to clean their plates.

You are allowed to only eat part of what you are offered.

I take the "snack in the morning, meal at night" approach with restaurant food. That way the 1700-2000 calories worth of food is still under my daily requirements.

For the last ten years, my spouse and I always split an entree when we eat out. We order one entree and ask for an extra plate. The portions are perfect, and eating out is much more affordable.

>Nutrition fact labels can be very misleading. e.g.: showing nutrition facts per certain some arbitrary amount of weight, or having multiple servings per container, which is misleading if it's an individual serving container.

The worst are chocolate bars, a serving is three squares. I don't know anyone who has just three squares, two year olds included.

My wife and I eat a dark chocolate bar by the square. A single bar can last us a month or more.

“Servings” must be the biggest fraud in nutrition ever. The companies can basically make up whatever they want to make their foods look better. It’s unbelievable that this nonsense can be done.

Exactly. As a (Central) European, I've never understood how can you calculate stuff in servings. To me, a serving is completely subjective.

I find it amazing how much effort and economic sacrifices we are willing to take to fight COVID, while at the same time, even now, the death toll because of unhealthy lifestyles is far greater. Why don't we put a similar effort into banning fast food, for instance? How can the USA allow companies to advertise that stuff when the bad consequences can be seen everywhere?

We should be doing both, but COVID is very different and I don't think I need to explain why.

Things must be politically unpopular in order to get banned. Merely being objectively bad for a given metric is not sufficient. See also alcohol vs marijuana.

With the virus you can get funding to get rid of it. But try enforcing limits of sugar in coke and you'll mostly find money that tries to stop you.

> A new report has also revealed that 19.3% of children and young people, aged between two and 19, had obesity, with 6.1% of kids identified as being severely obesity.

Small point but I found it interesting that 'obesity' is used here as a condition one can have, rather than be. Maybe that's the norm in science writing but first time I've seen it.

Maybe the norms or language is changing to be more accurate. This applies to mental health as well. For example: Skylar has bipolar disorder. Trevor has depression. A person is not their condition and many conditions can be overcome.

Isn’t it strange how the only way to eat healthy food in America is to cook it yourself?

Every fast food restaurant is unhealthy. Most sit down restaurants are unhealthy.

I can pay someone to change my oil, I can pay someone to cut my grass, but for some reason cooking healthy food, the most essential service, is difficult to find.

Why has our economy failed us in this sector specifically?

Lack of demand I'm guessing. Within cities it's much easier to find healthier food at restaurants.

I am on a high protein diet. I can find "healthy" choices in local SF restaurant, but its rare to find food with enough protein to meet my needs.

Even "healthy" restaurants sneak in sauces and sweet drinks or don't accurately measure their ingredients (and thus correctly report calories).

You can do healthy meal delivery plans or for the really rich, hire a chef. The healthy for life plans are quite good. I lost weight on them.

> I can pay someone to change my oil, I can pay someone to cut my grass, but for some reason cooking healthy food, the most essential service, is difficult to find.

> Why has our economy failed us in this sector specifically?

Because it's incredibly inefficient for a chef to cook a meal for a family, because people want their food to arrive warm, thus preventing factory-food-production, because delivery is expensive, because everyone has a refrigerator, thus making cooked-to-order food have compete on price with long-shelf-life refrigerated staples, and because people vote with their wallets by buying food that tastes good, as opposed to food that's healthy.

Do you know what makes food taste good? Sugar, fat, salt, and alcohol. Do you know what's not healthy for you? Sugar, fat, salt and alcohol. [1]

The other problem is that a lot of Americans don't know how to eat well - because eating well is a skill that you inherit from your parents. If your parents were feeding you crap food as a kid, you'll turn into an adult that craves that same crap.

There's a huge class divide, here. My parents were immigrants with lower-middle-class means, but upper-class habits. As a kid, soda was a treat for me. Soda was a staple for my lower-class friends - which was not by their choice, but rather by choice of their parents. They grew up into adults with bad diets, bad teeth, and bad overall health, and they find it really, really hard to change what they eat.

This sort of thing repeats, generation after generation.

[1] Yes, I'm aware that fat and salt aren't unhealthy in themselves - but are probably unhealthy in the amounts we consume.

Fat and salt are both critical for your health.

SOME fats are indeed essential for our health, but not every fat out there is.

Highly processed shit like trans-fats seems to be pretty destructive.

Most every fast food restaurant has reasonably healthy food that few people order. Mcdonalds has chicken burgers. Everywhere has salads (albeit fewer than in 2019 because of food handling concerns in 2020).

Subway caters to this heavily in their marketing. You can easily put together a cheap sub with whatever macro/micronutrient combo you want.

Also, most supermarkets have a hot prepared food section with very healthy cheap pre-prepared food. Again... few people take advantage of it.

Outside of food deserts (which yes, do exist) it's really not hard to find healthy cheap prepared food if you want it. But nobody does.

Mcdonalds has chicken burgers.

The cheapest chicken sandwich at McDonald's is slathered with mayonnaise. Of course one can specify that the mayonnaise be omitted, but then one is confronted with the fact that the factory-made chicken patty is fairly unpalatable by itself.

The main question about Subway is which is more disgusting: the food or the way they treat (especially immigrant) franchisees? I can't think of a single item at Subway that qualifies as "cheap" either.

Non-millionaires who seek tasty and healthy food must learn to cook.

What are you on about? You can get a perfectly health meal at subway for $5. Just get a turkey club with vegetables or whatever.

If you think Subway is garbage food, the problem is not Subway, the problem is that you're a rich food snob.

A couple of months ago, the Irish Supreme Court ruled that Subway's 'bread' wasn't bread (the reason this went to court was that it's important for setting a VAT rate), due to containing too much added sugar. In Ireland (and, as far as I know, most places in Europe) it would not be normal for bread to contain added sugar _at all_.

So, yeah, a sandwich made with what is legally cake seems fairly garbage (though, I do see the problem in that it seems to be hard to get normal bread cheaply in the US).

This does point to a potential solution, though. As I understand it, the determination was only directly relevant to taxation. However, it doesn’t seem unreasonable to imagine that a country could take the stance that advertising sandwiches made with non-bread as sandwiches wasn’t permissible. That might be enough of a marketing problem for Subway that they’d just drop the sugar.

It has like 3-5 grams of sugar in a loaf. A Coke is 60. Somehow, I think you will survive. And if you don't like it, get a wrap instead.

It's bread. Would I get it without sugar? Sure. Is it a real problem? No.

It all adds up. Okay, to acknowledge my biases, I’m coming at this from a cultural perspective of being vaguely disgusted by sugary bread, but... why is it there? It contributes to a general saturation of sugar in American food.

A) Subway is not garbage, but it's neither good nor good for you. If you get rid of the loaves of sugar and nitrites, you're left with a small amount of salad, which shouldn't cost $5.

B) I typically bring my lunch from home, and that costs less than $5.

[EDIT:] It's not too late to edit out the baseless "rich snob" accusation... you're calling me "rich" and you regularly waste $5 on terrible unethical food.

You're dismissing perfectly reasonable and macronutritionally balanced food as "loaves of sugar and nitrites" (I guess you don't like meat either?). See above, the 3-5g sugar content is meaningless.

You should consider that you might be a food snob.

Maybe eating out every day isn't the best idea.

The food is not so much unhealthy as portion sizes are just too big.

I eat literally the kids meal sizes at many places.

McDonalds burger is not very unhealthy for example.

And even the food you buy is loaded with sugar and other hidden carbs.

Yogurt - for example - is kind of positioned as 'healthy' when for the most part it's total junk food due to the addes sugar.

Most cereal, crackers are effectively junk food.

Pragmatically speaking even bread is junk food.

Salad dressing is usually junk food.

BarbQ sauce is junk food.

Eat less, avoid carbs and sugar ... we'd probably do just fine.

When I used to travel to the US with work, I would start to get split cuticles after a few days due to nutrition deficiencies eating out every day

Usually, healthier cooking doesn't taste as good. Most of the food industry is focused on providing the best tasting food so people will buy them. How do you make food taste good? Add a lot of fat and/or carbs, which are the macro nutrients that are calorie dense. There doesn't seem to be much demand in healthy food services.

I disagree that there isn’t much demand for healthy food services. I think the real problem is that healthy food just doesn’t have as high of profit margins as unhealthy food.

A satisfying healthy meal will be primarily meat based, which is expensive.

A satisfying unhealthy meal will contain lots of carbs and fat, which is cheap.

> A satisfying healthy meal will be primarily meat based, which is expensive.

Indian, vegan and vegetarian food would like a word.

I've had some stellar salads.

For the same amount of taste healthy food is incredibly more expensive. I have eaten vegetables as good as any meat.

No! Healthy food tastes great!

But not as great as unhealthy food. So if you're trying to sell food next door to someone selling tastier food, you're probably not going to succeed unless you have a weird number of health conscious folks. And health conscious folks tend to cook at home anyway and not eat out anyway.

Actually healthy food can taste really good. But a true great tasting healthy meal must be fresh and it is relatively hard to prepare, making it expensive.

Most Americans have negative feelings about vegetables because the average American gets vegetables that are either old or have been frozen or have been bred or genetically modified for long shelf life and thus bad taste. There are a million of children's stories about how gross broccoli is or brussels sprouts or peas, but all of these things can taste amazing if you get the right fresh ingredients and prepare them well.

Food is bulky and it goes bad quickly. This makes it challenging to have a long supply chain in food. The answer of modern industry to this challenge is to have a long supply chain anyways but to change food so that it does not go bad for a long time. This involved making food taste bad and then adding a bunch of refined sugar to mask the bad taste. This also involved replacing vegetables (which go bad quickly) with meat (which tends to last a while when refrigerated).

The cheapest way to get a food to taste ok is to add refined sugar to it. This is also a very cheap way to make food last longer and thus make it cheaper for it to be delivered to you from far away.

I am writing all this because there is an important lesson here many Americans do not get. The problem is the supply chain. To solve the problem we need to drastically change the supply chain. We Americans seem to have this fatalistic belief that healthy food tastes terrible, so it is better to enjoy life and eat great tasting food rather than suffer, so lets eat all these sugar covered processed meat products and die young. Unfortunately, usually the result is you get fat and miserable, so you do not get to enjoy life much.

But this is not true. Healthy food can taste much better than your sugar covered processed food. Sure if you get the salad at McDonalds, it will taste even worse than their horrible burgers. But if you go to a good locally sourced organic restaurant you can have better tasting food than all the harmful food you tell yourself "oh this is so bad for me but i might as well eat it because it tastes good and life is short". Of course that organic restaurant will be very expensive. This is because organic locally sourced food is a niche product with low volume high cost supply chain.

If we radically change the supply chain, we can all eat great tasting healthy food for a reasonable price. It will never be as cheap as processed food (it is hard to compete with a food item that can stay on a shelf for months at room temperatures without going bad); but it is possible to get good food to a more reasonable price. And of course even if you pay a little more for healthy food you will save ten times that in hospital bills.

Unfortunately this is a difficult task. Even the more popular companies that aim to revolutionize food tend to try to operate within the existing supply chain. Thus, for example, the "revolutionary" beyond meat aims to supply vegetarian burgers that are designed to neatly replace meat burgers in the supply chain without any change of the supply chain itself. As a result beyond meat burgers last a long time and do not taste very good.

But it is possible and it can be done.

My reality is the opposite. I ate healthier food when I worked in an urban office every day. There was basically a salad place on every corner -- enough variety that I basically never got tired of them. And when I did, I would usually get some ethnic vegetarian food that I have no idea how to cook anyway.

At home, I have fewer options in my fridge, it's easier for me to make a lazy choice for lunch, and there's nobody around to lean on for social support.

Not just that, but even if you cook it yourself, it can be hard to find certain things that are healthy, almost everything has added sugar, or sugar concentrates for example, and a lot of produce are adulterated and so arn't even the real thing, like some Olive Oils.

Because processed food yields the most profit. It’s cheap and quick to cook. It’s the economy of profit, with 8h of work and the same food budget you cook more and make more profit ...

Maybe there is space in the economy for a fast food restaurant that is slightly more expensive but also slightly healthier. Food for thought.

In Europe, at least in France there is lots and lots of restaurants with healthy cooked food and not expensive. Maybe it’s cultural ?

Because healthy food is not subsidized.

A raw Big Mac costs on the order of a dollar. If you tried to just match that with raw healthy ingredients you'd be looking at five to ten times that.

And that's before we get into the labor costs of cooking.

I don't think that this issue is specific to the food service sector. I think the reason healthy food is hard to find in America is the same reason that the only way to have a healthy social ecosystem online is to painstakingly develop it at a grassroots level: corporate interests have taken over. The second that a corporate entity takes hold, growth is made the only priority and the system will naturally develop insidious patterns which abuse our most pathological tendencies. Let's refactor your comment using social media:

> Isn’t it strange how the only way to have a meaningful discussion on the internet is to spend hours researching and filtering through a sea of clickbait/porn/fakenews/gossip?

> Every social media website is unhealthy. Most well-known forums are unhealthy.

I think the unfortunate reality is that we will continue to slip into these patterns until we stop responding to them. It's a self-perpetuating cycle. We all need to strive to find out what healthy means and crawl towards that. Unfortunately things will continue to spiral out of control to the degree they need to for us to change, and sadly some people will be lost along the way.

Other possibilities: * Food is now abundant. The whole idea of healthy food is relatively new. Only the very rich used to be overweight, but now even the poorest can afford enough food to become obese * American food is heavy and fatty as a matter of tradition. Burgers, fries, fast food are all cultural artifacts most commonly associated with the US. * Multiple generations of Americans have been raised in front of the television and have deep seeded emotional imprinting from fast food marketing (happy meals!)

A thing I wondered over the weekend:

Is there a correlation between frequency of bowel movements and BMI?

I read a book about pigs a couple years ago. It mentioned that once of the main differences between breeds of pigs that are high fat and those that are more lean is intestine length.

Basically, the longer food is in your guts, the more energy gets extracted from it.

My hypothesis would be that for an obese person, the length of time between food entering the body and food exiting the body is greater than in a person of a healthy weight.

Huh, I might have to look into that.

I've always had a "high metabolism" in that I can eat enormous quantities of food (and calories) and still struggle to put on weight. If I don't lift weights often I lose weight until people comment on how skinny I am.

I get the shakes and feel horrible if I skip a single meal, or if I don't constantly consume food - doubly so when working out.

I also use the bathroom often, certainly every day.

BMI has no scientific validity and never did. Huge numbers of people are "overweight" by BMI standards, which is why even the armed forces don't use it (the Marine Corps height/weight standards allow for heavier individuals at each height, which is pretty telling since were the most physically demanding branch and geared toward being light naval infantry).

BMI is valid for the vast majority of people. If you're no in the gym for a least an hour 7 days a week BMI is good enough for you.

Many folks that weight lift are overweight by the BMI metric. When I used to hit the gym 3-4 times a week I was overweight, now I don’t and bam lost most of the muscle and in the normal range. It’s pretty easy to fall into the overweight range of the bmi metric

Sometimes I wonder how this trend impacts dating and marriage

The Biden administration is going to try to advance a Medicare for All healthcare system. If the government wants to control the skyrocketing cost of healthcare, it can do well by addressing the root causes of health problems rather than structuring creative contracts with healthcare providers and pharmaceuticals. Even something as progressive as "incentivize healthy living" is very difficult when every legislator is lobbied nonstop by a long line of vested interests. Obese Americans create billions of dollars of financial opportunity. Think about the financial losses that people would experience if the mind and habits of every American were to change today. Healthcare, pharmaceutical, insurance, finance, food, academia, government agencies and administration -- all have a stake in keeping America the way it is.

Just as America is focusing resources on a Green New Deal, so too does it need to focus on a Lean New Deal. This doesn't seem to be on the agenda for the first term, though.

Using the BMI to gauge obeseness of a population is very lazy and disingenuous.

Is an average way to determine it but a good and quick estimation even if +-10%

The irony of the BMI is the more I workout to stay in the healthy range, the more difficult it is to stay in the healthy range. Best bet is to sit around not eating anything to be 'healthy' according to BMI.

True, I started weightlifting for three months and my BMI went into overweight territory. I had an athletic build both before and after. Probably good for a lot of people but weightlifting really puts it into question.

It's not like weightlifting is something only few men can do; most men can weightlift. Then they end up having healthy body fat levels, but end up with BMI in the overweight category. If something as simple and straightforward as weightlifting messes up a measure, then it's not a good measure.

You don’t lose weight lifting things up and putting them back down. You certainly don’t put any appreciable strain on the CV system.

I was doing a lot of cardio training for an ironman and had really low body fat, but still borderline overweight according to BMI.

Lifting heavy weight doesn't mean you're fit. You can still be very overweight and bloatmaxxed

This guy is strong as hell but he isn't healthy at all https://youtu.be/1LsIQr_4iSY

BMI in no way gauges fitness or health. Another reason it's lazy and disingenuous.

The question is not whether most men can weightlift, but whether most men do weightlift. They don't.

The question is what criteria would you want a measure to have for it to be called a good measure.

You are arguing that if it empirically works for most people, then it’s a good measure. I’m saying that a good measure should in principle work for most people.

Yeah I came here to say the same thing.

I’m 6’8” and if I were within the suggested range, I would be 227 pounds. I’ve been that weight and when I look at pictures of myself at that weight, I always think I look dangerously thin.

BMI is a far too simple a measure to be helpful.

BMI is an absurd measurement for people whose height is outside a small range. See, for example, https://people.maths.ox.ac.uk/trefethen/bmi.html

dangerously thin hahahha omg

Your height puts you at the 99.986 percentile [1]. You are an extreme outlier, so can't possibly expect general metrics to fit well.

[1] https://tall.life/height-percentile-calculator-age-country/

It seems correct to a first order of approximation for the general population. What is your objection?

I know people who lift weights regularly can have high BMI but low body fat. But until those people make up a large share of the population, I would think BMI is still an OK general measure.

I would say it is useful only to gauge obesity in a large population (where only a marginal percentage has such a high muscle mass that a high BMI does not represent obesity).

But how many people does having both muscle and fat push them from the overweight category to the obese category? At 5'-9" the overweight category starts a little over 169 lbs and the obese category starts just above 203 lbs. Given that as a teenager I was well into the overweight category with a six-pack and very little fat from an active lifestyle and playing a lot of basketball multiple times a week, I could easily see how just eating more might put be closer to obese while still having less fat than one would expect from that designation.

That's not to deny Americans have a problem with weight. I just think it's counter-productive to use metrics that people can easily see are problematic when trying to make a valid point. Using controversial measurements because the are easily available is lazy.

The level of fitness you describe would put you in the top 2% of people I have ever met.

I think that margin of error is acceptable compared to the ease of use of the BMI.

I did not feel overly fit. I was definitely not as fit as the people that played a sport competitively. I hung out with friends, ate (a lot of) fast food, and didn't do much outside of school. I did have a "weight training" class a few times a week, where we ran a mile and then I played basketball the whole time. A total of about five hours of exercise a week, and not being sedentary, definitely not an outlier for many teenagers. Yet still considered overweight?

The problem is that the BMI probably matches fairly well to a specific slice of the population. Maybe males 25-40. It likely loses accuracy of meaning the farther in age either direction you go, as well as the more different you are from the optimal subgroup. This is only barely noted in most cases (it's alluded to here in this article that Asian people might see problems at different BMI numbers). What about women vs men? What about the young and elderly? As a metric, BMI is poorly understood by the public, and this poor understanding is targeted and capitalized on by different studies. All it does is cloud our view of what's really going on.

Why? It can be inaccurate for individuals because it can show lean but muscular people as overweight, but those people are a tiny fraction of the population.

Accurate body fat tests either require expensive equipment or training to use. The inaccurate method those cheap bathroom scales use would probably be good enough to detect trends but if we're just going to detect trends: why not stick with BMI that's accurate enough for that purpose and way cheaper/easier to use? There aren't that many people with overweight BMIs that aren't overweight. Maybe it could be slightly better to change methods, but it's not like it would be orders of magnitude better.

-Someone with a BMI of 28 (smack in the middle of overweight) and a 6pack

>Accurate body fat tests either require expensive equipment or training to use.

I agree, that's why I think it's lazy and disingenuous. Look how much we fund global warming research. But when it comes to calling something a "national health crisis," we don't even bother and take something invented around the time of Andrew Jackson's administration. Good enough, right?

>There aren't that many people with overweight BMIs that aren't overweight.

How many people would you estimate have overweight BMI's aren't overweight? How are you even defining overweight? See how it's a soft metric? Countries basing taxation and policy on this stuff.

You are overweight and part of the national health crisis, period. No discussion because the BMI doesn't allow it.

My understanding is this is precisely backwards: using BMI to gauge your own health is inaccurate, but using it to analyze populations is the intended purpose.

As the country gets more fit, and that fat turns into muscle, what happens to the BMI? It either gets higher or stays the same, right? Certainly a good measure to perpetuate a crisis.

Let's cross that bridge when we get there.

In the meantime, I more regularly see the people whose BMI is highly correlated with their body fat percentage; and, one of those requires a scale and a number that doesn't change after your early 20s. The other one requires a tape measure, calipers or an immersion pool.

Oh come on. I'm overweight by BMI behind lifting, but take a trip outside a coastal city and you will find that the number of people in similar positions amounts to rounding error in the general population.

Yeah, I just worked backwards from the metrics they provided and at my height I would have to be under 165 lbs to not be considered overweight. In high school I weighed about 180, and was not overweight in the slightest. I had a six-pack, and was fairly active. Yet my BMI suggests I was half-way through the overweight range on my way to obese? That seems somewhat ridiculous.

I disagree.

Using BMI to gauge the obesity of an individual is lazy, but for a population, its quite okay.

How many people are more than 6'5" in a population? How many athletes? And even athletes sometime are overweight! A 6'5", 29 BMI NFL LB might be healthy, but the 32 BMI lineman with the same size will have the same problem as obese people once he's 35, discounting injuries.

BMI is generally fine as a statistical tool. Obviously if you're looking at a whole country of olympic athletes it'll break down a bit, but in practice that sort of extreme edge case doesn't exist on a national level.

For personal use, it can be an indicator, but only that.

BMI isn't a reliable indicator to gauge obesity. For example, Tom Brady at 6' 4" and 225 lbs is considered overweight, which is obviously not the case.

That being said, as an American, it really did shock me how fit the majority of people were in Italy when I visited there for the first time last year.

This New England Journal of Medicine chart really does a good job of showing that America has gotten heavier over the years: https://www.nejm.org/na101/home/literatum/publisher/mms/jour...

Source: https://www.nejm.org/doi/full/10.1056/NEJMsa1909301

For a population study BMI is fine, elite NFL players aren't going to move the needle.

A professional athlete doesn't need a simple metric to understand if he's at his ideal weight. It's part of his job. The general public do need a simple metric which covers 95% of the population. BMI is that.

BMI isn't a reliable indicator go gauge obesity FOR EVERY SINGLE PERSON. I would think most of us agree that the people like Tom Brady, Dwyane Johnson (the rock), or competitive body builders would be extreme ends of this scale.

For average people BMI is a reliable indicator.

That’s because muscles are heavier than fat, right?

They are more dense, yes.

It also doesn't a good job of modeling ideal weight for short or tall people. BMI models a human in only two dimensions.

BMI assumes you have an average amount of muscle. Any weight above that is assumed to be fat. So for someone like the Rock it treats a lot of muscle as though it were fat.

It goes the other way too. You might have a BMI in the "healthy" range, but actually have an unhealthy amount of body fat [0]. Of course, nobody puts themselves in this category.

[0]: https://en.wikipedia.org/wiki/Body_mass_index#/media/File:Co...

That tends to be called skinny fat, and it's the worst feeling and takes a whole different kind of work to escape.

A lot of non-cardio gym time and protein eating.

Same Paris, metro gates would simply filter out three quarters of population if installed in US.

Why, how many Americans have the figure of Tom Brady? Is that number big enough to have a meaningful impact on average BMIs?

I don’t understand why everyone is so quite to dismiss BMI based on edge cases, especially when the finding is backed up by your other evidence.

It makes it so that people don't have a strong sense of what a healthy version of themselves is, and can assert that they must be healthy "as they are".

I've found Body fat % to be a more useful number, it's easy to understand what you'd look like with 10% less body fat - and you won't see many/any athletes with 30%+ body fat. When I first started tracking this I was shocked by the initial number (35%) and managed to work it down to 17% over time, my total weight didn't change by more than 5%.

I think body fat percentage is a reasonable metric but even that isn't absolute. For example, studies on Sumo wrestlers in Japan found that while they had lots of fat, they didn't suffer from the adverse affects of obesity while they maintained their active workout schedule. Once they left the career and stopped exercising, the obesity related health problems showed up. Exercise and activity play a significant role in overall health, not just fat percentage and weight.

https://www.businessinsider.com/sumo-wrestlers-obesity-diet-....

Because it forces people to confront the reality of their obesity and how out of shape they are.

Define reliable.

If a metric had 95% accuracy would that qualify as reliable? I would certainly say so. Especially if the 5% outliers are not random but in fact an extremely obvious edge case?

I do not know how “reliable” BMI is. But elite athletes represent an exceedingly small percent of the population.

My intuition is that BMI is a pretty darn good first approximation. And instances where it’s not good there is supporting evidence.

Every time BMI is mentioned someone has to come up with an example of a body builder or fit athlete who has a high BMI. Yes, everyone realizes this already, and nobody who is in that position is going to be mislead into thinking they are obese. Sure, it would be great if everyone could do a caliper test or a water displacement test, but that isn't ever going to happen, and BMI is a trivial and good enough place to start.

Because being overweight/obese is normalized because it is seen everywhere, there are tens of millions of people who have no idea they are at an unhealthy weight ... they rightly think they look like everyone else. The BMI is a an easy metric to get people to evaluate if they need to do something about it.

> Yes, everyone realizes this already, and nobody who is in that position is going to be mislead into thinking they are obese.

No, but someone who works out the numbers and realizes that the BMI doesn't match them well, or their circumstances well, realizes it calls the study and what it represents into question. Using controversial metrics because they are easily available is counter-productive in the long run, because once people realize you were misrepresenting your credibility is lost. At best it's lazy.

Right now I'm obese. In high school according to the BMI I was almost half-way through overweight edging towards obese, and that was with very little fat, a very active lifestyle, and a visible six-pack. How do I consider studies that make claims about percentages of people that fit into those categories? As extremely ambiguous in what they are actually indicating.

Do Americans have a problem with weight? I think so. Does using false numbers to overestimate the problem help? I don't think so, especially when people realize the metrics leave a lot to be desired.

The measurements don't have to be precise to show a trend, relation, or infer a number of valid results. If someone calls the study into question based on using imperfect methods, rather than using those methods incorrectly... That's their opinion, but it's not useful.

They don't have to be precise to show a trend, but there needs to be some assurance that the measurements affects subgroups similarly and a measurement of how it affects those subgroups to infer a number of valid results.

How does BMI accuracy scale with age? How does it scale with different ethnic groups? How do these interact? How do you infer an accurate number without knowing these variables and accounting for them and the relative sized of those cohorts?

If the measurements to create the BMI were taken from a statistically valid cross section of the current makeup of Americans, then I would have no problem. But how was the BMI generated? When? With what type of participants?

This article itself notes that Asians experience relatively more problems at a lower BMI. Without knowing what the BMI is tuned to, how an we interpret how it applies to a cross section of Americans for a singular study?

As a measurement of similar studies seeing a change over time, I agree it's less problematic (but could still be affected by trends in physiology over time, possibly from immigration).

The fallacy of applying statistical measures to individuals. That fallacy has a name, which I cannot recall

We have an epidemic of overweight people. We can worry about misleading BMI stats when we have an epidemic of bodybuilders who worry they might actually be overweight.

Isn't that exactly what I'm addressing? How using misleading or bad metrics can lead to a mistrust in what is being conveyed?

Think "Reefer madness" and all the bunk science out about Marijuana in the 80's and 90's. Did anyone trust the information coming out at that time? I would hazard most in their teens and twenties didn't, which is exactly who that information was intended to sway.

Trust is important. If people don't trust that what you're saying is accurate because it's easy to point out the shortcuts taken that muddy the results, I think eventually they are going to look at most results about that subject with a grain of salt. At that point they've been trained to do so.

The best ammo against a problem is clear and accurate information. Not fear-mongering and FUD, or even something adjacent that's just imprecise enough to be easily called into question. All that does is cause confusion and arguments over veracity.

It should be an easy metric, yes. I think it does help some people realise they are in poor physical health.

The problem with it is that it’s so commonly responded to with ‘muscle means it isn’t right’.

I used to be fairly fit and fairly strong and a bit too much towards the ‘obese’ category. I remember semi-believing it was muscle pushing me up the scale that far.

I’m now right in the middle of the ‘healthy weight’ category and I’d like to go back and convince my younger self that it’s time to fix the food intake and that muscle isn’t what’s pushing the weight up.

You're not wrong that BMI is okay enough of a metric for most people. But, in terms of a metric that is even more simple (one simple measurement tool instead of two), accounts for athletic builds, and is arguably more predictive of health outcomes (example: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071369/), it would be great if we could standardize on waist-to-hip ratio instead of BMI.

Scales are common, fabric tape measures are rare; and, even men's jeans no longer correspond to their inch number. Learned that one the hard way this year.

Literally the exception that confirms the rule.

No athlete I know bothers with BMI - it's meant for non-athletes. Likewise athletes often accept that bodyweight corresponds almost directly with lifting potential, but obviously we know that's it's only true for athletes, otherwise every obese person would be setting world record deadlifts.

BMI is a poor indicator of Individuals Health

BMI is a good metric for POPULATION level studies, infact it was designed explicit for that purpose

So me calculating my individual BMI then making health judgments solely on that number is stupid.

However A person calculating the BMI of all persons in a Population then using those numbers to judge to overall condition of the population is valid

Professional athletes, along with most people who work out 4+ days / week, have their own more advanced/expensive ways of determining their own personal weight and judging where they should be, factoring other measurements like muscle mass percentage. They also make up a very small percentage of the US population. For everyone else, it's a decent approximation of weight.

As anecdata - I'm on the opposite end of the physical activity spectrum to Tom Brady, I'm also 6'4" and the heaviest I've been is about ~210 lbs. I was definitely starting to feel "a bit too big" at that, and would confidently say I'd feel overweight at 225 lbs, so the scale doesn't feel massively miscalibrated to me.

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