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Comment by euske | Hacker News Reader

What's not mentioned in the OP:

- INSANE peer pressure. If you're skinny as a twig in the US, you're probably considered normal in Japan. If you're actually an obese person (again, in the US standard), people here wouldn't even look at you straight. This kind of environment put a huge pressure for one to stay in shape.

- INSANE obsession for health. I hear that Americans are obsessed with health, but oh boy, have they looked into Japan. Small clinics are everywhere and they're always filled with anxious patients because they have a benign stomach pain or something. Physical checkup is mandatory for most companies. I also read that the fear of COVID in Japan is the strongest in the world, despite a relatively low infection/death number here. People are always talking about their health, and so is the national media. If you watch the Japanese TV, you'll also feel sick, simply because there's so much fear! Maybe this is good for public health overall, but I bet there's a certain mental toll.

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As an Italian person (also our life expectancy is really good on average) this hits home. An anecdotal example: I now live in Switzerland and my current doctor was shocked when I ask to get some blood analysis without being sick. He believed that I lied to my insurance company and hid some pre-existing condition.

In Italy, instead, it is pretty common that every couple of years you get a complete blood analysis just to see if everything is ok and whether you need to change something in your lifestyle.

Additionally, Sardinia (another "blue zone" with great life expectancy) also has a different diet compared to mainland Italy. Loads of seafood and relatively small amounts of livestock proteins.

As an Israeli, are blood tests not a normal thing done everywhere? I did not realize that...

My family doctor asks for a battery of lab tests about once a year (or whenever I get around to scheduling a check-up), including glucose and cholesterol and liver functions and so on. This has been going on since I was twenty something.

Not in my experience. I also lived in Sweden and UK. Blood tests are usually only a reactivate thing. You're sick you get blood tests. As prevention not as common I'm afraid.

The reason Sweden doesn't do regular health checks of the population is because there is no good scientific evidence that it has any effect. And that if a person feels healthy, they most likely are.

I think the similar reasoning is used in other countries.

If you can read swedish/use Google translate, this page explains it very clearly: https://www.1177.se/fragor--svar/nationellt/behandling--hjal...

"And that if a person feels healthy, they most likely are."

Uh, high blood pressure is a typical "silent" disease with major effect on health later.

You don't need a blood test to measure your blood pressure though.

The article says that you should check blood pressure and blood sugar every 5 years. And blood fats "some time". But that's very different from a regular check up.

> The reason Sweden doesn't do regular health checks of the population is because there is no good scientific evidence that it has any effect. And that if a person feels healthy, they most likely are.

I think this is naive: there are a number of reasons people in Sweden don't easily get health-checks, and among these are certainly cost-saving, where the healthcare representatives who you need to contact before speaking to a doctor or nurse act as gatekeepers to the system. This 'rationing' of resources can sometimes have dire consequences, as happened to a former colleague of mine, who was denied the in-person checks he needed and almost died as a consequence.

There's also an enormous amount of peer-pressure in Sweden to be skinny, fit and actively go to the gym several times each week. A fat person is an extreme rarity in Stockholm. Couple this with an ingrained cultural 'guilt-complex' instilled in everyone not to be a 'burden' on anyone else, and the health-service is suddenly transformed into an 'emergency-only' institution.

Naturally that may be seen as a positive - although for some people it may have bad outcomes. It certainly contrasts with my extended family in Spain, who have tests for every possible malady at all times. But otoh that seems to work pretty good too, as one of my uncles died last year at the age of 102.

I feel in UK they are not that common unless you are ill. For company medicals / private health schemes and for certain age groups they do happen.

In Belgium, my general practitioner told me it used to be common practice to simple cross every box on the blood test selection sheet for a client's annual checkup.

Right now there is rightfully pushback against unnecessary testing. Over-medicalization by which people are subjected to treatment without suffering under symptoms is very much a problem. Also the socialized healthcare providers are not happy with this, as you can imagine.

Why conflate over/unnecessary treatment with availability and evaluation of markers? I guess if neither the patient nor the health care practitioner are uninterested in careful consideration of the data, then why bother I suppose. But then why bother at all with seat-belts, environmental laws, or dental visits if there's no value to prevention? We can just react after its too late, for everything.

/s in some of this, perhaps all

There's a multitude of reasons, touched upon in a metastudy of inappropriate lab testing in medicine [1,2]:

> “But, unexpectedly, on a per-test basis, we actually found that the main problem was tests being over-ordered during a patient’s initial examination, rather than during repeat tests. This indicates to us that ordering the right test during the initial evaluation may lead to fewer errors and better patient care,” he said.

a. Tests are not accurate, a false positive causes alarm and follow-up examination where none was present.

b. On the inverse: negative tests provide a false sense of security and good-health. [2] discusses this as the prime motivator for patient blood test requests.

c. Economic cost to the insurer or ultimately patient/taxpayer, not of the tests themselves but of the downstream examinations.

As a general rule in medicine: Don't treat a patient without signs or symptoms. When a persons feels healthy, they usually are healthy.

1. https://hms.harvard.edu/news/unnecessary-testing

2. https://journals.plos.org/plosone/article?id=10.1371/journal...

3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1769380/

I appreciate all those considerations but prevention of disease is all about identifying issues that may disrupt ones current feelings of and actual healthy state.

We cannot keep waiting for randomized experimental research to identify all the ways health may degrade over time. If we can regularly gather data en masse, we regularly over time can identify more predictors and risk factors for poor (and good) health, and evaluate efficacy of treatments received or effects from lack of treatment.

Again, why pay for seatbelts (and get tickets for not having them) in vehicles if I've have no history of accidents, or receive preventative dental care despite no serious current oral issues, etc.

Why do we have heat sensors in vehicles? The vehicles I've driven in life have never overheated.

Somehow we continue to excuse doctors who practice poorly by treating by markers alone rather than the whole picture (including the patients feelings and desires), or despite contraindications for the treatment being considered.

Somehow the only practical solution is to allow health degradation, and then rush to identify and treat and attempt reversal.

Some tests not only don’t benefit patients when done without reason, they actually harm them. medical interventions and procedures are often invasive and not without side effects, including pain, severe disability, and death. In many cases the studies you allude to us waiting for have arrived, and they show active harm for many cases where you’d think “why not add a test, what’s the harm”. Unfortunately medicine is still way too complex to reason about without the research to back it.

In my field of nutrition alone, there is tons more we could do to individualize and thus improve the targets for macro and micronutrients, as just one example. RDAs are only a rough starting point (when there is an RDA) as we understand more about individual genetics, food environment, etc. Why is all of medicine just invasive procedures and pharma? I'm not convinced that we somehow just need to sit and wait for some future time before we can jnvest and safely make use of markers over ones life to improve behaviors and health outcomes (for the benefit of an individual and others with similar medical characteristics).

Theres room to debate the degree and depth that we would utilize labs and other measures, but a complete non-starter mentality just leaves health outcomes to blind fate and promotes development of complex conditions much more difficult to unwind.

I'm Irish and never heard of someone getting one unless they were checking for something specific. However, I do know that regular health checks are recommended once you hit 45 or so. Not sure if that includes blood tests.

We're currently ranked 16th in the world for longevity, so I doubt regular blood checks is that important - at least, I remember reading previously that there's no evidence regular blood checks are actually useful unless you have an ongoing condition.

Irish too, and I get bloods done every year because I noticed my health insurance covers me for an annual checkup. First time I got them done revealed I had very high cholesterol

I got a funny stare from the doctor in Germany when I wanted to check my cholesterol levels.

My wife OTOH got it done without an issue.

So yeah maybe they don't bother with males or foreigners.

Yep we only care about hot chics and Germans. But seriously, was it the same doctor? Then it would indeed be kinda weird, but otherwise there is a wide range of types of doctors, those who love checkups and prescribing stuff and sending you to a specialist whenever you report the slightest problem, and those that just send you home again no matter what, tell you to get some rest, work less, eat healthier, and maybe come back in two weeks if it doesn't fix itself. And then everything in between.

As an Indian I'll say that annual health check-ups are now normal amongst the privileged class. In my opinion it is a good thing considering how unhealthy our environment and lifestyle is along with a lot of predisposed conditions.

Anecdotal data - as a Sardinia native, we do eat seafood, but to be honest around me at least that's at most a once a week practice. My grandpas, which lived to 96, 98 and 101, didn't eat much fish either. Lots of veggies though. One of my grandfathers died young due to a heart condition. All of them were regularly checking their health and doing regular blood tests. I can confirm we don't see getting tested as being "obsessed with our health" but as a good (and for many, not very pleasurable) practice, part of the "preventing an illness is better than curing it" philosophy. Having cheap/free healthcare also helps.

Interesting! Some Friends from Sardinia told me that seafood is predominant in their diet! And of course, veggies.

I wouldn't say predominant, but certainly present! But we each represent a different set of connections, as I said, this kind of data is anecdotal ^^ I'd say i eat way more fish here in Japan than back in Sardinia.

seafood is cheap af in greece.

When I was in Athens, a kilogram of fresh caught sardines ran about 2 euro for a kilo. Thats cheaper than canned!

On Crete, it was a bit more expensive at 4 euro per kilo but I never paid more than 4 euro for a pound of fish. thats cheap enough to make fresh caught fish a daily meal

That's not a good thing. The Greeks are over fishing their waters.

https://www.reuters.com/article/us-greece-fishing/as-stocks-...

Goes to show how important culture and religion can be in diet. Eating seafood instead of meat once a week, usually on Friday, is a widespread Christian practice called the Friday Fast. [1]

In Europe, I know a lot of people that still stick to this practice even without practicing Christianity.

1. https://en.wikipedia.org/wiki/Friday_Fast

Oh, there was some people following the Friday thing, but I've only heard about it during lent and not everyone is following it - it's quite going out of fashion esp with younger generations.

Younger people make up a smaller and smaller percentage of the total population every year though.

Ironically though, the young that do practice Friday fasting are much more likely, demographically, to have children. So I imagine the practice will continue for many centuries.

> but I've only heard about it during lent

And even then, it's usually breaded and deep fried. Not sure, I'd qualify it as a healthy alternative to a steak.

> seafood instead of meat

most of that's still meat though?

According to science it should be better than red meat. Additionally, a lot of seafood comes in smaller portions, is full of bones, shells and whatnot, whereas it’s relatively easy and cheap to get large quantities of fully edible red meat. It’s not that you couldn’t have a pound of peeled shrimps, but my own experience with seafood says it’s not very common.

So overall you’re most likely ending up eating less meat, and not just different meat.

Better how? What science? Do you have a citation? Most comparative diet studies are only observational with multiple confounding factors and no proper controls.

E.g.

https://www.nhs.uk/live-well/eat-well/red-meat-and-the-risk-...

and

https://progressreport.cancer.gov/prevention/red_meat

I’m not going to single out studies and pretend that I’m in any way into this field.

Fish have lots of selenium that meat lacks.

Fish can also have lots of mercury that meat lacks. It's probably best to eat a variety of different foods in order to avoid excess toxins and nutrient deficiencies.

There’s some interesting research suggesting that mercury poisoning is in fact just pulling out the availability of selenium for bio chemistry by forming metal ion complexes

https://pubmed.ncbi.nlm.nih.gov/18761370/

The wikipedia page states more correctly: "animal meat, other than fish".

Does the cost of health insurance change in Switzerland with a pre-existing condition?

Not the basic one as it is the same for everyone and prices are mandated by the government, but the premium packages do. For instance, you can add to your package that were you to spend nights at the hospital you'd like a private room. If you have an existing condition that makes it more likely that you'll end up spending nights at the hospital you need to pay more for said premium package.

Fellow Italian here: in Sardinia consumption of seafood is not particularly higher than the Italian average, certainly not higher than South Italy (i.e. from Rome downwards) especially Sicily or Naples area.

In Sardinia they eat a lot of blue fish (or oily fish), not surprisingly the European pilchard also called "sardine" of the genus "Sardine" has a very similar name to "Sardinia".

According to some recent study Aristotle himself named the fish after the population of Sardinia Island that were the first ones to trade it in ancient Mediterranean markets (looks like the most popular way to prepare it was in salt, as we still do nowadays).

But that's probably not why they are a "blue zone", an important difference is the kind of meat they eat: there is an abundance of sheep meat but much less beef red meat.

But that's probably no it either, Sardinians have genetic markups that protects them from entire classes of diseases, being a quite homogeneous population from the DNA point of view, they passed them on from a generation to the next.

Annual blood tests are standard for all patients with my current GP in the US. He is a younger doctor, so that might be a factor. I'm a bad patient in that I don't go every year.

Yup. We get told our cholesterol is high, our triglycerides are high, our blood pressure is high, we're pre-diabetic, we ignore it and come back the next year and get prescribed more pills.

I suppose that might be true of a lot of the western world. The good thing about regular blood tests is that, in theory, you can catch things early before you have symptoms and they become serious problems.

Every blood test I've had, has come back with good results. I have low blood pressure, and I don't take anything other than a few dietary vitamins daily. I'm fortunate in that I established good dietary habits back in my early twenties. It can be difficult to break old habits though, so we'll see how I fare now that I've crossed the age where things start going downhill.

As an American with good health insurance, I’ve gotten blood labs with my annual physical since at least the mid-2000s.

Why do you get an annual physical?

I'm also an American with good health insurance (PPO not HMO if that makes a difference). My GP is at Stanford, although she only seems to practice once a week or something (it can be hard to get an appointment).

I go to the doctor when something's bothering me, but that's about it. It's never been suggested that I go regularly. (I'm not quite 40 yet, so maybe that's the difference?)

My dentist on the other hand, sends me a postcard every 6mo.. :)

It’s covered by insurance, and my doctor recommends it. I’ve caught a couple health problems early that could’ve turned into something major.

>In Italy, instead, it is pretty common that every couple of years you get a complete blood analysis just to see if everything is ok and whether you need to change something in your lifestyle.

This sounds like a great idea

I agree. Other people here mentioned that sounds like a waste of money, but I honestly am not sure as I don't have good figures about how different treatments cost.

However, I believe that by doing so I can avoid preventable conditions later in my life and it's well worth it both for my quality of life and potentially for other people as I might not need that much medical assistance and leave it for those who need it.

I remember some research with respect to the U.S.A. where such routine checkups are common, and it concluded that it was close to useless to do so.

Routine checkups never happen where I live. — one visits a healer when one feel sick.

I remember first reading about that as well. That's not to say we don't have preventative care in the Netherlands though, it's just more targeted. For example, women get regular screenings for breast cancer.

Which in itself seems rather odd, given that it's not the most common, most deadly, nor easily screenable ailment.

If there is screening for this specific ailment, then why not for all?

It doesn't strike me as a decision born from strategic thought.

I don't know too much about breast cancer, but it was just an example. There's plenty more preventative care, they're just not grouped together in a single periodic check-up (which also doesn't check for "all" ailments - I don't think we even know of all of them :) ).

Here is a medical editorial which makes the same point and cites the relevant research. Routine annual check ups are probably a waste of resources in most cases.

https://www.nejm.org/doi/full/10.1056/NEJMp1507485

For there to be benefit to an annual checkup, it would need to fall in the window wherein symptoms have not yet occurred, but the disease is already measurable, and also one that is searched for in those checkups.

I haven't visited a general practitioner in a decade, and when I last went it was indeed because of I noticed the symptoms of of an ear-infection that I indeed suffered.

Maybe it's egoist to do so, but if by doing check-ups I can improve the quality of my life when I'm older then I'm all in for that.

Moreover, some preventable conditions don't show symptoms. High cholesterol, for instance, doesn't show any symptoms until one of your blood vessels is clogged, but chances are that by then is too late and you might suffer a stroke/heart attack.

I don't know how much the average treatment for those costs, but I would say way less than few tens of blood/urine tests. Or even more "stealing" a good heart because you need a transplant due to a preventable condition.

By the way now I circumvent the Swiss reluctance to prevention by going to Italy and paying the analysis out of my pocket. It's still very cheap (~100 Euros every 18 month on average).

>I now live in Switzerland and my current doctor was shocked when I ask to get some blood analysis without being sick. He believed that I lied to my insurance company and hid some pre-existing condition.

this is the same kind of situation in Denmark, I've lived most of my life outside of Denmark, after I cam back in my early 40s I went to the Doctor and said innocently "well I guess I'm getting to that age now where I should have an annual checkup." There was no explaining the concept to him.

You should probably change your doctor.

Annual check ups aren't supported by evidence based medicine.

https://www.nejm.org/doi/full/10.1056/NEJMp1507485

thanks for that, I did not know this (obviously). That said, I don't think my doctor knew it either or he could have just said.

This seems indeed anecdotal.

I would consider a blood test every couple of years a default practice among GPs in Switzerland. Among other measures that fall under the "prevention is better than treatment" scheme such as free skin cancer screening or colon cancer screening from a certain age.

I find the described reaction of your doctor to be out of the ordinary, and with relation to the described accusation unacceptable.

I would have switched GP in that case.

Thanks. I ended up doing exactly what you said for other reasons (Covid). Now I have what is called telemedicine where I call some number where I describe my symptoms and I might get a prescription right away or some tests. I did it to minimize the interaction with people that have an higher chance of having covid due to their line of work.

Once per year in the norm in Argentina.

If you have fancy / private healthcare, you're also encouraged to have the FULL checkup. That is, running on a trend-mill while a doctor controls your heart rate, etc.

Many vegan friends also requested iron and B12 checkups with blood tests, and doctors had no issue with that.

Long-term resident of Japan here with no particular expertise or insights on longevity or health. Something that has struck me recently are the government-led educational efforts focused on nutrition for infants and children.

My daughter and one-year-old grandson live with me, and ever since he started eating solid food she has been feeding him exclusively homemade, vegetable-centric meals. When preparing the food, especially at first, she referred to guidelines for ri’nyū shoku (“weaning food”) in the Maternal and Child Health Handbook issued by the government for all babies [0, 1] as well as some cookbooks she bought. The emphasis of ri’nyū shoku guidance is on handmade, nonprocessed food; my daughter has yet to buy any commercial babyfood. She hasn't been able to have much interaction with other young parents (for obvious reasons), so I don't know how typical her approach to babyfood is. But my impression is that she is not unusual.

For older children, the government promotes something called shokuiku (food and nutrition education, [2]) that is incorporated into the school curriculum and is coordinated with the food that children actually eat at school. (Most schoolchildren eat school-supplied hot lunches.)

The specific guidelines for ri’nyū shoku and shokuiku seem to reflect both scientific research on nutrition and a nationalist nostalgia for traditional Japanese diet and eating customs.

[0] https://www.med.or.jp/english/journal/pdf/2010_04/259_265.pd...

[1] https://www.jstage.jst.go.jp/article/jaih/27/2/27_121/_pdf

[2] https://www.maff.go.jp/e/policies/tech_res/shokuiku.html

That all sounds very wholesome, but based on what I've seen, reality is pretty different. That commercial baby food you mentioned seems to avoid salt entirely and make up for it with gobs of sugar. Snacks for kids like tamago boro are little puffs of sugar and starch.

I'll readily grant that the universal free school food is a huge improvement on the US swill, although this too has its share on unhealthy practices: mandating that everything served has to be eaten whether you're hungry or not or you like it or not (kids are regularly told that sukikirai, liking/hating foods, is not allowed), and the mandatory milk & milk bun for that sugar kick. At least whale meat has become too expensive to feature regularly anymore.

Well, I am far from a food snob but even for me, what you can often buy as baby food is bland and has some weird mix of ingredients (ie some are too oily, some have weird aftertaste). I am talking about french and swiss rather premium products, so not some supercheap crap for 3rd world countries done by likes of Nestle/Kraft.

When you cook it yourself even with very little salt and reasonable spices for a baby, the result is so much better. We can see how much our little one enjoys cooked stuff vs bought ones, so we stopped quickly with those. It takes some time, but covid is actually helping with this particular thing right now. Thank god our kindergarden has proper chef who actually cooks and not just reheats frozen stuff from cheap retailers.

Its a bit sad that even in 2021 we can't really manufacture en masse reasonably processed food that contains just the food ingredients and tastes at least reasonably.

> people here wouldn't even look at you straight

Quite the opposite! Random strangers will stare, and friends and colleagues will make blunt comments in a way that would send them straight to HR in the US: you'll be told to your face you're fat, asked how much you weigh, get poked in the belly, asked if you've tried sumo wrestling, etc.

A random デブちゃん's experience: https://www.tofugu.com/japan/fat-in-japan/

I've had a real example of this! I've never even been overweight but a Japanese friend, who was an exchange student, would poke me in the stomach and if there was the slightest pudge he would yell "Hamburger!"

I’ve had those experiences in China, my friends would often comment on my weight. They never meant it in a offensive way, but it’s still hurtful.

Empathy isn't a cultural thing, it's a human thing.

If people are doing things that are hurtful and they don't care to notice, they aren't your friends, they're just people you know.

I beg to differ. What is considered as normal in some cultures, can be considered offensive in other cultures. It's not because those people lack empathy.

What matters is who is doing the considering. Each friendship between people is its own "culture" in that sense; I don't generally do things that my friend would consider offensive, if they are actually my friend.

It's nothing to do with the wider culture or ethnic environment, or what third parties may or may not be offended by: I don't do things that I know would hurt my friends.

We could go into a whole debate about this. From my perspective, I don't think they're wrong, at the end of the day, I'm a foreigner in their country, and it's up to me to adjust my mindset. I don't think it's up to them to change their behavior because I find something offensive, that to them is not considered offensive.

An interesting thing I experience in making friends later in life is mapping expectations about 'what friends do' (I guess I pester and expect to be pestered about a lot of personal things, the closer the friendship the more personal the teasing should be) to expectation 'new' friends have about the relationship.

> I don't generally do things that my friend would consider offensive, if they are actually my friend.

> I don't do things that I know would hurt my friends.

These two statements seem like they could be in conflict with each other. Suppose your friend has a methamphetamine addiction, but they consider it offensive for you to bring it up. Do you not bring it up ever because it's offensive to them?

No, of course not. Inaction/silence doesn't harm someone.

Furthermore, what someone who isn't me puts in their own body is none of my business.

You're describing a very superficial form of friendship. A true friend holds you accountable and tells you what you need to hear, even when it offends you.

I thought about your human empathy v culture remark. It is true, empathy is a human trait, however, each culture and society have unique mores of their own. These idiosyncrasies will miss, or emphasize, various aspects of personality en masse, to some extent; evidently, there are different cultures. So maybe in this case, those belly pokers have been indoctrinated to be less empathetic towards what they see as overweight.

Even so, that's contextual. What may be thought of as hurtful in one culture could be considered merely honest in another. Ignoring the things could get lost in cultural translation is an unfortunate way to miss the forest for the trees.

It does seem like it's offensive in america to mention overweightedness at all, which seems like it enables overweight people to ignore it. Seems unhealthy as well, both physically and mentally.

I once incurred the wrath of many on a forum for simply saying that my best friend is quite fat.

100% of the those that were angry were from the U.S.A. and this was pointed out in the discussion by others that didn't seem to see the problem with stating such a simple thing about my best friend and most of those that were angry relented after chalking it up to a cultural difference.

But apparently it is deeply sensitive in the U.S.A. to remark upon a man's weight being too much.

The last time it happened to me was someone's remarking that I was putting on some weight, and I agreed, so I switched to a diet with more fibres and in mere weeks it was fixed. — it seems quite constructive to me.

Yeah I lived in cuba for a work project. I travelled to another city for a month, and when I came back the head of my host family said “you’ve gained weight”. Was probably five pounds or so.

Was motivational to stop that weight gain in its tracks! At that level pretty simple diet changes will turn it around.

In American culture being fat is seen as a moral failing. Calling people out who already know they are overweight is offensive. You aren’t telling them something they don’t know. Likely they have already tried to lose weight and failed.

What's wrong with calling people out for a moral failing? It's more polite to ignore and pretend it hasn't happened, but it's a bit insane too, isn't it?

Well did it work?

It did actually.

A culture that promotes health and well-being sounds great to me. Here in the West any criticism of someone's health gets you sent to HR, or accused of hate speech (ok I'm exaggerating a little but I don't think we're far off from that). Perhaps after covid people will take their health more seriously?

Edit: by health I meant fitness, obviously many people have health issues that they cannot help.

> Perhaps after covid people will take their health more seriously?

I'm not hopeful of it. The problem is that it's just such good business to keep people in poor health. Consider all the products that can be sold to them:

- addictive junk food to exacerbate the cycle

- type 2 diabetes medication

- plus-size clothing

- plus-size identity media

- weight loss programs and medications

Now, I'm not saying that all of this is done intentionally. But what I am saying is that strong incentives exist to keep selling these products and keep demand for them high, unless society as a whole agrees that it's wrong to do so, (as it eventually did with tobacco) at least without warning.

Possibly, although the "healthy living" industry is also pretty large - think about all the vitamins, self-help books / media, non-GM food, etc.

It’s unlikely the problem will be solved until we can get some agreement on what is causing it. There isn’t consensus on this one. Why are people now overweight in many countries when they weren’t 50 years ago? What changed?

Your using it. The computer.

All the interesting things in the world compressed into a device that you mostly use while immobile.

Also, cost per calorie has never been lower, so technology has made it super cheap to feed us.

Are you sure? I would put it now down to the increased usage of cars.

I'm not sure why people think it's their duty to fat-shame people into losing weight. I'm 6'2" and weighed 220 lbs when I was working out three hours a day 5 times a week. You'll notice that's considered 'overweight' and nearly obese.

I'm about 100 lbs. heavier now. I know I'm too heavy. And I need to work on it. Incidentally, a large part of my weight problem stems from an anxiety/PTSD problem. Sugary junk food makes me feel better when I'm not doing well mentally.

Yet somehow attempt to make me feel guilty is going to make me more healthy? It's more likely to cause me to have an eating disorder and further hurt my mental health.

I've had co-workers who binge drink regularly and smoke daily try to tell me my lifestyle is unhealthy. I do neither.

It's crazy how entitled people feel to be rude to overweight people.

Yes you are right - but something has to be done about Western health (I live in the UK, so the populations' health is a concern to me as we have a national health-service - the more people who are sick means fewer resources to go around). As you say, fat-shaming people is unhelpful - but on the flip-side we have "progressive"-types who claim images of skinny-people in the London underground are "offensive" [1].

[1] https://www.huffingtonpost.co.uk/entry/body-shaming-adverts-...

I'm not saying that I agree with the idea that that ad is offensive. But the issue isn't that the person is skinny.

The issue that it's a very skinny model is pictured alongside the words "Are you beach body read?" This implies that the only people who have 'beach bodies' are those as skinny as that model.

The idea isn't 'OMG, skinny people are offensive' The idea is 'The implication of this ad is that only people who look like that very skinny model are beach body ready. Meaning, only incredibly skinny people are welcome at the beach.'

"only people who have 'beach bodies' are those as skinny as that model."

But that's true isn't it? A beach body = someone who is skinny or has abs. This is how we humans view healthy people.

It's something to aspire to if that's your thing.

Personally when I see images of fit, well-toned men, it reminds me that I need to do more exercise. I don't agree that such images should be removed because not everyone can achieve those things.

> INSANE peer pressure.

In China, it's even more so. If you're an obese person and many will throw "wow you're fat" and "you should really lose some weight" right in your face.

Although it sounds terrible, most of the time they're more concerned about you rather than trying to hurt you intentionally. But it does make people feel more guilty about being fat or eating high-calorie foods.

It's really quite interesting that it's really quite easy to insults that come from genuine concern, and insults that come from a desire to insult with no actual concern, and oddly enough, the former is what is often more a cultural taboo than the latter.

Insults such as “Get mental help.” are rarely a form of genuine concern, and fly around far more than legitimate concerned advise that one might benefit from such therapy.

There's also the different family organization. My impression in Asia was that the elderly there spend a lot of time with their grandchildren, to the point where they cannot travel because they're on babysitting duty.

Many people feel younger after playing with kids. I wouldn't be surprised if it also affects you on a more chemical level, for example by triggering different methylation and thereby changing gene expressions.

> I also read that the fear of COVID in Japan is the strongest in the world, despite a relatively low infection/death number here.

I’d expect the former to cause the latter.

From an external perspective being slim and healthy seems like to sensible things to be obsessed about.(Though your comment implies "too skinny" over "slim").

It seems better than "body positive" movements telling us that being overweight is "healthy" despite it being pretty common knowledge that it isn't. To me it's the equivalent of saying that smoking a few cigarettes a day is healthy.

> - INSANE obsession for health. I hear that Americans are obsessed with health, but oh boy, have they looked into Japan. Small clinics are everywhere and they're always filled with anxious patients because they have a benign stomach pain or something. Physical checkup is mandatory for most companies. I also read that the fear of COVID in Japan is the strongest in the world, despite a relatively low infection/death number here. People are always talking about their health, and so is the national media. If you watch the Japanese TV, you'll also feel sick, simply because there's so much fear! Maybe this is good for public health overall, but I bet there's a certain mental toll.

Ah, this explains how the rapey, but criminally attractive, bisyounen love interest in my favorite Japanese love fiction always rushes the protagonist to the infirmary in schools at the slightest cough, missing valuable lessons, and at the approval of the teacher, for merely walking their on one's own ambulance would be too much of a risk, if one have recently caughed.

From what I understand, in the U.S.A. and U.K. schools also have an infirmary and a licensed nurse that works there. — here in the Netherlands, no such thing existed, and a simple cough or headache was certainly not a reason to miss lessons.

The nurses in US schools (I've been out for 15 years, things may be different now) are mostly there if a kid gets a bloody nose, deals with a kid's allergic reaction, verify a sudden extreme temperature to dismiss the kid or generally stabilize before a paramedic arrives if it's serious. In high school, one kid cracked his head open on the gym floor from slipping while playing indoor soccer. Pretty much all she could do was slow the bleeding. Plus, school nurse isnt a cert nurse's first pick in jobs. Which I dont blame them. Who would want to deal with kids all day trying to fake sickness so they can skip class? A simple cough and low fever wouldn't get you out of class. You needed head lice, vomit 3 times within 1 hour, vomit blood, or a 101f fever to get out of class back in my day... or a cracked skull.

But "infirmary"... it's a $25 first aid kit (at best) and like 2 EpiPens. I carry a better medical kit in the trunk of my car just because I like being prepared.

Well, all of those things happened in my school too, including cracking my head open such that I had to go to a hospital's e.r. unit.

All of it was done by normal teachers that would otherwise teach history or geography and simply had taken a first aid course. I do not have a trained nurse at home either, and I can just as easily be hurt so to crack my head open there, dare I say more easily.

Not arguing with you. The whole school nurse thing is more for legality and insurance issues (I imagine). As a kid, I always thought the school nurse was borderline useless. The only thing I can see as being useful, a school nurse knowing how to perform a tracheotomy. Not something I expect a run of the mill teacher (or average person) can do. There's a relatively high peanut allergy rate in the USA amongst children due to our seriously flawed food knowledge and habits. Perhaps school nurses here do know how to do that well, amongst other "seconds matter" care before paramedics are needed. Though, I can't confirm or deny if they do.

> I also read that the fear of COVID in Japan is the strongest in the world, despite a relatively low infection/death number here

You mau want to reconsider your sources because having a promotional campaign to enhance travel during the midst of the pandemic has made lots of Japanese travel all over the place in crowds and stack in small restaurants. Does not match at all with a supposed fear of COVID.

> Maybe this is good for public health overall, but I bet there's a certain mental toll.

I'm trying to weigh this over the model in my country where even in private healthcare the doctors tend to downplay the severity of your ailments.

A friend of mine is currently suffering from multiple afflictions and this is his experience.

I've only ever got roped into unnecessary treatments (only affecting aesthetics really), so it was a surprise for me that even those who have all the incentive to look closely at your problems tend to leave it unless it something that can be done quickly.

The pressure is partially due to an understand of how public healthcare works.

If you're very obese, you're costing all other taxpayers a substantial amount of money. You're being careless with your health, and everyone collectively pays for it.

It's socially irresponsibly to be unhealthy.

I have a hard time imagine that stress and fear over ones health is positive correlated to long life span. One possibility however is that less uncertainty in regard to health has a strong beneficial effect.

> Small clinics are everywhere and they're always filled with anxious patients because they have a benign stomach pain or something

What are you talking about ? They are filled woth old people most of the time because of the large elderly population in Japan. Most salary men are too busy with their jobs to even take a break from office work which is why the OTC market is so large in Japan to treat various ailments without seeing doctors.

> - INSANE peer pressure

As an Italian I wouldn't call it peer pressure, but attention to ones health.

I have a mild condition of high blood pressure, it runs in my family, when my doctor visited me the first thing he said was "you're a bit overweight, let's lose 4-5 kg, it usually helps and if it doesn't we'll work on the drug dosage" (my current intake is a "kids' dose") and it actually worked, I went from a minimum of ~85 to 70 just by losing some weight.

Some body shapes, like being to skinny or too fat, are linked to "not being well".

> but I bet there's a certain mental toll.

We talk about three things in Italy: food, health and weather (and soccer if you are into it, I am not).

There's no real mental toll to it, we just talk about it, but there is no real pressure around it (except those who spread fear for personal or political gain, but that's not different from Trump saying that Mexicans bring 'tremendous infectious disease' to the US).

What's different, I think, it's that we grow up with the notion that "good health begins at the table" meaning that eating well is the most important thing to stay healthy, we keep doing it and teach it to our children.

Japan wearing face mask 24/7 since the 90s I believe (I wonder if it was all started after the diesel scandal)

This is not correct. Before covid only people who felt like thay might have a cold or similar wore face masks, to reduce risk of infecting others.

(This is my understanding after living there for one year and then travelling for a month every other year for ~20 years. I’m not native though so there may be some nuance to mask wearing I’m missing)

IIRC, I've also read that they consider it helpful for allergy season. Japan supposedly has one of the worst allergy seasons in the world due to misguided industrial policy around timber.

TL,DR; After WWII Japan heavily incentivized reforestation to provide cheap domestic timber for industrial and defense purposes, but only with two types of trees, Japanese cedar and Japanese cypress. It turns out that even with this explicit industrial policy, it's cheaper to import timber, so trees weren't being cut down as fast as expected and the forestry industry had a declining workforce that couldn't maintain the forests. The resulting bi-cultural conifer forests grew so thickly that no sunlight reached the forest floor and these forests became devoid of biodiversity. And now all of these trees release a lot of pollen.

10 minute Youtube video explaining all this: https://www.youtube.com/watch?v=VC4gRGPbTqE

“Male trees are one of the most significant reasons why seasonal allergies have gotten so bad in the recent decades.”

https://www.atlasobscura.com/articles/seasonal-allergies-bla...

That’s a US practice.

In Japan this isn’t really a problem, since the forests are clearly able to breed if they are growing denser, and the streets are mostly not wide enough to have trees except maybe on major roads.

There's also Japanese Alder allergy. And various flowers. It's hell for people with multiple allergies because it can be all year round for them.

Allergy sufferers as well.

That’s just false. In many places in Asia it’s considered a must to wear a mask when you’re sick, but nobody in Japan is wearing it 24/7. Not sure where you got this information from.

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