Adult Obesity Facts
cdc.gov
cdc.gov
Obesity is also highly correlated to covid19 hospitalizations and deaths.
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IIRC, slightly overweight (ex: BMI 26 or so) might be better for certain diseases... as having a layer of "emergency fat" for your body to consume during a sickness / illness is beneficial... with respect to a disease. Its worse for long-term health however.
However, "Slightly overweight" is also a condition for strong athletes, as muscle is far more dense than fat. So many strong and healthy athletes are technically overweight (but incredibly healthy). So IIRC, there's a bit of confounding going on in the overweight category.
Once we start getting to the obese category (BMI 30+), the number of muscular people in that group diminishes, and the vast majority of Americans in that group are in fact, unhealthy and sedentary individuals. (I'm sure there's some healthy boxers or wrestlers who are BMI 30+, but they'd be in the gross minority of BMI 30+ individuals in this country)
I saw a fascinating pre-print paper here a while ago: A Contamination Theory of the Obesity Epidemic. via: https://news.ycombinator.com/item?id=27936016
I also read an interesting book lately called "The Dorito Effect" in which the author makes the case that we have a finely developed ability to associate the flavour of food with the nutrients we get from it (and, when we need nutrients, we'll crave the foods that offer it), but, 1) food's flavour and nutritional value has become diluted as we've bread for larger yields, and 2) we add synthetic flavourings to everything, messing with the ability to crave and eat the foods we need.
They're probably more delicious though.
The key is to break the flavor dependence, then to only have healthy foods.
Broccoli always tastes the exact same.
This made me say "whoa!" How are asian adults so much lower probable obese?
Also can we please have a COVID-19 sized response to this issue? > was $147 billion in 2008.
And I've heard elsewhere the _economic_ impact is even greater in the long tail of small but numerous costs of obesity. For example the fuel cost on a flight is greater, or premature mortality meaning that education investment has a lower ROI.
Then the second and third generations pick up bad eating habits, namely alcohol and eating out.
But from my trips back to my parents’ country, I see a lot of fat rich people and fat kids who have rich parents. In the US, I feel like I hardly ever see rich and fat people.
So it is probably a pendulum where you go from being poor and having to eat home cooked food and not having access to excess calories, and then you might pass on some of those good habits to your kids, but the grandkids will not have them. But then if you are in a social circle that is all relatively rich where being fit is valued, then you might start focusing on being fit rather than enjoying all the wealth you have.
People still complain about portions being too small at places with massive portions, restaurant owners feel pressure to keep them large.
Most Americans concept of "value" is not quality, it's quantity. Being unable to otherwise judge a thing on its merits, they take the bigger one. Not the one that is healthier, or more nutrient-dense. This, IMO, stems from the industrialization of our food supply.
America came of age in post-WWII industrialization. Our food industry originally "began" because it was scaling to cheaply meet the food and logistics needs of a massive war.
So Baby boomers (and therefore subsequent generations) learned to buy shitty, processed food "For America". Buying a box of mac and cheese isn't like picking out the best vegetables. All things being equal, you just get the biggest one for the price.
This could be helped if the average person took more responsibility for their own health and wellbeing, easier said than done as there are many pressures on people now that weren't present 10, 20, 30 years ago.
While exercise is an important aspect of weight management, the single biggest factor is nutrition. So while I'd love to see more people getting off the couch, for no other reason than they'll feel better for it - addressing the food component is critical.
To make big strides in addressing this epidemic around the world, governments would need to start making sugar and fast food unattractive by imposing significant taxes. In parallel, they'd need to make high quality, nutrient dense foods cheaper so it is the obvious choice 6 out of 7 days.
At face value, that seems might seem daunting or unachievable but many governments have incrementally increased taxes on cigarettes as an example. As they get progressively more expensive, it gets harder for the average person to justify spending that money and coupled with education programs in schools and so forth it changes peoples behaviour over time.
people don’t care what they’re eating and don’t try to figure it out. this is a personal responsibility and it’s cultural, not universal. from this link not every demographic has the same obesity rates
If you visit any chain restaurant, nearly every meal (even the healthy looking ones) has added sugars and simple carbs.
If you limited your purchases to the "healthy" options, you would basically had to buy fruit, vegetables and raw poultry, meat and fish.
[1] https://mexiconewsdaily.com/news/new-warning-labels-now-requ...
"US Adults are 42.4% obese" leads me to believe that all US adults are 42.4% of the way to becoming obese, where as in actuality it appears that 42.4% of US adults are obese.
> The US obesity prevalence was 42.4% in 2017 – 2018.
So with the medical definition of obese not matching what peoples' eyes tell them, I'm not surprised that 42% are "obese".
And normal they are, but it's just a bad reference point.
I agree that the perception of "normal weight" has probably changed over the years, but I think "obese" has always meant something more extreme to the layman than it has to a medical professional.
Of course, there are many nuances. Your musculature (though surely if you were a bodybuilder you'd have said so). Your sex, both for where fat sits on your body and for social expectations. The clothes you wear. Normal human variation - if your femurs just happen to be -2 standard deviations in length, your BMI will always be higher than it would be otherwise.
Someone with a BMI just into the thirties can still have a good level of walking-around fitness, look good in a shirt, etc. They wouldn't stand out in today's society. But the medical risks are still increased in a statistical sense. It being normalised may make people feel better but doesn't solve the medical issue.
And I happen to think my legs are short for my height, and my arms are a bit long. It's worked out quite well for me.
But my point was simply that the number will seem hard to believe for many people if they don't realize that the layman word "obese" means something slightly different than the medical term.
My wife and myself are not overweight and have never been. She was a tom-boy and a jock during high school and did intramural stuff in college. I was on high school track team and either walked or rode my bicycle - no car. While in the military, most of the people in my shop had to eat 4x per day to maintain our weight. Afterwards, during college, I lived on cheap beans and pasta or rice, and the occasional can of cheap tuna, and peanut butter sandwiches until I met my wife. She taught me how to cook and introduced me to much better stuff. So I did not eat 'correctly' until my early 30s.
Until the last two years, we had remained physically active and were never overweight. We have gained some weight but are not overweight and, other than the incident that severely curbed our physical activity, have had no significant health problems.
The pattern of life-long activity and a physical mind-set seems to be a common factor when you look at older healthy people (over 55) that were never overweight, regardless of food quantity and type consumption.
You either are lucky enough to have decent genetics and the willingness to start an active life well, or you go through life increasingly overweight with chronic health problems.
https://www.health.harvard.edu/blog/artificial-sweeteners-su...
Despite their widespread consumption, I have yet to see any reports of people being directly affected by them, at least in the amounts currently consumed.
> Dr. Robert Lustig, an obesity expert and professor emeritus at the University of California, San Francisco, said that artificial sweeteners confuse the body: Their sweet flavors send a signal to the brain and the digestive system to brace for a flood of sugar. But when those calories never arrive, it can send hormones like insulin out of whack, over time leading to metabolic dysfunction, he said. > “The short answer is that artificial sweeteners are probably better than sugar, but not by much,” Dr. Lustig said.
NYT: https://archive.ph/MoRg7#selection-887.0-891.114
The difference between smoking and vaping is far more vast than the difference between sugar and artificial sugar
Makes sense.
> Although the difference was not statistically significant among non-Hispanic Black men, obesity prevalence increased with educational attainment.
That's unexpected. So every other demographic gets less fat as they get more money/education, but Non-Hispanic Black Men get more fat as they get more money/education. I wonder why.
1) Those who had X but overcame it, or 2) Those who've never had it.
Almost everyone, AFAICT, looks to Class #1. Indeed that's useful.
However, Class #2 also can instruct. Asians are much less obese than non-Asians. What do they eat that you can learn from?
https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/en...
Luckily I fall into the "normal" category, but trying a few variations suggests to me that clinically obese is not necessarily the same as what I think most people would consider "classically" obese. Certainly some very fit/muscular people and even elite athletes such as Alex Ovechkin are (very nearly) clinically obese.
Perhaps it is time to add a few more parameters to the obesity calculator.
If the average person suffers from what should be an anomaly, perhaps it is less a personal failing than a societal failing and we should try to fix the societal problems generating the poor outcome.
What would this look like policywise?
I really could go on.
At the local level, it is up to you. In my city of Pittsburgh, we are removing parking and expanding transit access and bike lane coverage. But there is still a lot to be done, so I am advocating for change by participating in groups and contacting my city councilman.
I know many would prefer bike lanes, but bicycle infrastructure isn't always safer for cyclists. Often city planners have no concept of what actually goes on, so even when token lines are painted on the street - it does nothing to increase cycling.
It may be best to put aside the issues of investment and which top-down solution is the best. There may be a time and place for that, but in the near term individuals with an interest can develop their skills incrementally.
Disclaimer: I am a self admitted cycling extremist
Most people do not care what form of transportation they take. They do not identify as cyclists, drivers, or anything else. Transportation is an inconvenience in their lives as they travel from A to B. They will do whatever is cheap, fast, and convenient.
Cities need to be built to a human scale and not a car scale. Cities should be designed so that riding a comfortable, durable, upright bicycle is a fast and convenient option for people. That means bicycle paths that are physically separated from other forms of traffic. It means constructing different kinds of buildings and businesses so that bicycle routes are short and convenient.
Most people are never going to risk their lives to ride bicycles on roads where cars, driven by people on their phone, are travelling at speeds exceeding 30 mph. They won't ride their bicycles for an hour over the vast distances that are convenient for cars to travel in a few minutes. And they won't take their bicycle to a big box store with car-parks larger than the store so that they can clumsily chain their bicycle to a street light pole.
If you want normal people to ride bicycles as transportation, you need extensive bicycle infrastructure.
>Most people are never going to risk their lives to ride bicycles on roads where cars, driven by people on their phone, are travelling at speeds exceeding 30 mph
From my admittedly biased or perhaps experienced perspective it really isn't as dangerous as people imagine.
What is clear to me is that no matter what happens, there will always be a contingent of individuals who will never ride a bicycle. Whether that is because of imagined safety reasons or because of infrastructure fantasies, I can't say. I can say with certainty that if you eliminated both of these objections, another excuse would be raised. That's fine. People should choose the lifestyle that suits them and brings them happiness.
Pick a "first world" country with much better BMI. Copy all of their regulations surrounding food and agriculture.
What about rolled oats or steel cut oats? They're clearly "processed", oats don't look like that when they come off the plant.
Potato chips + fries are just cut potatoes dropping into a vat of oil. Oil itself isn't very much processed either. But we all know that potato chips / fries are unhealthy and shouldn't be eaten all the time.
Cheese or butter require incredible amounts of processing to get done. But when properly portioned, they are part of a healthy diet (more so than potato chips anyway).
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Is honey any healthier than sugar? Is juice healthier than soda? From an obesity perspective, not really. You really want to be cutting back on these empty calories. (Sure, juice is __slightly__ better than soda cause juice has vitamins in it. But... its actually not that good for you)
Because "unhealthy" is a better starting point than the arbitrary metric "processed".
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You're going to do more for your health by cutting back on your rice portions, rather than worrying about what is or isn't processed. (And rice is barely "processed" at all... but its incredibly calorie dense with high glycemic index).
Switching out bread portions (since bread is highly processed) for rice portions won't do you jack diddly squat. Both are high calorie / high glycemic index foods.
And yet Asia has basically no obesity problem. We clearly need better nutrition science.
Citation: I'm Asian-American. Also, Filipino. We're not obese, but erm... Americans might be healthier, no joke. The amount of lechon we consume (incredibly fatty pig) + other fatty foods is a big problem to heart health, despite the fact that it doesn't cause obesity.
Oh, and Filipinos generally eat fresh foods. Fresh fish, fresh pork, fresh chicken. Relatively low processed foods (our Halo-Halo is similar to your "ice cream", except Halo-Halo is just milk poured over shaved ice + fruits + ube mixed in. "Low processing", but we all know its a desert and unhealthy).
That's the thing. Being Filipino gives me more insight into this "processed food" craze going on. Halo-halo has almost no processing involved and is made out of fresh ingredients. That doesn't make Halo-halo any healthier.
> And yet Asia has basically no obesity problem. We clearly need better nutrition science.
We all know beer and soda is bad for us, and yet we drink it all the time as a society. I'm not sure what nutrition science is beneficial when so many people choose to ignore it.
Cut back on high calorie foods. Watch your portion sizes. Count calories. Eat more fibrous meals to fill up your stomach ("tricking" your brain into thinking you're more full). Avoid non-fibrous foods (such as soda) because they miss out on the stomach/brain psychology.
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Its hard in America because of stupid little things. Plates are bigger in America, so when you're in America you trick yourself into putting more food into your plates.
Plates are literally smaller in the Philippines. So you end up eating less. Stupid cultural differences like that make a big difference.
Because American culture subtly forces you to overeat (bigger plates, bigger glasses, bigger drinks), you need to explicitly count calories. That's just the facts, if you aren't counting calories in America, you're going to overeat.
One policy choice (amongst many required) could be to stop subsidizing the inputs to junk food.
Another policy I've heard talked about by Joel Salatin is that a lot of low processed foods are getting crushed by regulation because the cost/barriers are very high and demand scale/volume. For example poultry processing is only feasible on a massive scale because of regulation policies like (paraphrased) "there must be a dedicated washroom onsite for the inspector to use". That makes no sense if you only process 10000 birds a year (something like $100k of gross market value).
NYC's obesity rate is half of the nation's; we could still do better, but it's a starting point.
This is a function of density. We walk more. Look at the boroughs that drive and they're closer to the national average.
Replicating this in e.g. San Francisco would require overcoming the anti-development NIMBYs. That's a hard problem.
Part of what I loved about living in Asia (Taipei, Tokyo, et al.) was that public transit required walking to, between and from stations/stops. It's not much but it's just enough.
Sugar is in everything. Snacks, restaurant food, drinks, sauces. It puts the metabolism into a bad state and desensitizes the body to its deleterious effects. Before you know it you're overweight, mentally foggy, and pre-diabetic. Not a good place to start working out or going for outdoor activities.
People exercise and walk more when they have energy to do so. Sugar saps that away.
Look at people in other "confined" spaces: submarines, ships, the space station. These people are not overweight for lack of walking.
It's diet.
America is pumped full of sugar.
edit to respond to comments (since I'm flagged / rate limited) :
Someone with a healthy body and mind won't "sit on their ass 23 hours a day". They won't consume too many calories, either.
Sugar pushes the body into more lethargy and higher sugar consumption.
His point basically is that Sugar is not in any way except for how it contributes to excess caloric intake. The key here is that sugar contains calories and can attribute to hyper-caloric state. But you can also eat lots of sugar and be in a hypo-caloric state. Therefore sugar has nothing to do with it. Total consumption is everything here (and body fat percent).
Have a watch of these videos:
https://www.youtube.com/watch?v=9JrT84PeTgw
It's true that countries where they don't put sugar in everything—or don't use HFCS at all—don't have this problem.
It's also true that between 1950 and 2000 portion sizes went up. For everything. If you travel in France and Italy, known for butter and pasta heavy cooking, respectively, their servings are half the size of the typical American restaurant.
At the same time, if you go from a walking city in the US to a suburb where it's all cars all the time, the visible difference if you just look around at people is jarring. Sure, cities might eat differently, but not that differently.
I'm not anti-car, but in some places the 100% sedentary lifestyle is a big part of the problem.
Do people want walkable cities? Or do they want single-family dwellings and yards?
Do people want to be healthy? Or do they want sugary foods and television programs?
Fortunately, the U.S. has plenty of each, to accommodate multiple preferences.
Life is trade-offs. It's the conceit of policy makers to force their trade-off preferences on people.
As of 2010, close to 24 million Americans lived in a "food desert"[1], i.e. an area without adequate access to healthy eating choices. These areas are disproportionately lower SES areas, and the people in them don't get to have a "preference"; the decision is being made for them.
Edit: Here's a paper explaining the correlation and absence of choice in detail[2].
[1]: https://en.wikipedia.org/wiki/Food_desert
[2]: https://academic.oup.com/nutritionreviews/article/66/4/216/1...
So, yeah, that's exactly my point.
This isn't forcing people to make a decision, it's including all of the costs in the dollar value of the product on the shelf.
But as much as possible, it's best to reduce decisions to the individual level.
Average rents indicate that Manhattan is once again the most highly desired place to live in the country, and for good reason.
(A) Emphasis on "onward." There's a massive amount of development since 70 years ago; if it were a fluke there's been ample opportunity for it to change.
(B) Who chooses urban planners?
(C) A large number of people want to live in dense population centers. Also, a large number of people don't.
Something else is a major contributor to this.
Research had came out indicating that exercise doesn't really do much good in losing weight. Might help in maintaining weight.
Running a 5k doesn't even burn 500 calories for most people, but you can eat that much in snacks without a second thought. To really make a difference in weight the much more important side of the equation is intake.
If the desired outcome is an improved quality of life, exercise has a plethora of mental-health benefits [0], cardiovascular and energy improvements[1], and has negative correlations with some of the risk-factors of obesity, like type 2 diabetes, high blood pressure, and some cancers [1][2].
I would hate for someone to read the common response and conclude that since obesity is causing their problems and weight loss seems more affected by diet changes, that exercise doesn't matter and can be safely skipped. To have a different life a lifestyle change is needed.
[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1470658/ [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6172294/ [2] https://www.mayoclinic.org/healthy-lifestyle/fitness/in-dept...
Of course there are exceptions, but we're a long long way from only having the exceptions left.
People also don't know tricks like meal preps, sous vide, and slow cooking.
Rice has a fairly high glycemic index. Nothing wrong with eating some rice in moderation, but getting the majority of your calories from rice isn't healthy.
https://www.health.harvard.edu/healthbeat/a-good-guide-to-go...
McDonalds and their ilk, have created taste formulas that are nearly irresistable. I've seen people from foreign countries come to america who've never tasted anything other than their local cuisines who can't imagine eating anything else. but the second they sink their teeth into a McDon hamburger, they are hooked.
MSG has been shown as a super reliable way to make mice obese: there's even a scientific procedure named after it: "MSG induced Obestity". It's a standard procedure used as a precurser to obesity experiments on rats. If it's that reliable on rats, just imagine what it would do to humans.
https://www.mcdonalds.com/ae/en-ae/your-right-to-know.3807.d...
I don't think fast food restaurant necessarily create delicious superpalatable food.
In reality, from a very young age people are bombarded with advertisements and other marketing materials that promote foods packed with sugar, carbs, and salt.
Cinnamon Toast Crunch is "part of this complete breakfast." In reality, it should never be a part of any breakfast.
Unhealthy foods are sold as healthy, e.g., the Nutella scandal: https://www.npr.org/sections/thesalt/2012/04/26/151454929/nu...
Another example: sugary, calorie-laden "vitamin" drinks and other "healthy" trends like flavored/sugared Kombucha, juices, etc.
I remember seeing advertisements from Coca-Cola "debunking" the idea that soda doesn't have hydration benefits.
Then you start realizing that doctors and other experts are receiving free materials from food and drug manufacturers. The food pyramid is influenced by food industry lobbyists.
So you're talking about it as if it's all "choice" but that becomes a very complex subject once you start following the money. The nutrition scientist at your local university or the dietician on main street doesn't have a marketing budget, but PepsiCo sure does.
However, despite that, I have a hard time believing that most people think eating at McDonalds is healthy, or that drinking Coca-Cola is healthy, or eating a bag of chips is healthy. They know it's not. Don't they? Am I wrong about that?
But there are a lot of products out there with more grey area than the typical McDonald's menu item.
For example, the Dunkin' "Power Breakfast Sandwich." The marketing sounds healthy without saying the words "healthy:" https://www.dunkindonuts.com/en/menu/sandwiches-and-more/pow...
Notice how this item has almost half your daily value of saturated fat! High cholesterol, high sodium!
A lot of people would see this menu and think "this is a good alternative to McDonald's."
Same deal with Subway. Jared was selling us on weight loss via eating sandwiches, but he himself didn't eat the Sweet Onion Chicken Teryaki – a.k.a. Chicken on Bread with Sugar Sauce. Subway was promoting footlongs (five...five dollar...five dollar footlongs!) specifically, a portion size that is objectively too large for a single meal unless you're skipping a meal or eating with basically no condiments. Everything about Subway is healthy-ish until you get to the end of the line and you have a spread of caloric sauces to choose from (all free) along with a translucent case of cookies, addictive chips, and unlimited-refill soda.
Another example: products labeled "no added sugar" that are largely sugar, such as orange juice. Sure, it's slightly better than added refined sugar, but it's still sugar and it's still calories.
I once dated someone who thought their daily Dunkin' Donuts coffee was a low-calorie menu item. Nope! It's 300+ calories, because it was a latte in a large portion size with sweetener. But it looks really similar to low-calorie items.
Portions are a huge issue, too. A lot of those fast food chains make larger drink and side sizes in the USA compared to the exact same menu items overseas. Why this is, I'm not actually 100% sure – maybe a more competitive fast food market in America where these companies are trying to beat competing restaurants in value?
All of this is to say:
1. We can't assume the average person's nutritional knowledge is very good. It's barely taught in school and the schools themselves are doing basically nothing to promote healthy eating. My public school provided meals like pizza, smiley-face french fries, Little Debbie desserts, and an entire cookie and slushie stand. They actually helped get me addicted to bad food!
2. We can't assume that the general population has any idea what rational portion sizes look like. This has been distorted beyond belief.
3. We can't even assume that the general population knows what a healthy-weight person looks like anymore! I had family members concerned about one family member who lost weight down to a healthy weight. They thought that this person was starving or something like that, even though they were basically the only person in the family who had reached ideal weight.
I know I ranted for a long bit here but I think the USA in particular is long-overdue for some really major reforms surrounding the food industry. There need to be serious restrictions on advertising, portions, and macronutrient transparency. Bad food should be treated a lot more like cigarettes. For example, if I could make all the decisions I'd make it illegal to mass-advertise any food item that exceeded certain daily value macro-nutrients like saturated fat, sugar, calories, etc. Sure, you can sell them, but you can't put them on TV.
That's not our ancestors eat, and that's not how I eat either. Though I did quit drinking half and half after realizing that it's supposed to be a food item rather than something to drink.
A lot of “default” portion sizes are too large.
A lot of companies heavily imply unhealthy products are healthy or beneficial.
A lot of high-calorie items are marketed as something that is okay to eat regularly and not just as an occasional treat.
That’s why in my mind advertising and packaging regulations are being underutilized.
Think of how cigarettes warn you about their unhealthy properties, and aren’t allowed to be advertised on TV. A lot of food products should really have similar restrictions.
E.g.:
“Caution: a full portion of this product provides an elevated level of sodium, increasing risk of heart attack and stroke.”
“This menu item exceeds recommended calorie levels for a single meal, and may cause weight gain and obesity with regular consumption.”
“This item is a high sugar item, increasing the risk of diabetes. Complications of diabetes can include nerve damage and glaucoma.”
- In the documentary Fed Up, it showed how Michelle Obama had to back down to the big food companies over her push for healthier food.
- I worked with bariatric surgeons and some incredibly cited papers stating that people can’t lose weight by diet and exercise alone. The surgeons I knew were incredibly narrow-minded and uninterested in any counter arguments.
- Sleeve gastrectomies are the most effective technology to fight obesity. If someone can’t change on their own in 10 years, then it is a good option. It removes 90% of the stomach including the hunger hormone ghrelin.
- The surgeon I worked with had a sleeve procedure, stretched his stomach out, and had a 2nd sleeve.
- Long term, the food environment has to change. Living expenses are high, work demands are high, people are stressed and all the easy options are terrible for you.
- We should distribute good meats, foods, vegetables and essentials in an entirely new way.
- Our business leaders like Buffett and Gates need to realize the absurdity of respectively owning Coca Cola and selling potatoes to the fast food industry. Buffet also owns DaVita, a dialysis company. Gates promotes global health but earns money from french fries being sold at McDonalds.
It's not obvious, but there are some ways to trade relatively small amounts of inconvenience for food that's healthier and often cheaper.
Some people will cook enough food on a weekend to last the rest of a week with refrigeration, optionally dividing it up into single-serving containers. Since a lot of recipes scale up well, this ends up taking much less cooking time than doing one meal at a time, and the labor is shifted to weekends when you might have more energy. A quality-of-life variation on this idea is to do ingredient preparation for a week on the weekend -- chop the vegetables, measure things out, etc. -- and cook meals for four days, then do a second (much quicker) batch of cooking mid-week so the food doesn't spend too long in the fridge. Googling for "once a week meal prep" will turn up a lot more information on this.
The big problem with the approach above, of course, is the monotony: having only a handful of meal choices each week can get old after a few days. For people who are willing to cook more often but would still like to economize on time, this guide from last year on quarantine meal-planning for people who normally don't make most of their food at home is very good:
https://www.seriouseats.com/our-tips-for-meal-planning-durin...
In particular, the big thing to take from it is the idea of making larger batches of meal components that you can quickly put together in various combinations with different flavors, which lets you save on cooking time (and shift it to when it's more convenient) while also giving more variety in your diet.
https://www.endocrine.org/news-and-advocacy/news-room/2014/r...
People are less active in their work and lives, and not just a little bit.
The fact is that multigrain bread, oats, beans, lentils and peanuts are all cheap, filling good sources of fiber and protein. Large animal protein portions are rarely truly needed.
Combine that with some vegetables, a bit of oil, some spices, a modest portion of pork/chicken protein, and you end up with an inexpensive healthy meal. I understand that eating well has other costs (namely, the time and effort it takes to make it and clean up afterwards). For people who value their health, this cost is usually acceptable.
If people tried to follow normal dieting advice, and they failed, do we keep telling them to try harder?
I am speaking as someone who had lost a lot of weight and achieved near normal BMI and had prioritized health. I found intermittent fasting to be much easier and less willpower taxing than counting calories, which was way too much work.
People do want to be healthier and a lot of people really tried hard. Problem is, in other societies, it's effortless.
The Dutch attitude towards walking, cycling, food and sports makes it extremely easy to manage one's weight, if you buy into it. When I visit my home country, no one in my family / friends circle enjoys walking. Most don't enjoy exercise, but they are truly fond of barbecues, beer, soft drinks and other such hyper palatable foods.
Had I remained in my home country, I would just be one more data point toward the obesity statistic, just by virtue of putting some effort to fit in.
Consider this - most people spend 40+ hours at work, 5+ hours in commute, only to go home and spend most of the rest of the waking hours doing house chores or attending to family needs - this is a truly epic investment of human effort, yet almost every adult does it without thinking and nobody thinks it's exceptional, thing is, it's kind of expected of people. Compared to that, the amount of sacrifice needed to get healthy is miniscule - only the lack of boring routine and social expectations make it seem otherwise.
It's much easier to do something you have to do. Much harder to do something that isn't required of you.
Sorry, but no. The person you're replying to made some spot on points.
If a person wants to maintain some semblance of physical fitness then they are going to have to work for it. It's astounding that this concept gets lost on so many people, as if having a normal-sized physique should come naturally to someone who lives a sedentary yet gluttonous lifestyle.
Also, to their point about being fat having become socially acceptable. Yes, it is true, at least as far as women are concerned. So much that euphemisms are being used all the time: plus size, curvy, thicc, voluptuous, and so on. I've heard people even use the term "athletic" to describe a thicker person's physique.
> If people tried to follow normal dieting advice, and they failed, do we keep telling them to try harder?
Really depends on how hard they "tried". If a person is actually determined to maintain a good physique, then yes they have to work at it AND they need to be honest with themselves about how much food (as well as the type of foods) that they consume. If someone gives up after a week of dieting and exercise because they don't see significant results or because it's just too hard for them to maintain then that's entirely on them. If they want to then view themselves as a victim, then that just shows a lack of accountability.
I am mostly concerned about health, rather than physical fitness.
Really depends on how hard they "tried". If a person is actually determined to maintain a good physique, then yes they have to work at it AND they need to be honest with themselves about how much food (as well as the type of foods) that they consume. If someone gives up after a week of dieting and exercise because they don't see significant results or because it's just too hard for them to maintain then that's entirely on them. If they want to then view themselves as a victim, then that just shows a lack of accountability.
Trust me, I am the first to sign up for accountability and looking over your health. I exercised fairly consistently and lost 30-40 pounds to the point of being almost normal BMI. Just need to lose like 5 more than I'll be happy.
People really do want to get healthy, and they spent prodigious amount of effort, and failed anyway. Maybe it's something wrong with our strategies/approach then it is something's wrong with the victim.
In the end, I don't really think it's an issue of gluttony either. I love food. I still eat a lot when I can, maybe even too much. However, I basically don't drink soda, or even artificially sweet soda, and excluded most sweets thing. Trying to make sure I eat veggies.
Well, perhaps. If multiple different factors (say: car culture, ease of food delivery, prevalence of tasty-if-unhealthy food, peer prestige via excess, and targeted advertising) -- or perhaps more -- combine, they can actually create an overriding sense of social acceptability that you then cite.
In that sense, the social acceptability becomes a defensive moat for all of the problematic practices that have created the obesity problem in the first place; and rational people will join in defending the moat rather than questioning what is behind it.
You can eat anything - vegetables, meat, fish, potatoes, pasta, bread - and be pretty thin. If you add 500 calories of dressing to a salad, then no matter what you eat, you are doomed... also, that and spices would bomb out your taste buds, so you wouldn't even be able to enjoy "purer" food anymore.
I wonder if we would find better connections between disease and "weight" with body fat % or similar measure.
On a population level, BMI actually underestimates obesity https://abcnews.go.com/Health/Wellness/bmi-underestimates-pr... so the real obesity percentage is probably even worse than 42.4%
1. Is it a "good enough" metric? 2. Is it "wildly inaccurate" for most, or just some outliers?
BMI can't be inaccurate, though conclusions drawn naively from it can be.
My point is that measuring obesity purely by weight is naive and leads to massive overcounting.
I’ve seen people exposing “body neutrality” lately - the idea that you should detach your sense of self worth from your body entirely, and simply view it as a functional thing. For example: “I’m not a bad or failed person because I’m overweight. I appreciate that my body allows me to live my life. However, my weight is negatively affecting the functionality of my body, and so I would like to change that”. Personally I think this is a much healthier mentality.
"It's society"
"It's portions"
"It's plastics"
"It's activity"
"It's overeating"
"It's contaminates"
"It's education"
"It's just calories"
This is a complex problem, and you are not experts. It could be some or all of those things, but this kind of pet-theory reductivism doesn't get us anywhere.
Hacker News talking about technology is usually able to engage with a topic or article with some manner of substance, or at the very least, informed by professional familiarity. In this case, as far as I can tell, no one even read the site's information beyond glancing at the troubling stats.
Taking a quote from the same area of the CDC's site, which articulates a clearer thesis and goal than here in the comments:
"Obesity is a complex disease with many contributing factors. Neighborhood design, access to healthy, affordable foods and beverages, and access to safe and convenient places for physical activity can all impact obesity. The racial and ethnic disparities in obesity underscore the need to address social determinants of health such as poverty, education, and housing to remove barriers to health. This will take action at the policy and systems level to ensure that obesity prevention and management starts early, and that everyone has access to good nutrition and safe places to be physically active. Policy makers and community leaders must work to ensure that their communities, environments, and systems support a healthy, active lifestyle for all."
The problem is not car culture, sugar, and processed foods. The problem is overeating. America, and the rest of the first world has major issues with food addiction and a culture associated with "eating until the plate is clean"
We've had a food surplus for a long time, why is obesity a relatively recent problem?
Why are chefs nearly always overweight? They work incredibly hard and tax their bodies for 10 hours a day. They aren't sitting in drive throughs. Maybe it has to do with the fact that they are around food all day and consume large quantities of it
These people must burn at the stake.
Our foods are unhealthy (low nutritional value, even if they provide the calorie content necessary to live; vitamin and mineral deficiencies lead to poor health outcomes).
Our foods are often too high in calories (portion sizing, sugary drinks, "coffee" that's 90% sugar).
Our culture is increasingly sedentary (cars versus walking and biking, television and computers that are engaging and help people lose track of time idling away on the couch).
And plenty of other factors I'm not thinking of right now. You can't point to any one of these and say this is the problem. They're all problems and all need to be addressed. Educating people on the impact of food choices and health (not even obesity, all the other health impacts). Reconstructing cities without the need for a 30+ minute commute to work or a grocery store. Emphasizing community activities that get people out of their homes and away from their televisions and computers (harder right now with COVID restrictions). Discouraging (by some measure) restaurants from serving grossly unhealthy serving sizes.
Some of these are more feasible than others. We aren't going to rebuild cities any time soon. Public transportation is a political third rail. People in some regions enjoy aiming their trucks at cyclists (too many close encounters in GA for me to even want to use a bike lane in that state again). Others are more feasibly addressed though.
You aren't going to "walk off" a 1500 calorie burger, unless that's the only thing you eat that day
Sugary sodas and drinks are not eaten, consequently what was a healthy and satiating meal is now overeating because people are getting 250-2000 extra calories a day (250/bottle of soda approximately). Drop the sodas and many people won't be overeating (or overeating to the same extreme) as they are now without changing their diet.
Poor nutritional quality of foods can be disruptive to metabolism and health in general. Which again can mean that what was an objectively healthy portion for them becomes an unhealthy portion. As an example, low iron (anemia) decreases a person's ability to engage in physical activity and leads to an increasingly sedentary lifestyle. So that a 2000 kcal a day diet that may have been healthy is now overeating.
The general sedentary nature of people also means that what was a perfectly reasonable diet for our grandparents and great-grandparents is now overeating. When people spend 1-2 hours a day sitting so that they can go from one place where they sit for 8-10 hours to another place where they'll sit in front of a computer or tv for another 4-5 hours and then sleep, their calorie needs are barely above that of someone who is bedridden for illness or injury.
Restaurant portion sizes are outrageous (though, anecdotally, the last few times I've been to a restaurant they seem to have toned it down). That is a problem. But these other issues cannot be neglected because it's a system, they all interact with each other.
And then I get a mass of people complaining that "it's not that simple! x y and z also impact weight!"
I think so much has to do with these two points:
1. Most don't know about CICO.
2. Many who do throw it away as not useful.
We should be teaching this in school health classes. I'm not sure if we are, as I'm from the food-pyramid era which was not even close to useful.
Edit: I went from +7 to 0 in a very short period of time. This isn't me complaining, this is me making my point. People downvote the most fundamental component of weight control, even among a likely more educated than average group of people.
Too many people complain about tracking calories not working for them, and I guarantee it's that they weren't tracking properly.
Edit: Oh another thing: with stuff like protein powder measuring itself in scoops, they tend to be way off in how many grams are in a scoop. I don't know how they get away with it, but if you measure with a scale how many grams are in a scoop, it can be like 25% more than what it says on the tub
However, now we have two options:
1. Education
2. Banning a ton of food-types.
Both seem hard at scale, but #1 can be achieved on an individual level, at least.
Or people will try to do something like cutting the 30 calories of cream from their coffee, while leaving their 1,400 calorie lunch untouched, trading big expenditures in effort and habit changing for tiny calorie improvements.
With broad strokes, those failures can be lumped into 2 categories: 1) lack of willpower (pretty self-explanatory) and 2) hoodwinked, bamboozled, and otherwise tricked by food package nutrition labels.
It is genuinely hard to discern real calories consumed using just food labels, and not 3rd party sources and at-home food scales.
That's the part that people don't understand, I think.
Source: I was fat, now I'm a little less fat because of CICO. Still kinda fat, but getting less fat slowly. I learned early that nutrition labels are your enemy and are just another marketing tool used by savvy companies.
In the US it's tightly controlled. The only thing I can think of (calories wise) is that people only look at the per-serving calories and not the per-package calories. This has gotten better over the past 5-10 years but still requires people to actually read it.
My method of losing weight and eventual weight maintenance, is intermittent fasting.
It just means that I don't eat for long periods of time. Every week, I undergo a 48 hours fast and for the rest of time, I effectively only eat one meal a day.
CICO does not mean counting calories. Counting calories is just the most direct diet. IF and Keto end up doing the same thing, just differently (and it's potentially easier for some).
There's a lot of talk online about how processed foods are making us fat and I think there's something to that. The CICO model doesn't factor in how our body processes macronutrients. We didn't evolve to eat the diet we're currently eating (ex: sugary drinks). I think there's something to eating a diet that's more in-tune with how the body works.
The key question though is not whether you are paying attention, but whether they are down or not. It is possible that you are getting full on fewer calories.
That's the whole point, and a key component of any CICO diet: finding foods that make you feel full with fewer calories.
Can some diets impact how many calories you burn? Sure. Not really to the extent that you need to worry about it, though.
Can some diets be effective but unhealthy? Of course. You can follow CICO and lose weight by eating nothing but twinkies[1]. That doesn't mean it's healthy.
At the end of the day, your lazy keto diet allowed you to consume fewer calories than you burned. You just didn't have to keep track.
[1] http://www.cnn.com/2010/HEALTH/11/08/twinkie.diet.professor/...
CICO still applies to Keto, the macronutrient breakdown is just more satiating for many people. It's important for people doing keto to understand this as
1) Keto has a dramatic water weight effect, so people can overindex on their early results "I lost 10 pounds in 5 days!"
2) If you go off track with carbs it becomes a terrible diet, you fall out of ketosis for multiple days and need equivalent carbs to feel ok, boosting your total calories very high.
I agree we should be teaching food fundamentals in schools, but it’s pretty hard when cereal and soda are so normalized. Normal food just tastes worse in comparison (I’ve lost count of the number of people who limit their food to chicken tenders). If you have parents who don’t cook, it’s pretty hard to break the cycle and your food preferences will likely shift to what’s readily available.
I think it’d at least be enlightening to show people how the food is made, so they could see for themselves. Perhaps they could have a lab where you make soda out of cups of sugar (or fry food)?
They can only do so acutely until the blood sugar drops. It will not matter in the long run if there is a calorie deficit. I like to summarize it like 24 hour calorie balance is far more important than short term acute effects.
I eat low-carb foods and intermittently fast to compensate, but if I ate a "mainstream heatlhy" diet (3 meals a day, grain bowls, etc), my blood sugar would be moderately elevated for most of the time.
How to lose weight, by me, someone who has lost 30 pounds and kept it off:
Step 1: Count every calorie you consume. If you don't know the exact amount of a dish, do your best. Apps like MyFitnessPal make this easier.
Step 2: Limit that amount to 1500 calories per day.
Step 3: Weigh yourself everyday first thing in the morning, and only look at 7 day averages at least. Daily fluctuations don't matter.
Step 4: After 2 weeks, see how much you've lost (if any). If you've lost more than 1% of your body weight per week, raise that 1500 number. If you've lost less than 1% per week, lower that 1500 number.
Repeat until satisfied!
How can you make this easier?
1. Eat things that are filling with fewer calories. Think vegetables and protein. Stay away from things that aren't filling and have a lot of calories. Think candy bars. Water helps too.
2. Walk/run. This will burn calories efficiently and if you attach a fit bit to it, you can incorporate the calories burned into your 1500 number above. Weight lifting doesn't burn many calories, though it's nice for your overall health of course.
You're stuck on how fat cells are stored or insulin levels? How is that at all approachable.
In technical terms, CICO is a very leaky abstraction.
I'd call everything else an abstraction. Intermittent fasting and Keto all conform to CICO as an abstraction.
Which is fine and you're right. Calorie counting is the most direct diet but is not for everyone.
I think it entirely has to do with impatience and desire for a "tip" or "shortcut" to get where they want to go. Why diet (aka suffer) for 2 years to lose 100 lbs, when someone else is promising you can lose 10lbs a week for 10 weeks?
We want to believe there is a cheap, easy, fast, solution to all our problems.
I've seen a lot of threads with people asking for advice on losing weight and inevitably someone chimes in with "Calories in, calories out." Great, but that doesn't provide any strategy or guidelines for actually losing weight. Calorie counting and tracking is a strategy (and so are many other things, like intermittent fasting, the potato diet, etc. As long as at the end of the day you are at a calorie deficit).
Additionally CICO ignores the reasons why people overeat in the first place. There are a lot of physiological and psychological reasons for that. Maybe someone is overweight because they eat to cope with trauma. Maybe they have a hormonal imbalance that doesn't properly regulate how full they feel. Dealing with those underlying issues is often more beneficial in the long run.
Like duh, if you eat burgers and fries you're going to be hungry when you hit your calorie limit, and then cheat on the diet. Then it won't work. That must mean CICO is useless! Why bother teaching it!
Let's say you are now 120 lbs over weight. You know CICO. How long will it take you to get skinny, assuming you ate nothing at all until you hit your goal weight? A pound of fat is 454g. A gram of fat contains 9 kcal. Being 120 lbs over weight means you have to burn 9x454x120. Let's say your basal metabolic rate is 2000 kcal/day 9x454x120/2000 => 245 days of not eating a single thing. Is this a reasonable thing to expect society to adopt en masse? Do you think you could starve for that long? Could you instead only eat 700 calories a day for 3-4 years?
It's a privilege of both time and wealth in the US to be able to tightly control your diet and eat healthy, most American's can't afford the luxury. A more reasonable position is to just accept that some people are going to remain fat and focus on positive health outcomes for those people. 'Educating' them about simple arithmetic that doesn't change the fact that losing 100+lbs of weight is a multi-year commitment you cannot break if you wish a modicum of success.
I say this as a person who did lose 80lbs when I reached adulthood and successfully kept it off.
Edit re your edit: "Downvotes mean I'm onto something" is not a wise stance to take almost ever. I didn't downvote. but I'd wager the reason folks are downvoting you isn't because they hate trivially obvious facts, it's more to do with your analysis being shallow compared to the scale and complexity of the actual problem.
I lose around 2 lbs per week at 1500 calories/day. This is pretty normal. 120lbs would be 60 weeks of that. Little over a year. You are completely off with 700 calories for 3-4 years. It's irresponsible to spout that nonsense.
> A more reasonable position is to just accept that some people are going to remain fat and focus on positive health outcomes for those people.
Unbelievable. You've given up.
Edit:
> but I'd wager the reason folks are downvoting you isn't because they hate trivially obvious facts, it's more to do with your analysis being shallow compared to the scale and complexity of the actual problem.
I'd believe you if a ton of responses weren't people claiming that insulin levels or how fat is stored is actually what matters.
I think it should be treated just like any other chronic condition, you try to be as healthy as possible within the paradigm. If you want to lose weight, great, but people starting to lose weight need to understand that the habits they are using will likely have to be permanent fixtures for the rest of their life. Returning to a "normal" lifestyle is how the weight was gained in the first place after all.
Irresponsible to whom? You are the one advocating for this exact kind of analysis, not me, I merely obliged you.
Your stated solutions below are 'ban food' and 'education'.
If you know anything about how fat people are treated at doctor's offices, 'stop being fat, eat less' is probably the first and last thing they hear at any checkup.
It's not working. ' Ban food' is intriguing, but I don't believe it's practical for, I hope, obvious reasons.
- I lose around 2 lbs per week at 1500 calories/day. I don't care about your anecdotal data. Show me your CICO analysis.
Do you control for water and glycogen loss?
What about exercise, what's your basal metabolic rate? etc...
It's irresponsible to say that you need to be on a 700 calorie diet for 3-4 years to lose 120 pounds. That's so far from reality that it's irresponsible.
> Do you control for water and glycogen loss?
I lose more in the first week or so to what I assume is water retention. After that it settles into 2lbs/week.
> What about exercise, what's your basal metabolic rate? etc...
I wear a fitbit and allow myself more calories if I run (based on what it tells me). None of this needs to be perfect. If you're off by 100-200 calories a day, you'll still lose weight.
None of that matters, though. I have my number: 1500 calories. If I'm not losing enough, I'll lower it 100 at a time. Or if I'm losing too much, I'll raise it 100 at a time. That adjusts for BMR and mistakes in my calorie counting. Finding my exact BMR is wasted effort.
I'm happy you've found a method of weight loss that works for you. The way I lost weight was more extreme, but similar. However, you shouldn't universalize your personal experience as hidden wisdom. The are people who are born fat and will die fat. If they are otherwise healthy and happy for the duration, I see no reason for society to 'educate' or intervene on their lives.
And make no mistake, it is possible to be fat and healthy. Your heart, cholesterol, and diabetic markers can all be normal if you are eating healthy and exercising at (within reason) any weight.
I said previously, I don't care about your personal diet, as it has little to do with how the CDC should dictate policy. The diet I described was a crash diet.
'education is a pointless endeavor'. You are putting words in my mouth, my point, of course, was that knowing about CICO doesn't change the fact that weight loss takes a long time, is hard, and requires resources that many don't have access to. A word of warning, keeping it off is also hard when you've been fat, so prepare for that.
Since we won't speak again, I want you to interrogate why you are emotionally engaged with this topic. I had similar thoughts about how other people should behave when I discovered how to lose the weight, but realized only later that those thoughts made me view all fat people in a dim light, that it was ok to assume bad things about them, to view them as in need of 'education' like you advocate for.
If you ignore everything else I've said, please think about the perspective of a person who has lost 120 lbs, but is still 280lbs, and are receiving their 100th unsolicited lecture about CICO from someone like you. Most fat people go through that, from elementary school to adulthood in the US. It's pointless, they definitely don't want to hear about that from a stranger.
Also, fasting had shown to me that we can have an empty stomach and yet not be hungry. Yet, the state of not being feed seems to be a foreign idea to most people.
I lost weight by mostly intermittent fasting, without needing to count calories. Sometime, I even eat way too much food in one sitting. Over the long term, I did lose weight.
But that doesn't make it necessarily the most useful model for a complex animal to modify its own behaviour. We are dynamic systems that can voluntarily and involuntarily vary the amount of energy we expend. Our bodies send appetite signals to our consciousness, which can be pretty hard to ignore.
The only times I've consistently lost weight has been via a calorie deficit. But it's totally understandable that people want another model, either something like keto which purportedly produces weight loss without a calorie deficit by messing with the body's fat-storage mechanics in some way, or some behaviour+diet which produces a calorie deficit but with minimum lethargy and hunger. There's a lot of nonsense around dieting but the basic desire is understandable.
[1] https://www.cdc.gov/obesity/data/obesity-and-covid-19.html
But I agree with you on your first point: there's nothing wrong with sugar in moderation. But it seems that it's just too hard to keep it in moderation for a lot of people. And that's understandable: high calorie, highly palatable foods are often packed with sugar and fat (hence "highly palatable") but don't contain enough fiber to fill you up and -more importantly- keep you full for a long time. So you're gonna be hungry again soon, despite having just consumed a shit load of calories.
It's too easy to consume more calories than you actually burn, especially since we hardly move anymore compared to previous generations. Our life style is sitting down.
(/sarcasm)
I would say if a food item that people would think should not have added sugar, a very large label would be required on the package that states "SUGAR/CORN SYRUP ADDED".
I heard corn syrup is even worse and that is used instead of Sugar in a lot of places.
I see a strong parallel between this idea and the now-ubiquitous GDPR consent banners.
It's not just industrialized preprocessed and prepackaged food, because restaurants are guilty of this too.
I don't buy the "cars and suburbs" as a root cause argument. People would be less sedentary if they felt healthier and more energetic.
Sugar is the problem.
Why? I didn’t think the connection between infrastructure and transportation was particularly controversial. Also, real world problems often have multiple causes…
It sucks that this is as commonplace as it is.
I imagine you'd have an easier time at the nearest German restaurant. Not sure what they even could put sugar into and have any positive impact.
Until you drift out to the outer boroughs where cars are more convenient, that is.
Also I think that the assertion that "people would be less sedentary if they felt healthier" requires evidence. Some people who feel healthy and energetic would still rather sit down and play videogames.
Any fitness system that requires carving time out of the day is doomed to failure; what works is fitness that is built into the things people already do. In other words, if you walk or bike everywhere, you don't have to make time to work out.
It caters to a very specific body-type.
Highly muscular people are usually classified as "obese" according to BMI.
That such a deeply flawed measure achieved mainstream acceptance is quite the achievement.