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I would say it’s much more harmful to rationalize obesity as something that afflicts people according to their circumstances, rather than what it actually is, a direct outcome of a person’s intentional choices.

It’s also quite harmful to dramatize the solutions out to be something unattainable to many people. They are attainable to all people. The healthiest diet I’ve ever eaten was also the cheapest diet I’ve ever eaten, and almost everybody can get 30 minutes of low intensity exercise a day.

Nutrition and fitness are hardly a one-size-fits-all problem.

To take an example, my self, I am doing intermittent fasting and do moderate intensity exercise everyday for at least 30 minutes(gym, cycling, bouldering, etc). No matter what I do, I still have a muffin belly.

I also believed that for many years, that no matter what I do, I cannot control my weight.

Until one day I began to both weigh myself each day at the same hour with a precise digital scale and also weigh or measure by volume all the food that I eat.

After that moment, I reduced my weight by 2/3 and I have maintained easily any target weight. Even now, after some culinary orgy I easily gain a couple of pounds in a day, but then, by eating only measured quantities of food, I lose them after a week.

The reason why I have failed to control my weight during many years and most people also fail, is that if you eat until you are satiated, then it is guaranteed that you will not be able to control your weight, no matter how much exercise you do.

If you measure what you eat and you only eat pre-planned quantities, it is trivial to reduce how much you eat until you see that the next day you weigh slightly less (e.g. 100 grams less). Then you must keep eating such quantities until you reach the target.

If you do not respect your plan and you eat random extra snacks or drink sweet beverages, then of course you have no chance to control your weight.

It is much easier to follow a plan when you eat less meals per day, because they can be larger. When eating small meals many times per day it is far more difficult to stop after eating just a little. It is much easier to not start eating.

If you want to lose body fat you need a caloric deficit, squeezing a caloric surplus into a smaller window of the day isn’t going to do anything productive. Intermittent fasting itself has absolutely no benefit, it can only be useful if the fasting routine helps you maintain a caloric deficit.

>a direct outcome of a person’s intentional choices.

You mean like a politician promoting obesity inducing foods?

If it is really about individuals then obesity shouldn't be going up in African nations that quickly.

No food is specifically obesity inducing, and you personally are responsible for everything you choose to eat, not a politician.

> No food is specifically obesity inducing

This is false. Of course certain foods are metabolized in ways that are more likely to lead to obesity than others.

Absolute nonsense. Your food contains calories in the form of carbohydrates, protein and fat. None of those macronutrients are metabolized in a way that is likely to lead to obesity. Obesity comes from consuming more calories than you burn. It doesn’t matter at all where those calories come from.

I agree. After living and traveling abroad, it's easy to see America has an obese-default culture.

Most cities and towns have little walking or public transportation. Cheap, high-calorie, nutrient-poor food is easily available anywhere 24 hours a day. Restaurants have an abundance of large amounts of meat and carbohydrates drenched in low-quality oils and sugary seasonings.

You have to be consciously active to stay fit or cook the majority of your own food. People in a lot of other countries stay lean and aren't as obsessed with fitness as we are.

I lost 20 pounds, got off antidepressants and found love all within 6 months of leaving America at age 24.

I don’t really have a point, but there is a lot of poison for body and mind in that country.

Out of curiosity, where did you move to?

Cambodia

Gp probably could have stopped after:

> Prescriptions of diet and exercise are ineffective

Which seems to be true. If any advice your doctor could give yields no measurable difference, is there really a point to giving it?

Agree, mostly. Primary care doctors in the US are often limited to 15-30 minutes per patient for routine matters. Referrals to nutritionists / dieticians and other expensive options often lack follow through, or aren’t offered in the first place because prescribing is so much easier. Medical professionals have a duty to arm patients with the information needed to make good choices about their health, but often shirk that duty due to inconvenience or these kinds of time limits. In a perfect world, access to medical professionals would be less scarce and at least the tools (nutrition info) would not be an issue. The medical system really isn’t designed for obese people on multiple levels in the US, and it isn’t designed for good long-term outcomes…yet.

Most systems, like Epic, will print out the standard info and counseling related to your conditions and medications when you get your paperwork at the end of the visit. That's easy and takes almost no time.

Considering the root(?) commenter said that a low carb diet did in fact work for them even though they had to go research it on their own, it sounds like it was effective.

A lot of diets work at least in the short/medium term, for those that have selection bias and "completed" them.

That's very much _not_ the same thing as a doctor recommending or prescribing them having any effect.

There's no talk of completion. This isn't a "diet", it's a diet. We aren't using it as some colloquial meaning for losing weight, etc. This is about a lifelong dietary change to address excessive carbohydrate intake.

If it doesn't have "any effect" then I guess all type 1 diabetics are already dead?

The point still stands - doctors should be counseling diabetics on dietary changes, even if they are being prescribed medication. Some patients can improve their condition and overall health to the point that they can stop the medication. If you disagree with this, please, show me some sources. As for mine, you can check the AMA, AHA, ADA, and PubMed (American Medical/Heart/Diabetes Associations).

People weren't obese ages ago, and I am sure that's not because of better nutritional education.

It's a multifactorial problem.

People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped while the calorie inputs available cheaply dramatically increased. That is all part of “overcome metabolic efficiency.” :-)

The obesity epidemic is a lot more recent than barn-raising days. Even in the 90s people were considerably skinnier.

> People didn’t have McDonalds and cars ages ago. Barn-raising, (manual) farming, and hunting are hard energy-intensive work. Our calorie output required to survive dropped

Not saying I know any better, but at it's face I don't buy this. The change in day-to-day activity doesn't feel like it would account for the difference from just the 80s to now.

> while the calorie inputs available cheaply dramatically increased.

This I buy much more, confounded with maybe the specifics of the nutrients available.

Even a small change in average daily activity can account for a large difference. If you cut your total daily energy expenditure by just 50 kcal (the equivalent of walking less than a mile) while keeping intake the same then you can gain up to 5 lb in one year. Add that up over a few years and suddenly you're obese.

Not to mention increase in sugars in foods; soda pops also drastically increased from 8oz to 20oz. Combined with even small decreases in activity can add up quickly.

You're right in one way, but not another. Small increases in caloric content can have a large and counter-intuitive impact due to the nature of systems in equilibrium: just one small soda or candy bar a day above your equilibrium will drive large weight gains.

But you're not factoring in the fact that as your weight increases so does your idle energy costs, meaning that as you gain weight you burn more calories doing nothing. Put another way, if today you burn 1500 calories a day idle, and you start eating 2000 calories a day - at some point you will reach an equilibrium, likely well before you're obese.

I'm also in the camp that thinks that lifestyle explanation for rises in obesity is completely unsubstantiated.

It's easy to demonize fast-food but that's not even the worst of it.

High-fructose corn syrup has been added to so many foods that didn't have it 10-20 years ago.

The second or third ingredient on a bottle of ketchup, for example, is high-fructose corn syrup. You can get ketchup that doesn't have high-fructose corn syrup added to it; often it's a natural or organic brand that often costs more than the regular brand.

And depending on where someone lives, brands without refined sugars may not be readily available. Google "food desert" and see what comes up.

It was literally impossible a generation or two ago to ingest the amount of carbohydrates the average American gets just from eating prepared and processed foods today.

> It's easy to demonize fast-food but that's not even the worst of it. High-fructose corn syrup has been added to so many foods that didn't have it 10-20 years ago.

We should just count ready-meals etc. as 'fast-food' too, no good reason that it implicitly refers to 'restaurants' only really.

> The second or third ingredient on a bottle of ketchup, for example, is high-fructose corn syrup.

Interesting, that didn't sound right to me (but it has been a long time since I've had it) - found this: https://www.truthorfiction.com/heinz-ketchup-ingredients-u-s... (tldr just sugar in the UK)

Robert Lustig talks about this quite a bit. The data shows widespread obesity in modern times is a direct result of all the added sugars in the standard American diet.

What about other countries? America might be leading the way, but a lot of European countries brag about "only" having a 1 in 4 obesity rate, which is still incredible.

Nutritional science got better at making people fat.

It's much more harmful to obsess over the optics of something potentially offensive at the expense of reality. None of the excuses you listed hold any ground.

Time: it costs about 20 minutes to cook a simple, basic fresh meal. With a single weekly groceries delivery (or visit to the store), you're covered for some 5-6 main meals as well as breakfast and lunch. Are you telling me Americans don't have 20 minutes to prepare a meal yet do have that time, or more, to eat out? I've been home cooking 6 days a week for 2 decades. It costs LESS time, not more.

The average American watches over 3 hours of TV, or TV-like experiences in their leisure time, but they don't have 20 mins to cook a meal? I guess they all get home from work and fall asleep?

Costs: Rice, potatos, bread, vegetables and lean meats...please do the math for me how this is unaffordable? They are incredibly cheap commodities.

"Most people in the US live in poverty".

Now they do not. The US is in the top 5 of median incomes worldwide, one of the richest countries in the world. If you dismiss Luxembourg and UAE, the USA is in the top 3. It's not a monetary issue.

Further, 12 hour work days are an anomaly, not a standard. And even 12 hours is not an excuse. Exercise isn't the core of the issue, junk food is.

Time needed to educate on nutrition: your parents or school should have done that, but here goes: don't eat garbage. Cut down on fats, sugars. Education completed. But it's not an educational issue as the person sitting in McDonalds knows exactly what's up.

It most definitely is a willpower issue as every other excuse does not hold ground. People in other countries have less time and less money, and still don't have this issue at this scale.

Please know that this is a not a burn at obese people, I fully sympathize with the difficulty of lifestyle changes, even more so in a culture like the US where the environment seems stacked up against healthy eating.

But we need to attempt to come to real and realistic root causes, and time and money are not the core issues. It creates this illusion that if only economic conditions would improve, we'd all be eating healthier, which is false.

The issue is cultural.

Youve identified the chain but keep it going: stress and lack of sleep!

Ubiquitous coffee, economic pressure, overpriced and weak preventative healthcare system, social pressure, status anxiety, housing insecurity, political threats, public-facing crimes, rampant racism. These all test our self-control around food.

None of those things help, yet none of those things prevent healthy living. For the simple reason that healthy living does not cost a lot of time or money.

Like I said, home cook 5-6 days per week, which costs little time or money. None of the issues you mention prevent you from doing it. Exercise costs no money at all.

I don't mean to dismiss your reasons as if they don't matter at all, I'm stating they are a trap. They provide a shield to hide behind. If only all of that would improve, I'd be healthier. This imaginary utopian society will not make you healthier. You become healthier by stop eating crap.

Nobody's going to do that for you, but you.

I agree abt the importance of home cooking, bit if you have a chance, look into how stress affects digestion. The same food can affect the body differently based on its stress state.

There is no digestive condition that causes the body to metabolise more calories than you consume.

No, it's the lack of will power, with few exceptions. Most of the food these days, even expensive food, has atrocious amount of calories, so to burn one cookie-worth of energy one would have to do a stupid amount of weight lifting. For example, lifting a 50 lbs dumbbell 3 feet high burns just 5 calories, while a small cookie I have on my plate has 200 calories. That's 40 times to lift that dumbbell just to burn 1 cookie.

Edit: or let's take a look at cheese. I've found some pretty expensive cheese in my fridge, packed into small cube boxes, because otherwise its price per pound would be offensive. So we might expect that cheese would do better than cookies. The nutrinion facts label on its reverse begins with "serving size: 2 table spoons, 120 calories" - a borderline fradulent label that's trying to hide the fact that the small chunk of cheese has 600 calories in it.