Obesity Is Now the Top Modifiable Dementia Risk Factor in the US
jamanetwork.com
jamanetwork.com
The problem is we are doing the opposite: We pay people (subsidize) their unhealthy food (corn, sugar, and beef).
We should just make healthy food cheaper.
The current article suggests obesity is the top modifiable dementia risk, which suggests that there's other risk factors that are more important and not modifiable.
It might be tricky to actually reward healthy lifestyles via health plans, since people generally need more care as they get older.
Cars are not the reason this nation is getting fatter
[1] https://en.wikipedia.org/wiki/List_of_countries_by_vehicles_...
[2] https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...
https://www.thecarcrashdetective.com/americans-drive-more-dy...
Obesity rates started rising with the introduction of drive-in food, which wouldn’t exist if it wasn’t for car culture.
I choose FAT... every day.
Thankfully that is a False dilemma, and we can keep our car culture and rollback obesity at the same time
Most of the people focusing on "car culture" do not really care about obesity, it is a proxy war for Climate Change, and opposition to Rural America.
I will never accept high population density, and electric cars will resolve the climate change issue
To use an extreme example so that it's easier to relate to: You can eat only sugar and nothing else and far exceed your energy requirements, but you will still have lots of appetite despite already having eaten too much in just energy.
Food composition matters - and optimizing for energy (counting calories) is a losing battle. Of course, this also requires that people have had experience with various foods. Kids grown on mostly just fast food, pizza and coke probably won't be able to develop healthy habits no matter what.
Yes it is technically possible to force a body to remain slim by counting calories. It also is either very cruel or, if you manage it on your own, requires an absurd amount of discipline to constantly battle your desires. Yes some people have a huge appetite for the obviously wrong kinds of foods, like more pizza and more ice cream and no water please because it "does not have taste" but coke or some other industry-made drink. When the body was "mis-trained" it can't magically desire the right stuff that it never learned about. The environment matters too, it's probably a lot easier to not eat terribly in Japan than in some US mid-west town.
Why would you only care about mortality?
I had some unfortunate experience with heavy metal poisoning (university clinic diagnosed - mercury, shown by lab tests). There was zero danger of dying and I doubt it took away any of my life expectancy. But it SUCKS and especially the brain works at a substantially lower level. I did not understand even simple sentences even after reading them several times at the height of the problem. I wrote Internet comments that made no sense when I read them again the next day, but at the time it felt perfectly alright and logical (sentence structure was weird too).
(Just an aside) And you know what? I had to end up with a senior researcher doctor at a university clinic before getting diagnosed. Because most doctors were a little like your question: They looked at the vitals and found no obvious disease and sent me home "it's all in your head". Which is funny because it's largely true - mercury being a neurotoxin, but for some reason the brain being the product of physics and bio-chemistry not registering with the oh so "science and evidence" based doctors, who seem to have a strangely meta-physical and esoteric view of it.
Anyway, back on topic:
I find this obsession with the binary outcome "death / no death" strange. Before death, your extremely parallel structure (not just your own trillions cells, each cell itself has lots of independently working parts, and then there are even more bacteria and other organisms occupying your insides and the outside who all contribute and are often affected too) does a poorer job of bringing the "you" into being. See your body like a computer running the software that is "you". The quality of the simulation drops if the hardware is impacted (you are the activity of your parts - a brain without activity is not "you", you are not there if the hardware does not run the "you" software). But the life expectancy may not be impacted at all.
Surely, if you provide far from optimal fuel you can expect the quality to suffer too, not just when you are poisoned or otherwise restricted.
So, it is a question of what version of "you" do you want to be? Is mere existence enough?
A healthy diet requires more than just the appropriate caloric intake. Although that’s a great starting point.
Things like a high sugar Twinkie diet will expose you to diabetes risk independent of calorie intake.
For example, an Apple weights 200g and is 110 calories. Whereas a double cheeseburger at McDonald's is 173 grams but 450 calories.
I am 44 and I am aghast at how fat some of the youngsters here in Czechia are. Middle-aged people are, too, much fatter than when I was young. This isn't a common grumbling of an aging person, the trend can be measured fairly well.
I am not sure how our public healthcare systems will cope 20-30 years down the line. Aging (greying) of the population plus chronic metabolic diseases caused by obesity, treatable but not yet curable, will be a double whammy.
https://www.alzheimers.org.uk/sites/default/files/pdf/factsh...
So, as more people live longer, the odds of getting dementia increases greatly.
Maybe we should spend the money to cure the disease?
I think we should dig deeper into the numbers before deciding. I get the feeling we aren’t going to see the same numbers like we do for smoking.
The odds for *everyone* increases greatly simply by aging.
And it’s costing a fortune.
“Costs Associated With Alzheimer’s Disease Reach $277 Billion Annually, Report Finds”
https://acl.gov/news-and-events/news/costs-associated-alzhei...
I agree that just solving the disease, or at least making its treatment options cheaper (so that it's not a big deal if some people cost a bit more to treat than others), is a lot better than trying to alter levels of service based on BMI. But throwing more money at ADRD directly is probably a mistake, especially given findings like https://www.science.org/content/blog-post/faked-beta-amyloid...
I'm much more in favor of solving aging. Maybe see what happens if you give SENS $1bn/yr. Don't even need to take more public money, I'm sure Alzheimer's researchers won't miss it. (Though even without SENS being better funded, things are looking up; there are more groups, and things have been able to be spun out into startups. It's especially relieving that the Theranos case hasn't completely destroyed the concept of VC-funded health-related startups as a class, since VC money is a lot better than government money dollar-for-dollar. Before his personal drama with SENS recently, Aubrey estimated 50-50 odds at solving aging by 2035. With more funding, that could probably be improved.)
Spending a decade with Alzheimer’s then dying is expensive.
Simply dying quietly in your sleep at the age of 99 after living a healthy life, not so much
Our system of election is not designed to elect the "best and brightest" and we hardly ever get that option
They used to cling to statistical fallacies about "keeping an active mind" but now we know no amount of crossword puzzles will keep proteins folding right. Cognitive health just masks symptoms longer.
But only a bit surprised.
For example, Type 2 diabetes is a big cost burden for any health system. 70% of people with Type 2 diabetes who are also overweight would be asymtomatic if they lost weight. Why spend money on these people if the best course of action is free? (I.e., eat less food)
It may sound find and good to impose limits in this way, but I can think of all kinds of ways that could be abused
Insurance companies already ask for a subset of this. My health and life insurance asked about smoking (multiple times), and life insurance specifically requires you to get a health exam done at a doctor if you are trying to opt into a high tier of coverage. My life insurance also asked me if I am doing any "extreme sports/activities", with their listed top examples of it being motorcycle riding and skydiving.
None ever asked about obesity or inactivity. I am all for obesity being treated like smoking, but inactivity is a bit of a tough one to filter or screen for.
Edit: Downvote me all you want, these are just stupid internet points. But what the guy/gal said was offensive to anyone who’s struggled with weight loss.
Edit 2: Sounds like I should really lose some weight before I interview.
for example I have for force myself to eat vegetables, cant stand them, no matter how they are prepared, I have a heightened sensitivity to bitter things. It is not a cost issue that prevents me (and many others I know) from eating "healtly" things, it is fact that to us they taste like crap
and yes I know "how to prepare them", I am actually a pretty decent cook, and tried every preparation method known to man, just my taste buds reject veggies, especially cooked veggies, Salads greens, Spinach, Green Peppers, Tomato's, Cabbages, etc are tolerable and make up the bulk of my vegetable intake
money is a motivator
losing weight sucks because the changes are slow
weekly payments could help with motivation
this would create a dystopian nightmare but people would be thinner
It feels like we're either not even trying, or are ruinously confused about what we're up against.
Nobody knows the reason, but the data all shows when it started.
https://twitter.com/mold_time/status/1412827749828513800?t=e...
* I know too; but it's not like the actual replication-crisis-suffering capital S Science reviews are that much better than twitter randos on certain topics... It's useful to reserve judgement and be skeptical about a lot of things. And demand base rates in addition to risk factors.
Why we do this is maybe up for debate (personally my guess is because we can and food is tasty), but the basics of thermodynamics is not up for debate.
When you eat too much, you can choose to eat less. When your critical organ is about to stop functioning, what can you even do? Use that organ less?
Either I am missing something major in that analogy, or it is just bad.
But there is an important nuance. In many if not most cases, obesity is really a behavioral health issue, and feelings of shame make it so much harder to deal with that productively. If overeating is a maladaptive strategy to negative emotions, walking around feeling shame and embarrassment all the time makes that so much harder.
So fat pride isn’t great, but fat acceptance, to one degree or another, may be productive.
It really should be something more like how society is moving to treat depression - an unfortunate thing that happens and requires treatment, but not necessarily a flaw that makes someone a bad person.
The current stigmatization around obese people is that they are seen as stupid, lazy, gross, and generally bad, inferior people. Even as a recovering fat person, who knows it’s wrong, it is hard to overcome the implicit bias.
If you want to feel angry, listen to this Vox Conversations episode: https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGh...
However, the issue is that a lot of times when someone says "fat acceptance", they mean it in a sense of accepting that being extremely overweight can be totally healthy and fine. With a giant dose of anti-doctor sentiment mixed in, because "i know more than doctors because I use google to find other opinions supporting my current opinion".
If we want "fat acceptance" to be taken seriously, there needs to be a clear line drawn between those two usages of the term. The one you propose (aka the one in my first paragraph) is extremely reasonable and humane, and should be taken seriously. While the one I mentioned in my second paragraph should be separated as far as possible from that term. It just taints the definition you propose and makes people take it less seriously, which slows down the needle of progress that your definition is supposed to accomplish.
If we get a "fat pill" one day like we have for depression I would expect a similar trend
Culturally, the 'pro gender revolution, LGBTQ' movements and the fat pride movement (amongst other movements) are part of the same underlying thrust of our society. The basis is the idea that the individual should be free to be/do whatever they want (especially wrt themselves/bodies), and it's oppressive to have social norms/laws which restrict or even make the individual feel bad for being as they 'truly' are.
To suggest a way of living is not ideal (even with solid utilitarian arguments) for a set of individuals can be considered oppressive, as you are saying who they are is somehow not good enough. The individuals sense of themself and their feelings are tantamount in a culture so centered on the individual.
On a slightly related note, it does seem like our culture is also moving away from believing humans have free will. A lot of maladaptive states (from a utilitarian perspective) that humans can be in are increasingly described as 'unfortunate'/'unlucky' things that 'happen' to them. This relates to the sense of oppression for social norms that would suggest one way of being/living is not good - "How dare you say my current state is bad, I can't control that!"
What's interesting is the question of agency getting tied up with fatness in the first place. There have been times even not that long ago that being fat was considered a sign of success. There were even these "Fat Men's Clubs" (https://en.wikipedia.org/wiki/Fat_men%27s_club) of rich and fat businessmen celebrating their weight and eating a lot. But then fatness became bad, marking a lack of agency, and acquired other negative aspects like being greedy (contra magnanimous) and stupid and having 0 sex appeal (contra, say, the Venus of Willendorf, though you don't really need to go back that far), and being unhealthy, and being an overall burden to society whether it comes to airplane seats or healthcare costs.
Since dieting/keeping slim in the face of our modern abundance is now considered a mark of successful exercise of agency, fat acceptance types have to somehow decouple their eating behavior from their weight, if they want to maintain some semblance of agency here. (Despite the way our culture seems to be moving I still think most people want to maintain an idea of agency, even if that's in going against what it means to be agent-y.) So sure the 'fatness' is something that just happens to them, like being tall or short, it's not even unlucky really, and it's pretty much impossible to change in the long term anyway (with even some science backing up the failures of long-term weight loss after dieting). However they can twist it, the goal is to be free from the moral failing/agency failing concern that they're not acting in responsible/good ways. They can still be considered good in other ways.
And now that they're no longer preoccupied with their "exercising agency" failings from fruitless dieting and what have you, they begin to exercise more agency! Check out this cover letter from 1981 by Wilma Kuns on how she was able to start living her life once she accepted her fat: https://naafa.org/s/Nov-Dec_1981.pdf I think it's pretty typical, even today, and sure is reminiscent of other groups' "coming out" expressions of exuberance. Instances of exercising agency can be as simple as throwing out a scale, or a sense of a new-found ability to actually make choices and decisions (the foundation of agency) for things like clothing, sex (either feeling able to pursue it at all without feeling disgusted in themselves/partner, or being able to say 'no' and not just take what they can get), or doing activities or working jobs they wanted to do but were previously afraid of suffering social ridicule for. Having a bit of self-confidence feels like an agency booster, so of course removing this constant "you're fat and unworthy of life/fair treatment/love/health/..." mentality helps, regardless of whether it's rationally backed or not.
But it also gives a sense of agency in another way: exercising resistance, namely to society's (or some segment of society's) ideas of what it means to be healthy and beautiful. There's a lot of this form of agency these days. It's rather amusing that such acts of agency still reinforce the overall societal demand for agency, for distinguishing yourself as an individual making choices and pursuing what you think of as your idea of success.
Alcohol is substantially engrained in culture, country music or top 40 playlists. Today listening to a country playlist, about 70% of songs mention beer, whisky, or tequila.
And you could say, they're talking about a cool beverage every few days; and then you'll see the Social posts normalizing that a bottle or 2 of wine a night is normal, or that "it's 5 o'clock somewhere" as if alcohol every day at 5 is healthy. But then you'll meet a reformed alcoholic who started from these references. And then you'll hang out with "normals" with a person who is sober or even a moderate drinker and realize that the majority of American adults do have a problem with alcohol (they even feel uncomfortable if someone is asks for a water), it's just normalized
This is one of the reasons, people are moving away from the term, and using "unhealthy alcohol use" as a term for the condition, and also “a person with an alcohol use disorder” or “a person with a drug use disorder" rather than alcoholic or addict.
so once you are addicted, you'll stay that way, even if your consumption ceases completely (at which point you're an addict who doesn't exhibit problematic consumption). that's why clean alcoholics (or any clean drug addicts) are usually advised to stay teetotal indefinitely: they'll usually bounce back to their old patterns very quickly if they have a fallback.
False dichotomy.
If the stats show that being overweight increases your risk "X-fold", I promise the doctor is suggesting weight loss, which is at least a partial solution.
Be mad at McDonald’s. Be mad at Family Dollar. Be mad at bullies. And be made about fat pride too, that we as people have created the conditions that have been so toxic to some people that almost by necessity they inoculate themselves from horrible attitudes that have never helped them in the slightest.
Some people think that there are more important values in life than those things, and don’t want to have to fight for their right to live by those other values.
Here, it’s a right to eat and be active in the way they want, for whatever reasons they want, without having to answer to someone else’s concern over their health or longevity.
Do that many people just not know better? I know some people really have no idea how calories work but I see obese smart people who should know better.
Do people just not care? I understand some people not caring, like computer scientists or “manly” men. But even they should understand that obesity is really bad for health and QOL. They don’t have to become normal weight either: being overweight doesn’t have the negative physical and mental health effects, but they are obese to the point where it does affect those things.
Are they hungry? I get this part. I’ve experienced real hunger and it’s not the “just wait until dinner” kind. I could never maintain a normal weight if I had to endure constant hunger and the effects associated with it (low energy, brain fog, mood dysregulation - these are very real things people experience when not eating enough, and which fat people experience even when eating enough when they have hormonal issues).
Except, obese people also eat junk food which makes you more hungry. If it was hunger I would expect to see more people eating large plates of protein and vegetables, but it seems like even with CICO most people just don’t get fat on protein and vegetables. Do whole foods just not satiate? Or do people not understand which foods make you feel full, which make you satisfied, and which make you satisfied while tasting good (skinless chicken breast and raw salads with no dressing are not good meals).
I don’t have anything against obese people. But supposedly over 40% of Americans are obese, and many are obese in other countries. This is very strange and honestly depressing. Maybe it’s because I live in communities where less people are obese (college towns and a suburban community in a very blue state), because indeed while I see obese people it seems like way less than 40%. Particularly depressing is child obesity, which is really strange because kids tend to have higher metabolisms and even skinny kids’ diets are really junky.
I think most people would really like to be not obese, and if those people could lose weight with low effort it would be a huge benefit to them and society. So it’s important to understand why so many people are obese. Because like I said, 40% are obese despite most knowing better, and a lot of people seem to be like “yeah”.
Even from a pure health perspective, the relative risks of being fat often top out at like 2x for the most fat and specific health issues. The relative risk for dementia from this submission's study is only 1.177x. (Smoking, in contrast, finds relative risks for lung cancers > 20x.) But if the base rate is low, even 2x of that rate is still fairly low, and not necessarily enough to care about making a potentially difficult life change over.
Getting into the "severely obese" category (BMI > 40) I think is where day-to-day issues become more common, though that's "only" about 9% of the US adult population.
Obesity hasn’t been an issue since somewhere in the 1970s. And not everyone was constantly starving before then. Yeah we are predisposed to eat more than we need but we have satiety signals, unlike some animals which will literally eat until they explode.
More importantly people display self-control in other regards. Lots of obese people have become really successful, lots are genuinely tough people. People have the self-control to finish school, work, and otherwise take care of themselves (e.g. keep the house clean). Why don’t they have the self-control to choose a steak and salad instead of pizza and fries?
How are depression and hearing loss modifiable? Is the implication that untreated depression or not using hearing aids is a dementia risk?
But soy is a rotation crop for corn and instead of feeding it to animals it gets used in the human diet.
https://ourworldindata.org/soy
Japan has one of the highest rates of soy consumption in the world and they also have some of the least obesity and the longest lifespans so I fail to see how soy is problematic in increasing obesity.
However, I was referring to the soybean oil.
Soybean oil is not used in cooking inside the Japanese home, but used for fast food/restaurant cooking.
https://www.world-grain.com/articles/16740-soybean-oil-deman...
Next time you get virtually any salad dressing or even a non-sriracha hot sauce such as that served in little packets from e.g. Wendy's or McDonald's, you will find soybean oil as one of the ingredients.
Soybean oil is nearly impossible to avoid if you are eating out; and it is found in a lot of other foods such as salad dressing, etc. I would encourage you on your next trip to supermarket to make note of how many processed foods contain soybean oil. Only good quality olive oil is free from PUFAs among the various vegetable oils.
(edited for clarity)
If your point was blaming soybean oil say that instead of a blanket statement that soy causes obesity.
Yet our life expectancy continues to decline
Its obesity
No amount of healthcare access can save those determined to stay obese