Chronic illness rates in the US are far higher than in France, too. In the US 40% of adults report suffering from 2 or more chronic conditions.
Some issues could be resolved completely if attended to early, but instead the patients suffer until they have no choice.
If it were free/cheap to visit a doctor then more people would go, which would cut down on long-term suffering.
and doctors don't even try to solve that problem anymore - they just push pills to counter the bad diet and bad lifestyle.
You can point to activity levels, but weight is about food consumption, not activity levels, and (eg) Aussies are a pretty car-reliant culture too. Pretty much any way you can argue that the US is "unique" - it's not, we are a culture exporter and some other place has inevitably picked up some of our habits.
Americans aren't even uniquely fat anymore. There are other populations (like aussies) that are getting close to our obesity levels and they still don't 5x their healthcare spending. And the idea that obesity makes up even a simple majority of total healthcare costs (as it would need to be for this to be the factor that 2-5x's healthcare spending) is generally ridiculous.
(also, paradoxically, a lot of things that we think of as unhealthy actually reduce total life healthcare spending, because US care is heavily weighted towards end-of-life care. It's cheaper to die of lung cancer at 40 than to have three knee replacements and spend a month in the ICU at 80, and US health care is heavily weighted towards the latter because of medicare, everyone else struggles to get affordable access to the system.)
Like it would be interesting to see an attribution of what specifically americans are eating so differently vs everyone else, and the caloric/macronutrient balance and total inflow/outflow, and total life expectancy (and total spending) changes. I suspect it's just a "how much of it" more than anything, but the "gosh americans just eat like shit, that's why!" really doesn't justify 5x per-capita expenditures on the face of it, in the way people try to use it. The rest of the world drives cars and eats like shit, and eats too much too, in varying proportions.
But to go back to spending - it's really hard to argue that it's any one thing. It's everything. Everyone at every layer is bleeding everyone else. Americans are a bit unhealthier, but we also have for-profit hospitals (even non-profits make a "profit", it just goes into real estate investments), for-profit insurance, doctors who make $400k because they need to pay off $300k of loans from for-profit education, drug and device manufacturers who have no cost containment before approvals, a political system that tolerates evergreening and similar practices, an "access problem" for delivering basic care before it escalates into expensive problems (even "preventative care" often still ends up costing), etc etc.
That is really the problem and why the system cannot be reformed. Medical care is at the nexus of every single "unsolvable problem" of the US political system, from patents to education to farm-lobby and environmental regulation, and it involves a million taking hands that after a true reform will no longer be able to take. There is a lot of people who have become reliant on the revenue streams from this rent-seeking/unproductive activity, and they will lobby heavily to make sure they can keep taking.
1. Where “western diets” go in the world we see healthcare costs go up.
2. The US fits the bill for about 90% of the global R&D costs on healthcare. Many universal healthcare systems only fund existing methods.
3. The US is more unhealthy than most other places. This can be observed with higher percentage of the population having chronic illnesses.
People wake up, go to an incredibly stressful workplace and use up all possible productive hours of the day, come home extremely tired, pop on the incredibly stressful news cycle and get permanently angry as they eat their TV dinners, then fall asleep in their chair as the news continues to unsettle and disturb them even in their most peaceful moments. I've seen this over and over again, it's how a lot of people live here.
There's a million places a resolution to this type of issue could start, but damn it's gotta start somewhere!
Most doctors are never taught to deal with lifestyle. It’s sick care with things like medications and surgery. Doctors office visit won’t address this for most.
I agree - it won't come from doctors - there is no financial incentive to keep people healthy.
and even more so, patients don't even want to hear it, they want the magic pill instead.
What if people just never had most of those issues that require treatment?
In a healthy individual, cholesterol intake is not related to blood cholesterol levels (beyond some reasonable threshold, like not eating a tub of lard in one sitting).
Holy cow, really? Is this a case of over-diagnosing things, or are virtually half of Americans legitimately struggling with multiple health issues?
There isnt much incentive in the US to prevent disease, doctors make their money from visits fees, procedures, etc. Not saying they purposefully make people sick, but I think there is some Darwinism in a system like this -- a hospital system that keeps people healthy would wither and go bankrupt because hospital systems dont get paid to keep people healhty, they make most of their money when people get very ill.
what usually causes this also causes a bunch of other chronic issues. So, yeah.
Life expectancy rates in the US were going down before COVID. Chronic illness.
The numbers aren’t looking good. Unless you’re trying to make money on healthcare. Healthcare income goes up when health goes down. Capitalism.
Far more than a super majority of those with high cholesterol are due to lifestyle. At my least yearly doctors appointment I asked about the genetic case. My doctor, in his mid-40s, said he had only had a few patients with that in his career. I've listened to lipid PhDs lecture and they talk about it being rare but present.
We cannot change the genetic case. But everyone else can be affected.
I was talking with someone recently who changed her diet. In a matter of weeks her LDL cholesterol dropped 50 points.
Can you provide any basic literature on how large of an effect can be achieved through lifestyle alone? It sounds like my vaguely recalled ~15% is way, way off.
(I do wonder how statins are so easily justified if lifestyle is so effective, but pharma profits/lobbying may explain that.)
Instead we as a country are glamorizing obesity, which has become a bizarre and deadly trend in the USA, we should attack it like we did smoking.
Even my local doctors office is advertising how you can be 'healthy at any weight' - talk about gaslighting, no you cannot.
Without a doubt the 'healthy at any weight' campaign is directly or indirectly funded by food companies and drug companies - neither of them which want thin and health populice.
The body positivity movement, plus sedentary lifestyles, plus the increasing cost of healthful foods, the time it takes out of your day to exercise, almost mandatory amounts of sitting in a car daily… there’s a lot of factors in modern American life that are just bad for our health. It’s not just the money spent on healthcare.
in many cases, when looking at total life spending, things that kill you earlier actually can reduce total life spending (smokers are a great example) because it means you don't incur the three knee replacements and bouncing in and out of hospital for the last 2 years of your life and spend the last 2 weeks dying in an ICU. Having a heart attack and dying on the surgical table is pretty cheap in terms of total healthcare spending.
Obesity is still cost-positive, but it's a lot less than you think from numbers like "X% of total medical funds spent on obesity" - you are going to substitute around 50-75% of that cost in cancer treatment and knee replacements instead (see table 2).
https://dom-pubs.onlinelibrary.wiley.com/doi/full/10.1111/do...
anyway, one of the problems is that obese people are massively stigmatized and shamed. they are already treated worse (and receive worse medical care, etc) than others, for every moment of their lives, they have constantly-reinforced negative body image, which is psychologically unhealthy to impose on people. And the point of "healthy at any size" (when not taken to an absurd extreme) is to get people to at least feel like they aren't so far gone that it's pointless to make better choices, because starting to make better choices are the foundation of starting to climb out.
This is usually met (even here, in past discussions) by some variety of "good, they should feel bad", and "well, I was fat and it helped me!", but that's basically a riff on "my parents spanked me and I turned out fine". Not only is that probably not a medically-supportable opinion (stress and fear are themselves powerfully negative causative factors that place actual physical damage on the body over time), but not everyone's brains work the same in the first place. What inspires you to improve might just reinforce someone else's depressive spiral, a lot of obese people have very negative body image ("good", says the peanut gallery).
Black Mirror wasn't wrong, people love having an underclass to look down on, and obese people are a very visible and very socially-acceptable underclass to punch down on. A "steelmanned" view of HAES, when not taken to ridiculous extremes (and I'm not saying nobody does!) is that it's simply asking that we not go full Black Mirror on shaming fat people, but frankly I think a lot of people don't even agree on that much, or that it would be a good thing. "It's for their own good" etc.
The whole reaction to the idea of HAES, itself, is a microcosm of the social problems around obesity and self-image - how dare you feel good about yourself? Why aren't you going through every day in a haze of shame like you deserve to? It's for your own good!
While obesity is a huge issue and a huge cost factor, there are more obese countries with nevertheless a tiny sliver of the US medical budget - even after adjusting for life expectancy.