Obesity rates in the USA are 42% while in Norway they are 14%.
Not only that increases the death rates exponentially, but it also diverts money away from other healthcare areas.
https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...
Not only that increases the death rates exponentially, but it also diverts money away from other healthcare areas.
https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...
The, IMO, logical solution would be to change the underlying problem. Maybe even through some "national emergency". Force the food industry to change, help people to make healthy decisions, punish/rewards etc. But no: let's put everyone on medication.
I could imagine the latter to be a legitimate option if a country's people have some genetic trait that makes obesity harder to fight. But I don't believe that's the case in the US.
I live in the Netherlands, which in the '70s and '80s was just as car infested as any place. Part luck, part timing and part political caused it to turn away from that, invest in bikes. And not top-down, nor bottom-up, just an accidental "perfect storm". We're now a in a situation where PT, car and bike infrastructure are a complex network that co-exists and is highly efficient. Where virtually everyone has (at least) one bike, takes that to work/school on average almost daily and also travels by car, train and other PT a lot. But where, above all, this is commonly seen as something good and people do feel really happy in it.
And even here, still, removing stroads or parking lots to turn them into parks, restaurant-areas or pedestrianized areas, will always meet a lot of resistance from people who think the cars are crucial to their lives/businesses/shops/schools. Yet when it's pushed through, generally, even those opposing it, often are much happier with the space after cars were removed from it.
However, I’m struggling to imagine how centralised actions would work. e.g.:
* Food and food ingredients are probably part of the problem, yet lots of people in America also manage to not be obese. There are some low-hanging fruit (eg high fructose corn syrup and saturated fats), but how far to go and where to stop? Also, this would generate a huge fight with those industries affected.
* We could create economic incentives or disincentives, but give there’re links between obesity and lower socioeconomic status, this would hit poor people harder and potentially exacerbate inequality.
* Education also seems like a rational response, but agreeing the ‘truth’ to educate people with would be a difficult fight! As in, the ‘Standard American Diet’ pyramid taught for generations and supported by “experts” is arguably a very bad diet to teach people to follow, yet misaligned incentives and economic influences meant that it persisted for generations. If that dogma was changed, where to go: low carb, vs. plant-based, vs. calorie counting, vs. paleo/primal, vs. intermittent fasting…?
And ultimately, as we saw during the pandemic, large groups of people are able to be stubborn and make scientifically bad decisions, especially in this world of ever-more polarised politics. You really think the anti-maskers will cope well with centralised (“communist”) meddling with their freedoms around food and drink?
Don't imagine, just have a look at what is happening in other countries. Overlooking the world outside of the USA is also very "American".
Chile has the same problem with obesity. Some national policies where introduced, including mandatory information on food packages and a sugar tax. Of course, it did not magically solve the problem, but the obesity pandemic is decelerating, and the sales of unhealthy food have dropped, especially for children.
Other countries have introduced similar rules for mandatory package labels. In this domain, Mexico and Canada are ahead of the USA.
Eliminate zoning to enable functional walkable communities
Tax sugar (and eliminate subsidies for corn that goes into corn syrup)
The anti-maskers are going to be crybabies about literally anything. If we invented yellow paint today they’d insist it couldn’t be put on roads because they sometimes prefer to drive on the left side. We can’t let our country be permanently held hostage by the tyranny of the minority.
It has been shown, for example, that statins prevent much of the heart disease that kills middle-aged people, but this medication needs to be taken for decades before. And yet in many countries, although it is a known fact and statins are safe, doctors don’t prescribe it until people have heart failure and it won’t help much anyways.
Our approach to pain management has also shifted a lot in the last 2-4 decades. Managing pain was about finding the root cause and treating it. Now its about hiding the symptoms with paracetamol and ibuprofen.
Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common. We in the West also know the science, but more often than appropriate make fun of Asians exercising in the parks every morning. Then we medicate for all the symptoms of diseases that obesity brings. Doctors do not even prescribe exercise to most obese people. That is a prescription which is very effective with $0 monthly costs.
The goal is not quality of life. It is not to prevent disease, or to holistically treat it. The goal is to do interventions to prevent death.
And maybe that’s more liberal in a way — people can live their lives more consequence-free, enjoy unhealthy habits, and know that some % will be bailed out of their coffins just before things get bad enough. Ozempic is such a bail-out.
Yes, Ozempic is an effective drug in reversing obesity. It is a great drug. It will give people back many years of their lives that would have been lost to obesity. Maybe it is even as effective as good exercise habits, which cost $0 and have about 0 side-effects. It is definitely not a better option than exercise for most of the population. But if it’s the only option possible in our healthcare culture, then it is still very valuable. It just won’t end the obesity epidemic. A health culture that only prevents death simply does not concern itself with improving the quality of life.
Unfortunately, we are also quite proud to have such a dysfunctional culture.
> Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common.
I was talking about the broader culture that values Tai Chi. Tai Chi is one of “morning exercises” in China. Others include just walking. But my point was about a culture that incorporates morning exercises as a norm. Japan has “radio taiso”, which is a similar phenomenon. I think the West had a similar culture in the 80s and 90s. I was actually growing up in the Central Europe then, and it was normal in elementary and middle school to start the day with a 30-minute exercise lead by school staff.
I don’t know how to label this culture but “culture where it is the norm to exercise daily”.
Yes, as you say, obesity also has many, many other causes. And many other cures. It’s definitely not so one-dimensional. But exercise is very effective, and a culture that promotes exercise daily for everyone, at all paces, would benefit us a lot in the West.
I think people tremendously underestimate what 30 minutes of daily body weight exercises like push-ups, squats, and sit-ups, plus a little bit of walking can do for the said weight. There are many, many technology workers that now just work from home and barely walk at all. Not the majority, but many. There are many more office workers that just commute to work with their cars and never walk more than that demands. In that context, 30 minutes of morning exercise is quite a lot.
The study you shared talks about primary and secondary prevention in a clinical setting. So this is for people who either have heart disease or are likely going to develop it. At that point, it seems like it is already too late and I would say primordial prevention[0] is better. When I say prevention, I speak as not a medical professional, and I mean it in the common sense of the word, which aligns with primordial prevention.
There seems to be extensive research that they work well if prescribed preventatively decades in advance, and it’s covered in a few recently popular books by doctors on the topic of lifespan vs. healthspan. For example, Outlive: The Science and Art of Longevity by L. Attia.
Moreover, the study you quoted shows a 9-29% relative reductions of the outcomes. About 1% is absolute. For the entire population, 1.3% fewer will die from a myocardial infarction. But it is a 29% reduction in the sub-population that would die from it. And those are fantastic results with only primary and secondary prevention. Unless I misunderstand something.
The study you provided is relevant and valuable for critical reading of such books as the aforementioned. Thank you.
The drug may be a band-aid solution, but if it actually works for making people lose weight, it's better than telling them to eat better and get more exercise and then being shocked when they don't.
Cities all over the country are already assessing which roads can be converted from four lane stroads to two lane streets with protected bike lanes on either side. We can provide federal funds to encourage more of this.
Weight isn’t even the only problem with our culture. Being stuck in cars and eating unhealthy food also affects rates of heart disease and depression. Making those people lose body fat might help with those factors, but I suspect it would do so less than actually making healthier food options more accessible.
For those that really feel medication is their best choice, when we have made sure other options are available, we should also offer free medical care to all people. But that should not be the primary solution to this problem for most people!
And it's a relatively simple, relatively easy policy lever, unlike every other proposal.
Once the demand is solid, there will be supply for bike lanes, pedestrian paths...
Sure, there's a small portion of the electorate that wants this, but they're a minority and not powerful enough to get real change outside of a few localities.
I'd dig one deeper and look at the reasons why it's "not feasible" and the change that first. If people propose "national emergency" as a solution, clearly such options should be on the table.
I can think of several reasons, but to me the most obvious cause is "runaway capitalism", where a few big corporations lobby and market and (mis)inform, to make people think this is what they want, just so they can sell more cars, sugar, processed (high marging) foods and so on.
Not to make this an anti-capitalist rant, to be clear. Just that I'm fairly sure we're seeing a clear limitation of "free markets", where people simply aren't the rational homo-economicus that many promised we'd be.
In a democratic society, it's the people's responsibility to be educated about issues, so they can vote accordingly. Most Americans are making conscious choices to eat bad foods, not exercise, live in suburbs with car-dependent lifestyles, etc. They could move to inner cities and/or push locally for more density and anti-car measures, but they don't, outside of a few select places.
Instead, a large chunk of American society "educates" itself about conspiracy theories and the "importance" of guns and religion, and votes accordingly, and what you get is the society you see now.
The general consensus seems to be that obesity is not lifestyle related, those affected can't do anything about it, and the only option is taking a drug (that has other severe side effects imo).
Caloric restriction and exercise of course do not work because thermodynamics are subjective.
That isn't how things work.
They are not just "big boned" or genetically predisposed to being 500lbs.
Do you support the use of statins and diabetes medications in this population for this process or do you consider that cheating as well?
Which is almost never the problem. Socioeconomic status mostly is. By claiming it's willpower you are going for the "poor people are lazy" cow manure.
How does personality develop?
Is it somehow inherent to sub-humans or a product of ones environment?
Of course its a socioeconomic factor. If you try to argue against this one, you have essentially only the other option left and derserve to be ripped apart in the comments.
Others have asked for the root cause before, here is my grand take: better education <- fair taxation <- social mobility <- wealth distribution <- matured laicists and a healthy democracy. I tried to put capitalism in there but it just lingers all over it. That socialist take is also my broad explanaition why other developed countries habe better health metrics. Guess what happens when you argue against this one :)
I'll assume you'll either accidentally or deliberately find a way to box what I'm saying into a much narrower confine, which you will then threaten to beat the straw out of. Given it's happened twice now.
> Of course its a socioeconomic factor. If you try to argue against this one, you have essentially only the other option left and derserve to be ripped apart in the comments.
What is the other option?
The complex socioeconomic environmemt does play a huge role imo, the other indefensible option is the racist one. Which one is yours?
One theory:
- Their original food culture was wiped by colonialism
- Now they rely on imported foods without regard for its composition
It is easier for imported foods to beat existing options, because the island culture does not preserve attractive options so well. And it is easy for imported foods to be unhealthy.
https://www.ox.ac.uk/news/2014-08-29-obesity-pacific-islands...
> ... Pacific islanders are more prone to obesity than people in other nations. Now a new study led by the University of Oxford has examined why islanders on Nauru and in the Cook Islands in the Pacific have the highest levels and fastest rates of obesity increase in the world. On both the islands, between 1980 and 2008 the increase in the average body mass index was four times higher than the global average. The paper, published in the journal Public Health Nutrition, provides a novel theory for why obesity levels are so high there. It suggests that social changes, introduced when the islands were under colonial rule, have significantly contributed to unhealthy dietary habits.
Orthogonally, the USA has a fentanyl epidemic, and neither China or India (who export fentanyl) nor Mexico (where it flows into the USA) have a fentanyl problem.