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Comment by keiferski | Hacker News Reader

I am no expert on the public health system and so I'm more than willing to be educated/corrected here, but I have the following impression:

There is more money to be made by stakeholders treating health problems than there is in preventing them. And so there is a lot more money and effort invested in developing pharmaceutical and treatment solutions than there is in preventing the problems they treat – even though that would be far, far better for society as a whole.

Alternatively/additionally, the stakeholders that make money treating things (insurance companies, hospitals, etc.) are simply larger and better capitalized than those that make money preventing health problems (gyms, health food stores, etc.) The biggest gym or fitness company in the world is probably minuscule in comparison to the average medical company.

The only wrinkle in my understanding here is that as far as I know, insurance rates are lower for healthy people, and thus doctors(?) are somewhat incentivized to have healthier patients.

Is there a market-based solution to this? And if so, what would it look like? Tax breaks for gyms? More lobbying from Big Gym?

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Well, one clear market-based solution would be pricing transportation appropriately. If people were allowed to not pay for car infrastructure (via parking minimums, restrictive zoning, taxpayer-funded highways, etc. et.) and take their bike and train instead there would be a strong price signal to encourage the healthier activity.

I moved to the Netherlands a year ago and have already lost 9kg (about 20 pounds) without really even trying that hard. I just don't have a car.

It's even more baffling we don't do this because this is cheaper AND healthier. If the same organisation is paying for health care and transport (like a national government) than it should be a blindingly obvious solution.

This policy would be too unrelated to health.

You can have a sedentary person who works from home and orders takeaways.

You can have a person who has a car who goes to gym 4 times per week, hikes during weekends and plays tennis 2 times per week and eats healthy food.

There is no reason to tax the second person more than the first one.

Public policies are designed to work on populations, massive number of people - not anecdotal evidences like these.

And taxing private transportation / providing incentives for public transportation does not only benefit our health, it also bring other benefits; global warming issues, dependency on fossil fuels, etc

From the health perspective I agree, but there's a pretty clear reason to tax the second person more, since they have a car: more emissions, road use, infrastructure costs etc.

Well, we're talking about population-level health here, not individuals. And, in general, places where it's easier to get around using your own body have healthier people. Our current tax policy actively disincentivizes this - literally collecting _less_ tax could result in better health outcomes if it meant narrower, safer streets (which are cheaper to build and maintain), less parking (parking spots can cost tens of thousands of USD/EUR depending on where they are, and more insidiously, often displace housing), etc.

Looking at car ownership rates in the US over time and comparing to hypertension rates over time there doesn't seem to be much correlation.

There is like a multi decade lag between walking less and health issues. There's no way you're going to see correlations like that.

Hell I doubt you will even see much correlation between car ownership rates and miles driven in a car or walking distances but at least that's a correlation that you might possibly see in data.

I'm surprised I need to say this on HN, but you can't make inferences from this sort of uncontrolled choose-your-own-correlation-adventure in a whole population over time because thousands of things have changed in the population over that time.

If this were your epistemic standard, you'd have to accept all sorts of absurd or conflicting conclusions.

When someone is suggesting that a particular thing is causing or partly causing a particular outcome it is not a choose-your-own-correlate-adventure to look at how prevalence of that thing and that outcome have changed over time.

Things tend to be affected by their causes (!) so when the outcome is changing significantly and the purported cause is not then it suggests more evidence needs to be offered before we accept that the purported cause actually has a significant affect.

About half of the people United States are on government supplied medical insurance, and most of the people in other countries are on some version of that.

It is cheaper for people to die younger and so we should be encouraging unhealthy habits if we want to minimize medical care costs.

In spite of it's near ubiquity, I am trying to avoid the phrase "health care" because that is, as another comment talked about, not really what we do.

Treating long term is a lot more profitable than curing too.

One of the worst things that ever happened to pharmaceutical industry profits was the the discovery that most ulcers can be cheaply cured with antibiotics (which won the discovers a well deserved Nobel prize).

Even after this ulcer drugs were hugely profitable. I cannot remember the numbers from when I was an analyst covering them (more than 20 years ago!), but at one point a very big proportion (maybe even most) of Astrazeneca's profits came from their blockbuster ulcer treatment. Imagine how much more profitable that would be without a cheap cure around!

Gyms are not the solution, nor are health food stores. Far more people join gyms than make use of them. You can keep fit going for walks or running or a multitude of cheap things. IMO the problems are lack of time for exercise and money for a healthy diet.

Poor people have a far worse diet than rich people because they have to fill up with cheap junk. Junk food takes less time to prepare. I have ready meals sometimes because I am tired. Some people have to do it all the time, and they do not have the money to be fussy about how healthy the meals are.

>the problems are lack of time for exercise and money for a healthy diet.

pretty much. You go to some circles that will keep swearing by "Calories in, Calories out", and blaming any detteral of this as laziness. It's basically the equivalent of saying "stop smoking" to a smoker. Yes, they are objectiely right, but also miss all the subtlety of the steps needed to "stop smoking".

Time is definitely the biggest factor, and modern society feels like it's demanding more time than ever of workers for less spending power than ever. Of course people don't have time to work on their diet/exercise when some are working 2+ jobs at barely above minimum wage.

Where exactly is the nuance in this?

I pity the smoker more because they don’t have to smoke but feel compelled to smoke through addiction.

You have direct control over how many calories you consume and it’s a basic human instinct to eat.

Saying there’s nuanced steps inbetween is just a way to hand wave away someone’s laziness to not tackle the problem.

The same compulsion that drives the smoker to smoke drives the person that eats compulsively to eat. Be it for comfort or habit. Hormones and neurotransmitters drive behavior.

What gets deposited into your bank account and what gets stocked at your local grocery drives what you put into your body to survive.

If eating healthy is too expensive or outright impossible because of what is stocked at your local grocery and your hormones and neurotransmitters are telling you overwhelmingly to eat poorly... Is this laziness?

I'd argue that it's harder to quit compulsive eating than it is to quit compulsive smoking. You can't go cold turkey on food

That's true, you can't go cold turkey on food, but you can change what you eat. Gorging on fats and proteins and high density foods (nuts, cheeses, legumes, olive oil, eggs, etc) will have a very different effect than gorging on fats and sugars (pastries, white breads, soda etc.)

What does “going cold turkey on food” look like here? Because I’ve quit a pack-a-day-for-ten-years nicotine addiction, and I’ve dieted by slightly increasing exercise and slightly decreasing caloric consumption to produce a daily deficit of about 250-500 calories in line with mainstream medical recommendations, and I can tell you which I found harder… and it wasn’t drinking diet soda and walking around the block in the morning.

I suppose the cold turkey equivalent here is intermittent fasting. Disciplining yourself to ignore the most basic instincts of survival and eat at a specific time.

I never smoked nor fasted, so I can't really compare the two.

> I pity the smoker more because they don’t have to smoke but feel compelled to smoke through addiction.

We all feel compelled to eat.

A lot of cheap food does not satisfy hunger for as long as better food.

Just cutting calories in can make you feel less able to do things, so you automatically cut back on exercise.

People differ in many ways: metabolism, genetics, physical sicknesses, mental health, gut bacteria and probably many more things I cannot think of will change how the same diet affects different people, and their ability to exercise.

>>>Just cutting calories in can make you feel less able to do things, so you automatically cut back on exercise.

As someone who has dieted by cutting and counting calories. This wasn’t true, I didn’t have the energy for high intensity workouts sure but I did have the energy to walk a mile or two and the result is the same loss of calories as 2 mile run. Walking just takes a bit longer.

The important thing was drinking a lot of water or gassy things to feel full to quiet the urge to snack.

Also Deleting junk food, sodas , and beer completely from my pantry. Having coffee without cream, Replacing them with low calories snacks like carrots, celery, bananas.

I dropped 15 lbs fairly fast.

> Also Deleting junk food, sodas , and beer completely from my pantry.

So you improved the quality of your diet significantly. That is very different from just eating fewer calories. I suspect that if you had not done this it would have worked.

> Replacing them with low calories snacks like carrots, celery, bananas.

Also improving your fibre intake, and other improvements in nutrition too.

The cost of diet point is absolutely true. I'm a writer and filmmaker living in Europe - i.e.: poor. I've also got a variety of food intolerances and health issues, which compound over time. To help with stomach and sleep issues I'm currently trying to eat only foods I cook from scratch: mostly fish, meat and veg and a little fruit. It's wildly more expensive (and time consuming) than cooking prepackaged food. Fortunately I'm located in Ireland where there are plentiful sources of good quality fresh veg and meat, but it has literally doubled my weekly shop cost vs say pasta, chips, processed meat and other cheap carbs.

> pasta, chips, processed meat and other cheap carbs.

Carbs are one aspect of diet. There's very little actual nutrition in any of those things.

Yes, that's my point... It's cheaper to eat poorly. It's (significantly) more expensive to eat well. As I said before I'm spending more than twice as much cooking from scratch. And (as I'm coeliac and intolerant of milk) I wasn't eating the cheapest food before by any means. I reckon here in Dublin, the cheapest (and extremely unhealthy) diet of oven chips, pasta, bread etc - could be had for well under 20 euro per person per week. Whereas my partner and I are currently spending around 150 on veg and meet between us.

On the topic of time.

I’m a fitness person, I love it and have made it large part of my none professional life. One of the most annoying things I hear fitness people say is:

We all have the same 24 hours.

Yeh no, people don’t and telling them that isn’t helping. What’s better is to accept people have different lived and see how exercise can be snuck in.

Getting off the bus two stops early to get a 10 minute walk for example is a pretty manageable one.

I am also a fit person. When I hear someone tell me that they don't have time for doing exercise I do not respond, I just listen and watch. I almost always will see the same person in the next days watching TV, or social media or playing video games for hours.

I do minimal high intensity exercise every single day, it is just routine, because I am busy. Everyone can learn that. In fact I see the biggest number of betting shops in the poorest part of the cities as they are more vulnerable to learning bad habits, as companies are eager to teach those as it is great business.

Sure, and you’re right in plenty of cases. But likewise if your day to day is hard, stressful and has a decent amount of worry then once you’ve got the kids to bed at 8:30 the will power required to do some exercise is monumental. Quite frankly their will power points are gone for the day.

So, instead try to find a way to squeeze exercise in as part of daily life (essentially habit stacking)

I don't think "have to" is correct here. I've lived without savings and income without ever eating any unhealthy foods.Education and motivation is a big deal.

Here in France there seem to be a lot of subsidies for physical activity. For example, each town has a swimming pool, used by kids and adults alike, with very cheap membership. Then there are the associations, each focused on an activity -- tennis, badminton, pilates, etc. If you pay in September for the year, it's again quite cheap.

There are of course typical gyms, but the associations are much more popular afaict.

It's cheap only for a few sports. The martial art I'd like to do is at least 200€/year in the few clubs of my town, plus additional fees for administrative stuff like license and "passport".

And then membership is often based on somewhat calendar years starting in September, so if you don't register exactly at this moment the cost per month is even higher.

The September issue aside, 20€/mo seems pretty reasonable depending on how often you can go. Especially if there is a coach involved. Typical gyms in my area are about $20/mo just to access the machines and weights. Specialized gyms like Crossfit are all >$100/mo.

What is expensive to you? 200EUR works out to a few euros a week. That is fantastic value compared to anything I have experienced in other EU countries in this decade.

While it is true that pharma does not earn money if you do not need drugs, I would not blame them for not forcing people into gyms.

Unlike the food industry which directly causes the issue by pushing addictive and unhealthy food, I suspect the underlying problem with treatment vs. prevention is in culture and mentally.

You need to convince people to spend a significant portion of time exercising and eating healthy when they do not yet have issues in order to prevent future issues, taking time away from other, more entertaining things. Even with a goal, exercise is hard work. Treatment on the other hand rarely requires significant effort, and once it is needed it is no longer something you can ignore and postpone like you could with prevention.

At the same time, many conditions which pharma develops treatment for are not fixed with exercise.

Gyms aren't the solution. Gyms also make most of their money treating the problem. They are massively oversubscribed because they know most of their members don't actually go. Most of their members are on the "forever diet". You know, the one where you're always trying to "lose weight" but never actually do (usually the opposite).

The actual problems are things like food addiction and forced sedentary lifestyles. The solutions to these are things like taking food addiction seriously and treating junk food the way we treated cigarettes (ban all advertising for a start) and getting rid of cars in towns.

To go in your direction, a few countries in South American did ban advertising for junk food. In addition to education in schools, it dramatically helped reduce overweight-related sickness.

>There is more money to be made by stakeholders treating health problems than there is in preventing them. And so there is a lot more money and effort invested in developing pharmaceutical and treatment solutions than there is in preventing them – even though that would be far, far better for society as a whole.

The health care system in US is very broken. This paper [1] really outlines. It not just more money made in treating health problems than prevention. Due to the health insurance is structured in US, there is also an incentive for doctors to prescribe the more expensive treatment instead of the cheaper more effective treatment.

https://pubmedinfo.org/wp-content/uploads/2017/11/Is-US-Heal...

Neatly skewered 3 decades ago in the Sunday funnies: https://www.gocomics.com/outland/2023/01/16

It is depressing how many of those comic strips are still relevant today.

The issue is simple really. We evolved in an environment where resources are scarce and energy conservation is critical. These instincts applied to the industrialized society lead to overeating and inactivity. Very few possess the willpower to overcome this on their own.

But there are plenty of industrialized societies where obesity is less of a problem.

https://en.wikipedia.org/wiki/List_of_countries_by_obesity_r...

This fact is being used as an excuse that to ignore two other enormous problems: people refuse to grow up and take responsability on the one hand and on the other hand they are completly drowned in a sea of manipulation that does everything it can to make sure they consume as much as possible. Ban all advertising and foster a culture of maturity.

Maybe, just maybe, sometimes a free market is not the solution ? The US people have the lowest life expectancy and the most money spent amongst rich countries [1]. I am not 100% sure, but it seems to me that all the other rich countries have a more government-controlled healthcare ?

[1]: https://www.kff.org/other/slide/the-u-s-has-the-lowest-life-...

I don't think the situation in the US is as market-based as these kinds of comments imply. There are a ton of regulations in the US healthcare market and quite a lot of anti-competitive corporate influence, probably even more than in some other countries.

Regulations don't imply that the healthcare is backed by the government, it's a different thing

I’m just saying that the idea of “the healthcare system in the US is extremely market based” is not really accurate. If anything it seems less affected by market dynamics than healthcare in other places.

In the US.

Anywhere the healthcare system is public, there is more pressure in lowering its cost / raising its efficiency.

Insurance/banking company I worked for has made billions from incentives. Exercise, getting preventative tests, driving slower, reducing dangerous credit behaviour. Works in their market (might not in yours) and the clientele has self selected, so now they have a huge client base who largely follow incentives, which reduces their risks massively. If you drive fast you go elsewhere. That’s half the secret. It’s harder to replicate without the client base.

Did they operate in Germany? If you can name them, I would like to check them out?

Reminds me of Vitality health insurance in the UK

Yup related. I messaged you on LinkedIn.

The barrier to exercise isn’t money in most cases. It is that exercise is misery.

Exercise sucks. I am overweight. I much prefer Ozempic (and pay a substantial premium for it) vs lifestyle change. So do millions of other Americans who are shelling out for it.

You would basically need to economically torture fat people to the point that exercise is less horrible than your incentives.

I’m paying 8K a year to avoid exercise.

It's a shame that exercise is linked to misery for so many people, because it doesn't have to be miserable. Hell, it's so so much easier to stick with it if it isn't miserable.

I always tell new runners to slow down, like ridiculously slow, laughably slow. If it feels like the lung is burning and you want to vomit, oh that is wayyyyy too fast. Keep it slow and steady and maybe only ever so slightly uncomfortable, then allow your body to adapt and ride that feeling until you're all of the sudden exercising much harder but without feeling like you do.

I posit that exercise does not have to feel terrible to work, and that it can be turned into something that feels maybe a little bit uncomfortable during, but really nice after.

I think you probably just need to find a form of exercise that you enjoy. For me, I really don't like going to the gym, but I do enjoy biking.

That aside, exercise is just one aspect of prevention. In most places that have lower obesity rates, people probably exercise less than they do in America, which is ironic.

My broader point is more that the system is set up in such a way that it's easier for you to get overweight and then pay $8K a year to buy a treatment drug, than to just help you avoid getting overweight in the first place. Probably because the cost to do that is much less than $8K, so the stakeholders are much less incentivized to do it.

Lots of people love exercise. It can even be a lot of fun to play a game of basketball, soccer, or to dance… We are all different, and one just has to find a type of exercise that one likes.

Also, being low in fat is great, but it’s not the same as also having a developed muscle structure, strong bones, and performant cardiovascular system.

Then the benefits of exercise are broadly inaccessible to you - which is a fair choice. That said, maybe it is useful not to think about excerise as exercise?

Exercise doesn't have to suck. For it not to suck, it has to be on the right level for you (if you think you'll about to puke or die, it's not on the right level), and it has to stimulating in one way or another. If you can't find anything of all the possibilities, from Karate to soccer to windsurfing, stimulating in itself, maybe just reward yourself watching your favourite series on Netflix from a stationary bike.

Not all exercise sucks.

When the weather is good and I ride my recumbent through the beautiful Dutch landscape, I'm getting both exercise and joy.

[There are three types of fun (I, II, III) described in https://www.rei.com/blog/climb/fun-scale ]

That's odd, I'd think even for people who barely exercise there'd be plenty of Type I fun, available much more cheaply than USD 8K/yr. Distance is what matters; people who actually like jogging get their distance in much more quickly than the rest of us, but long slow distances can also be covered much more pleasantly.

(Type II fun is probably indistinguishable from type III fun at the start, but should you ever get more involved in sport you'll discover that there are many, many things that are type II but not type III)

> We condition the masses to hate the country, but simultaneously we condition them to love all country sports. At the same time, we see to it that all country sports shall entail the use of elaborate apparatus. So that they consume manufactured articles as well as transport. —DHC for Central London

The truth however is that to choose the pill is to choose uncertainty. There is no certainty that the drug you choose for your symptoms will work, less certainty that it will work for years into the future, and no certainty that it won't cause you further issues that will be remedied by a different pill, and on it goes.

Some things can't be fixed by exercise, so take the pills. Some things can, it's probably best to take the exercise. If it doesn't work, the pills are still waiting for you.

I guess what I'm saying is: exercise is misery, but not preventing damage is delayed misery of uncertain magnitude.

As countless others have replied, those of us that enjoy exercise feel like something is off here :-). I may be wrong, but my impression is that it is like driving a car with flat tires. Yes, that feels wrong, but once you inflate those tires, driving the car no longer feels wrong.

  At times when I have been out of shape, it has felt taxing to start up. But as soon as my shape starts to tighten up, it no longer feels like misery at all, instead it feels like the privilege getting to drive around in a cool machine - your very own body.
  It may be this is fundamentally different between types of people. For example, I have heard many women claim that running never felt good to them, even when they were in shape (this might there be related to how hips may be  differently shaped for running).

That's good because exercise wouldn't solve your problem anyway. You'd just be a fat guy who exercises.

Exercise isn't a misery when you aren't fat.

To lose weight you eat less. Unfortunately we've decided treating food addiction with pills and removing organs is the way to go rather than targeting the addictive stuff itself. Kinda like treating heroin addiction by removing arms.

Yeah, there are studies that show that eating less is much more effective than exercising more for losing weight.

There are other studies that show quite often the most effective way to eat less is to fast every now and again. And that's because if you're trying to diet by eating a small meal, your stomach/brain is going to be yelling at you all the time that you're hungry and you should eat some more, but if you fast, after 16 hours or so that urgency goes away and you stop feeling as hungry. Fasting sounds a lot more scary than it actually is. The record fast length is 382 days [0].

[0] https://en.wikipedia.org/wiki/Angus_Barbieri%27s_fast

I’ll hazard a guess: you never liked exercise, even as a kid?

If that’s the case, I’ll hazard another guess: you lived in an environment where you couldn’t just go out and play whenever you wanted?

I might be completely wrong in my guesses, and I apologize if I am. But I strongly believe that all kids are naturally predisposed for physical activity, and it’s the duty of the society to let them do that in an easy and safe way.

Interesting thesis - however I was one of those kids. I had plenty of access to exercise we lived in a quiet housing estate where we could easily play hockey or football in the streets. The only exercise I enjoyed was cycling and that wasn't really the done thing in late high-school.

Weirdly enough, I now go to the gym 3 times a week. I don't love it like some people do but I've made it enough of a habit that I do it anyway.

The main motivation for me was wanting to be active enough to keep up with my kids and a string of minor ailments (mostly not relating to lack of exercise) which gave me a bit of a shove to do something.

Hard to let your kids play outside when there's 2500kg Dodge Rams going 80kph in the streets.

As somebody who had been outside all the time during childhood and hated exercise starting with the PE in school, I don't think your guess is well founded in reality. None of my childhood friends had been keen on exercise either and PE was not the most popular class in my school...

For me there is a huge difference of doing something that requires physical exertion in order to complete and doing pointless physical exertion for exertion's sake. I can skate on a board or skates, or ride a bike for hours because it's about skill and technique for me, I feel frustrated after running for a minute. Similarly I can free-dive whole day but swimming laps feels like a massive chore.

I believe some people can enjoy exercise but, judging by how many fit people are there - they are in small minority.

> Exercise sucks.

Lots of people, including myself, love exercising. If nothing else, endorphins are a great natural "high". And I can tell that the rest of my system just works better when I'm working out regularly: I have fewer hunger attacks, I sleep better, I feel better. And, I just really like the feeling of picking up really heavy things (that being my current exercise of choice).

From what I can tell, the "exercise sucks" barriers most people face are 1) not everybody likes everything, and 2) it takes at least 2 months of training to get to the point where you can get the taste for the endorphins without being overly sore afterwards.

Now maybe you've spent 2 months trying all kinds of different activities (swimming, walking, hiking, weight lifting, cycling, wrestling, football) and none of them have worked, in which case fair enough. But if you haven't, I'd recommend trying it.

I can see why if you're overweight that running wouldn't be very fun. If you haven't tried weight lifting, definitely give that a go. If you're overweight, you've got a head start lifting heavy things (you), so it shouldn't be as hard to get into. People who've never lifted weights have this idea that it's mind-numbingly boring; but the mental focus you need to lift heavy things is actually a bit more like meditation. And being able to confidently lift really heavy things is an amazing feeling, not to mention having pumped-up muscles.

> Lots of people, including myself, love exercising.

great, good for you and those people. but clearly most people don't.

plus you cannot out-exercise a poor diet. doesn't matter how hard you go in the gym or on a hike if you slam donuts and pepsi all day.

> great, good for you and those people. but clearly most people don't.

If throwawaysleep had said, "Some people seem to like exercise, but I've tried all kinds of things and never found anything that wasn't a misery", I probably wouldn't have replied. But rather, they said, "Exercise is a misery" -- no exceptions or qualifications. They have acknowledged the importance of exercise, and seemed to indicate that they would be willing to do it for their own health if it were just boring or mildly annoying; but they believe exercise is always unpleasant. They seem to believe that everyone who does exercise regularly does so by just powering through the misery; but that this is realistically not an option for them.

So there's something they don't know, something they need to know -- exercise doesn't always suck. Lots of people exercise without having to "power through" any misery, because they've found routines they actually enjoy. And so, maybe there's a routine that they will enjoy as well. You're not going to look for something unless you know that it might exist.

> plus you cannot out-exercise a poor diet. doesn't matter how hard you go in the gym or on a hike if you slam donuts and pepsi all day.

I'm not sure where the donuts and pepsi are coming from. I don't know what happens if you take Ozempic while only eating donuts and pepsi; it's possible you could stay thin, but you definitely won't be healthy.

But since you raised it: Slim != healthy, and healthy eating !=> slim. It's possible to gain weight eating healthy most days and only eating really unhealthy once a month. And it's possible to have healthy muscles / cardiovascular system and still be overweight, or to have poor cardio and be slim. I'm pretty sure it's healthier to be overweight and cycle 20 minutes every day than to be slim and a couch potato.

If throwawaysleep is slamming donuts and pepsi all day, they should stop that for their health and well-being. But although it might slow the rate at which they gain weight, it probably won't make them slim.

Similarly, if they're overweight, while a normal, sustainable exercise routine will probably slow the rate at which they gain weight, or help them lose a bit, it probably will never make them slim. But they will be a lot healthier nonetheless.

>The barrier to exercise isn’t money in most cases. It is that exercise is misery

Only if you haven't been doing it. When you follow through and get the hang of it, it can be ecstasy.

>I’m paying 8K a year to avoid exercise.

And paying a lot more in cognitive and health decline long term, both in monetary terms (treatment) and in non-measurable quality of life terms.

Ozempic is just weight loss (and the potential side-effects of longer term use with it, we'll find out in the future).

Weight loss is table stakes for optimal performance.

> Exercise sucks. I am overweight. I much prefer Ozempic

There is zero need for exercise if one wants to lose weight.

"Exercise sucks. I am overweight." - to beat the weight problem exercise will do little. It's mostly what you eat. Exercise is for muscles, shape, health, blood pressure and many other great stuff and sometimes for weight loss, but generally exercise is not a good way to lose weight, in fact it can boost the hunger feeling and you could eat more calories without noticing. Ozempic is good for weight loss (with some risks but it's a great tool) and if combined with shaping good food habits - eventually you can drop the ozempic and keep the weight, and when weight is good, exercise is much easier (but still sucks for many). Some do prefer to bike as a form of exercise that's both healthy and greatly improves leg muscles which can help if joints were destroyed when the person was overweight. But ozempic will not help with health problems related to lack of exercise and sedentary life, it'll help just for weight(and sometimes addiction) loss. Use the right tools for right puroses to reach your goals

There are fun ways to exercise. You should give more things a try!

Ozempic may help with weight loss but there are other health reasons to exercise.

Have you tried walking? Just by walking one or two hours every day, you should burn enough calories to steadily lose weight. The health benefits of just walking are numerous: staving off musculosceletal degeneration (it will get to you quite quickly if you don't exercise at all - just look at astronauts), better sleep, improved mood and mental clarity. If you can walk in nature or at least peaceful and green urban environment, your mental health will benefit as well. There's a reason so many great thinkers in history were proponents of long walks in nature.

A couple of hours every day?

I spend 8 hours a day sleeping and 8 hours a day at work. Anther 4 hours in meal prep and consumption, personal hygiene, commuting, and mandatory household chores. That leaves 4 hours a day in elective time. Now you suggest I dedicate 50% of that time in non-productive exercise where I'm stuck with my own thoughts and no other mental stimulation while being physically uncomfortable?

Or once a month I could go to the doctor and get a shot.

I can see the appeal of Ozempic.

Now mind, I'm not overweight, but I do have diabetes and mild hypertension controlled through diet and, until my old dog "went to sleep" recently, regular exercise. I don't like the diet and often resented the twice daily long walks in all kinds of weather but still prefer that over chronic medication, especially one delivered through a means the gods did not give you an orifice for. My choice, but I respect other people's choices.

Whenever I think about the exercise I'm doing being unpleasant, I remember how unpleasant existing was as an unfit out of shape person day to day.

I used to be 280 pounds (127kg). My BMI was 38 and I was in horrible shape. People told me I needed to go to the gym, take up running, etc. - and that advice, while well-meaning, was mostly bad.

For me, what I needed was to swim and bike more. I loved those things. Running hurt and was miserable. Weight lifting was horrible. Team sports were a misery.

But I could happily bike (on a recumbent in particular) for ages, at my own pace.

When I sold my car, started riding a bike everywhere, and started a volumetric diet (don't eat tiny meals, eat big ones of low-calorie-density foods) I dropped to about 200 pounds.

And I stayed there for a long time (over a decade) until I moved somewhere I could do this even better - the Netherlands - and I've lost another 20 pounds. And I just ride my bike around. I don't go to a gym (I do get a swim in a couple times a month though).

Riding my bike in suburban California was, indeed, torture, but only because it's a horribly-designed place. In nice places it's a delight.

>>>>Is there a market-based solution to this? And if so, what would it look like? Tax breaks for gyms? More lobbying from Big gym?

Using your point, how would lobbying from big gym be able to compete with the dominate interests of pharm and medical.

The desire to work out comes down to the self determination of the person and I don’t think there is any product that is a substitute or replacement for that.

You don’t need a fancy gym to get rigorous exercise. You can do everything in your home. Walking, running, Push ups, sit ups, squats, dips, are free and easily accessible to do anywhere. biking, swimming, and pull-ups are less accesible but are also relatively easy and cheap, these also are the best exercises one can do to avoid injury.

I would say building more bike roads, walkable spaces, outdoor exercise areas, and emphasize these things early in schooling are the best and most effective. I’m sure it is emphasized highly in Europe where people are generally more in shape.

We have many (about 1 per 20'000 people) short circuits consisting of exercise stations scattered about a forest with a jogging/walking path connecting them.

As far as I know, the insurance companies sponsor these, and presumably they find the upkeep costs (under $1'500/year?) pay back in reduced overall payouts?

> There is more money to be made by stakeholders treating health problems than there is in preventing them

This is not in line with economic theory. According to it, actors would simply price the treatment and an npv of the potential future cash flow. It would actually be more beneficial to treat people completely, as it reduces the risk of the cash-cow suddenly being hit by a car, for example.

Reminds me of something similar I read.

> Large companies will tell you that you need to eat different. Never to eat less.

It's unfortunate that the one answer to this from a person actually being prescribed "diet and exercise" is saying they don't want to and that comment is currently greyed out.

Because my less than expert observation is this comment is the kind that gets trotted out consistently by cynical systems thinkers who think they've uncovered sinister forces making the population sick on purpose. This seems to ignore that tremendous effort does go into trying to convince people to eat better and exercise more. Money put into youth sports, mandatory gym classes, amateur athletics as their own carveout for nonprofit activity. Lyndon Johnson launched the presidential fitness challenge in 1966. Michelle Obama tried to make this her entire pet project for 8 years while her husband was in office. Other parts of the Internet are full of people like the greyed out comment making the exact opposite observation to yours. They complain that doctors don't take them seriously or give them medicine, refuse surgeries if you're overweight, and are always prescribing diet and exercise.

For what it's worth, and I guess it doesn't have to be worth much, my personal hobbies outside of work have always consisted of sports and fitness. I was into these things well before I ever discovered my first computer. One consequence is most of the informational/entertainment content I consume is sports and fitness focused, including a few podcasts hosted by both coaches and medical doctors, who also make the same counterarguments to your own observation here. Every major medical association out there, national and international standards bodies, primary care physicians themselves, do in fact prescribe preventive measures like diet and exercise, but either the patients and general population ignore these and don't do it anyway, or they don't seek any sort of remedy until they're too far gone in the first place.

There are clearly plenty of environmental factors causing higher levels of diseases of civilization, ranging from the accessibility of sports and recreation facilities in particular places to a poor walking environment to food abundance, but it certainly isn't just this. Plenty of nobility of old got fat eating minimally processed, locally grown foods that their ancestors ate, before cars and concrete existed. We can see the same thing happening to our own pets. They're seeing elevated rates of obesity and hypertension and stuff you'd never see in the wild, and this happens even when they're fed great food and allowed every opportunity to exercise. The unfortunate reality is evolution equipped mammals with an incredible propensity to conserve energy and overeat when the opportunity to do so is available, presumably because such an environment would have largely been seasonal and not permanent in the distant past. We've made it permanent.

I'm not at all trying to say that we can't do anything society-wide. There are obvious differences between nations and regions. There have to be reasons some places do better than others, but I doubt that market forces are one of those things because those are largely the same everywhere, and the entire world has seen diseases of civilization pop up as soon as people have the chance to overeat and live sedentary lives. Hacker News really hates this for some reason, but things like GLP-1 agonists are going to be necessary if you really want to hit everyone that is affected by this. A whole lot of people simply are not going to eat less and move more no matter what incentives you give them.

There is no solution. The problem is not in the lack of funding or interest from investors. The public itself is not interested in preventing. They think the probability of something bad happening for them is low (for example heart attack) thus they are not willing to put in the effort and proactively try to prevent it (for example by exercising). This can be either from a lack of accurate data or even when the data is accurate and available someone might still interpret it differently. For me a 3 percent chance might be insignificant for someone else 1 percent is still high.

> The public itself is not interested in preventing. They think the probability of something bad happening for them is low

Which is ironic because we all know someone who’s had a heart attack, cancer or a stroke.

And if someone decides to make lifestyle changes, they’re often going against society and the medical establishment.

A friend recently was able to stop taking her diabetes and hypertension meds after she did things her doctors discouraged her from doing, like intermittent fasting, which I told her about.

Now she distrusts doctors because they told her she’d have take these meds for the rest of her life.

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