Being overweight overtakes tobacco smoking as the leading disease risk factor | Hacker News Reader

Being overweight overtakes tobacco smoking as the leading disease risk factor

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This paper provides a helpful breakdown of types of mortalities and how they're associated with BMI. It's interesting to see that the lowest All-cause mortality is at a BMI of 25. A BMI of 30 doesn't increase the hazard ratio that much, but a BMI of ~45 doubles it. The minimum for cancer mortality is notably lower (21) but perhaps surprisingly the minimum communicable disease mortality is at a BMI of 26.

https://www.thelancet.com/journals/landia/article/PIIS2213-8...

My guess: less cells mean less cancer, but it's good to have reserves if you're fighting off a virus?

More likely relates to diet. There was a recent WashU study directly linking high fructose diets to increased cancer. Cancer cells are vigorously growing, needs lots of available fuel, a diet full of corn syrup fuels both fat and cancer.

> a diet full of corn syrup fuels both fat and cancer

Or sugar. Or modern fruits. The problem with HFCS isn't that it's got fructose (so does cane sugar) or is made from corn, it's that it's cheap sugar.

How much fruit do you have to eat before it becomes harmful? I can imagine juice can easily be over consumed but solid fruit is very satiating.

> How much fruit do you have to eat before it becomes harmful?

Unclear. The aforementioned study fed mice sugar water [1], and cautions against extending its findings to fruit as "natural fructose obtained from plants typically confers metabolic benefits due to its slower absorption rate and the presence of beneficial plant fiber and antioxidants."

It does mention, however, that "human physiology...confronts challenges when metabolizing fructose beyond 25g/day." That's like a cup of grapes, a medium pear or half a mango [2].

[1] https://www.ijbs.com/v20p3480.pdf

[2] https://www.webmd.com/diet/ss/slideshow-fruit-sugar

>solid fruit is very satiating.

Very briefly.

I've stopped eating fruit (and carrots, which have fruit-like levels of sugar) with the exception of tart (i.e., less sugary) cherries out of a desire to limit my fructose intake. I was eating raspberries, too, which are much lower in sugar than most fruit, but stopped because of their high levels of oxalic acid, but I do expect to restart raspberries in a few years because I expect my ability to tolerate oxalic acid in my diet to improve slowly over the next few years. (In contrast, high-fructose foods including most fruit are probably gone for good.)

Of course, I'm not asserting that everyone should do as I am doing. There is substantial variation between individuals here.

It's funny all the modern fruit I see is bigger but dry and not sweet at all

AIUI cancer cells are also metabolically inflexible; they like glucose, not ketones.

Good evidence for this found here: “Tripping over the Truth: The Metabolic Theory of Cancer”[0]

[0] https://www.goodreads.com/book/show/23496164

> AIUI cancer cells are also metabolically inflexible; they like glucose, not ketones

Is there a selection effect at play? As in, a person with high serum glucose levels will tend to have cancer that likes glucose? That would imply the solution isn't ketones per se, but changing the fuel from whatever the cancer grew up with.

iirc the talk I learned this from said there's simply not many cancer variants that don't need abundant glucose to grow tumors. That the whole defect stems from hijacking the energy side to fuel uncontrolled growth, and it needs glucose.

I know someone who tried to use keto to manage her bowel cancer, and died. Used to know rather than know I guess

Yeah I see this take all the time and it's dangerous, it might have an element of truth but it's definitely dangerously simplistic. You can find advocates of low fat high carb diets also claiming that very low fat intakes improve cancer survivability.

I'm sorry for your loss

You're absolutely right it's dangerous. It's likely that I gave myself cancer by adopting this 'simplistic truth'.

A decade ago I read about the keto diet and thought "why not?". Lots of positive stories about dropping weight fast, getting mental clarity and starving cancer.

A few years later, I was diagnosed with a rare Leukaemia (with a distinctive BRAF mutation). I was too young to have a cancer so I thought... maybe this keto thing is not so good after all?

Cue to several Pubmed rabbit holes, where I find studies suggesting that one of the ketones (acetoacetate) promotes tumor growth in BRAF-related cancers (melanoma, colorectal, hairy cell leukemia, and others).

Well, that was the moment I stopped doing stupid 'hacks' with my body and strictly adhere to the 'common sense diet' - ie eating like my grandpa did.

While I can't confirm 100% that my cancer was triggered by the keto diet, I have a strong suspicion it did. So yeah, before going online and stating grandiose things like "cancer starve on ketones, they need glucose" let's all acknowledge that we humans know very little about what's going on with cancer, and the potential adaptations it can do.

Some sources: https://pubmed.ncbi.nlm.nih.gov/28089569/ https://pubmed.ncbi.nlm.nih.gov/26145173/

It also doesn't pass the smell test for me because some of the most long-lived, relatively cancer-resistent populations like the Japanese eat carb based diets. That's hard to explain if it really is just a case of replacing glucose in the fuel mixture with fat and ketones.

+1 for the 'grandpa diet', I also feel best eating normally

Perhaps people getting cancer treatments tend to lose a lot of weight before dying?

Another possibility is that unexplained and unintended weight loss is associated with increased risk for many types of cancers.

Yet another showing "overweight but not obese" might not actually be bad, and this post's title is wrong?

("Overweight" is the BMI range 25 - 30, "obese" is 30+)

Being overweight increases the risk of developing quality of life reducing conditions and that is bad (it’s not being overweight itself that is bad). This is the case even if it doesn’t lead directly to dying. I would be careful about pushing the narrative that being overweight but not obese is just fine just because it won’t significantly increase your chance of straight up dying. Type 2 diabetes is a treatable condition so might not lead to a significant increase in deaths, but not exactly something you would want to develop if you can avoid it. And your chance of developing just that does increase if you are overweight even if you are not obese.

I'd like to emphasize the "might not": The impression I get from all these studies (I've seen them pop up pretty regularly for as long as I've been paying attention, nearly two decades) is that the border is actually wrong, that going from "normal" to "overweight" should be increased slightly from 25 to 27 or so. We're probably getting mixed signals in the "overweight" classification because "okay" and "bad" levels are being combined.

The focus on kg/m2 (BMI) I cannot understand. Surely the lowly “body fat percentage” should be a better variable than kg/m2? Bodies are three dimensional you know!

It is much easier to measure, and is a good enough proxy for the vast majority of people.

To quantify, I've heard MDs say that the outliers (relatively high BMI but low body fat) constitute less than 1% of high BMI people. They also said that those outliers are still at risk of certain health troubles, like sleep apnea.

The suggestion of using BMI + waist circumference is an easier to measure risk factor than bodyfat percentage and helps to better capture those outliers.

I imagine the missing spatial dimensions are correlated with weight, for any given height.

BMI is trivial to measure conclusively, using tools that are almost universally available and ready. And at population scale, it's proven to be a strong and pretty signal for analyzing in studies like these as the ways in which BMI can fail for individuals is too uncommon for it to matter to population studies.

It's a perfect tool to use for studies like these, as it can contribute understanding society-level concerns about the obesity epidemic and what impact we can expect it to have if it continues not to be tackled.

But like with almost all medical and nutritional research, drawing conclusions for yourself as an individual based on these population-scale studies is inevitably fraught. In the case of BMI studies, you can often get a fair sense of whether you should be concerned or not, but do need to take into account other things that you know about your lifestyle and health. Your doctor, presumably, does exactly that.

Meanwhile, body fat percentage tends to be very hard to measure accurately in the first place and has different techniques that tend to have different error characteristics, making it hard to correlate it between studies done through different clinics, let alone against someone's personal assessment at home or with their personal doctor/trainer/whatever. It probably has high relevance to some medical and nutritional outcomes, but isn't a very useful input variable for research because its inescapably noisy.

I apologize if this is tangential, but I have noticed BMI research is often heavily criticized, but the same issues that plague BMI can easily be applied to psychometric measurements of intelligence (IQ), but somehow IQ is spared the same beating for some reason I must not understand.

Perhaps my low IQ is showing, but why is one metric heavily criticized while the other is not? (Rhetorical)

Huh? I haven’t seen “IQ” seriously used in decades. Its flaw are well known.

Even in popsci/social media I've seen more and more awareness that it's "bunk" science.

It's in the same category as all that "alpha male" theory, Meyers Briggs, polygraphs, and "left vs right brained" people.

I'm starting to see more awareness around the concerns of "ballistic forensics" too, which is heartening.

> Even in popsci/social media I've seen more and more awareness that it's "bunk" science.

Devil's Advocate: Then why is it so heavily used still? (Then again, I guess back to my initial point -- the same could be said for BMI.)

Proof that's it's still heavily used in serious scientific literature?

How do you define 'serious scientific literature?' In other words, what type of evidence would you like me to present? Does any peer reviewed research that uses IQ as a factor count as serious? (Obviously, I won't present research that is about IQ measurement.)

I have never had IQ test taken, but countless of times BMI has been calculated. Mind you I have had other mental tests done due to ADHD and Autism concerns, and some of them were similar about abstract logic, but they were combined with other things like focus, memory, multitasking, literary understanding and other mental capabilities. The results of these tests were presented as percentiles in the population.

Interesting. I was given an IQ test for ADHD diagnostic purposes. There were other test given, as well. And in my opinion, the other tests were more indicative than the IQ test was (which I think is falling out of favor with ADHD testing). Then again, there were some issues with my test and scoring, so it makes me even more dubious of the (psuedo)science.

I went through the arduous process merely for the formal documentation, which in hindsight has served me well. Not a single doctor has ever questioned my diagnosis. However, as the psych told me, a 10 minute conversation with me should honestly have been evidence enough. ;)

Interestingly, the actual ADHD tests didn't find any issues, my main issue was my mind wandering in social situations, listening, understanding, keeping track of conversations and my own input. But whatever the tests were they were stimulating enough that I had no problem focusing. It's also repetitive, routineus actions that I have trouble focusing on, so it's almost like untestable issues. I did get the diagnosis though, I don't remember with what justification since the tests didn't allow for that.

Do you mean "why is it still used in popsci"? I'd wager because it makes people feel a similar way to other pseudo scientific categorizations, but that's mostly speculation on my part. Add in a bit of inertia and the simplicity of it ("let's reduce the cognitive ability of people across the world to a single number!") and, to me, I can see the appeal for others.

I was administered the WAIS-IV for the purpose of a clinical diagnosis about 10 years ago. My state still considers it one of many factors in whether one is a candidate for the death penalty. Some gifted programs still accept the scores as necessary evidence for admission.

Army too, back then. IQ test and MBTI (Myers Briggs), if I recall correctly, then OCS considerations if ranked well enough, including an oral interview.

> somehow IQ is spared the same beating

I think this is the part you're getting wrong, which is why you're confused.

IQ was contentious from its introduction in the beginning of the 20th century, caught some traction in the mid-century, and has mostly been on a decline of esteem and respect again since. It's never been very broadly accepted, let alone spared from criticism, nor have most other psychometrics, although (as always) there are bubbles of academia, industry, and the general population that swear by them and work to legitimize them.

Kurt Danziger has published really great histories of all this.

I'll add that his books are especially interesting in the context of all the AI buzz as insight into the history of "intelligence" (the word, the socially constructed concept, etc) helps wrap one's head around what it means when people working in CS try to repurpose its terminology in their own field.

IQ is as far as I can tell quite well accepted as a diagnostic tool. The pushback is in its application across whole populations.

FWIW, anecdotal data is also considered a valid diagnostic tool too, and we know how unreliable such information can be.

Also, by populations, do you mean groups of particular types of people or just groups of people in general? If anything, I thought IQ really only had anything close to merit at large population levels. Much of what I have read clearly fails at an individual level.

However, if you are talking about IQ's application in regards to populations like one race vs. another, then yes, I think the pushback is well deserved.

I agree with you about your last statement! I think it's actually a pretty interesting comparable to BMI. BMI: useful epidemiologically, across large populations, but much less useful individually. IQ: much less useful across large populations, but useful as a diagnostic/clinical tool in individual settings.

> IQ is as far as I can tell quite well accepted as a diagnostic tool

Inside certain bubbles, sure, because there's pressing demand to have something quantifiable and sufficient supporters willing to assert its legitimacy.

But good luck taking your test results outside of those bubbles to earn you some opportunity or respect, even if you can say your test was administered to the highest standards by the most respected administrators.

Nobody here will take your results to mean anything. Nobody at your work will take your results to mean anything. The recruiter at some new potential job won't either. The prestigious university you want to attend won't care. Most of your partners and friends probably won't.

Many of them may already have a sense of whether you're "intelligent" or not, either from personal interactions or from other practical indications. But good luck finding somebody of material influence who would hear your IQ score results and change their mind. It just doesn't have that weight.

That's what it means for it not to be treated seriously outside of bubbles. There are supporters that back it, and there are institutions that rely on it, but outside of those very specific places, there's very very little trust in it.

In any bubble where IQ is considered legitimate, just mention that Richard Feynman apparently had a recorded IQ of 124 or so (or Lewis Terman's study of gifted children).

You'd think someone tried to convince those in the bubble that the Earth is flat. In my experiences, I have been met with all kinds of rebuttals like, "The test he took was probably over-weighted in verbal vs. spatial reasoning" or "He probably just blew the whole test off."

No one has a copy of the actual results to my knowledge, but he and his sister (who oddly enough scored higher) verified the story back in the day according to biographers. So, not telling what is the true story.

For the sake of argument, let's assume Feynman's score was indeed accurate. I think it makes people extremely uncomfortable for two reasons:

1. Some individuals with high IQs (IQ >= 130) feel threatened or ashamed by the fact that someone with an high but unremarkable score was capable of truly remarkable contributions to their field.

2. The scores are truly not always accurate or might potentially measure something that isn't intelligence.

If Feynman's score was indeed an inaccurate measurement of his intelligence, then that says more than I need to know about IQ testing.

I mention Feynman because I am in agreement with you:

> Many of them may already have a sense of whether you're "intelligent" or not, either from personal interactions or from other practical indications.

No one would consider Feynman to be unintelligent by any stretch of the imagination. However, at the end of the day, his score truly doesn't matter. Feynman nor anyone else is not remembered because of their intelligence, but rather, his contributions. Besides, exceptional people tend to be, well, exceptional.

> IQ is as far as I can tell quite well accepted as a diagnostic tool.

not at a scientific level, no

Are you sure about that? I'm shoplifting an argument from Twitter from a quantitative psychologist.

The pushback is because it suggests some uncomfortable possibilities...

Also wait until people find out the correlation between IQ and obesity (runs for cover)...

> there are bubbles of academia, industry, and the general population that swear by them and work to legitimize them.

Perhaps you a right, because this is my main exposure to psychometric. From much of what I have read from various journals, there are clearly those that are contrarians, but mainstream academic psychology presents IQ as if IQ is some infallible measurement of human intelligence.

Despite IQ's merits being contentious (like BMI), it is still widely used regardless. IQ testing is still used for clinical diagnostic purposes (why I had to take one), entrance in to some gifted academic programs, in judicial contexts, etc..

Based on my personal research and experiences, I align with the contrarian views vs. the mainstream, academic views.

IQ routinely gets destroyed. As an example, I was an undergraduate in the 1990s. My statistics class skewered the use of IQ back then. According to some friends with undergraduates, they still use that as an example of statistics being used badly.

People say that, but then people like me are administered the tests for clinical diagnostic purposes (right or wrong), and even my state still considers the scores to be a valid measurement of intelligence, and thus a factor in whether someone convicted of murder is eligible for the death penalty.

I think the concept is bullshit myself, but regardless the damage is done, and still being done for what it is worth.

My crude understanding is, we don't have a good way to calibrate above-average scores, but it is a good measure for below average (provided there aren't arbitrary barriers like the language it's in).

That’s too bad, but I replied to something that claimed there is no criticism of IQ. IQ is criticized and used. Those are not exclusive states.

Yup. Polygraphs are still used in the intelligence community and court too.

I'm seeing the tide turn (imo), but by no means am I claiming it's no longer used (regardless of merit). I acknowledge I'm starting a personal anecdote which is subject to my own biases such as cohort affects.

IQ is an interesting one. There are indeed plenty of issues in actually measuring it and deciding what we're even measuring to begin with, but at the same time, I've heard some people try to say it doesn't even exist at all.

Which seems odd, because I've yet to see anyone who doesn't believe that stupidity exists and it's the other side of the same coin.

> I've yet to see anyone who doesn't believe that stupidity exists and it's the other side of the same coin.

I do not think that is the argument though. Clearly, there is some sort of distribution of all human attributes. I think the argument is in how (in)accurately something as qualitative and arbitrary as intelligence can be measured.

I like the analogy of athleticism. Some people are more athletic than others, but again, such differences are generally highly contextual. I am sure some sort of test composed of factors like the number of push-ups, sit-ups, and time trial of a 100m dash could be used to generate some sort of AQ (athletic quotient).

However, scoring high on the 100m dash might positively correlate with performance in sports, but I would not wager that a high AQ is truly indicative of athletic performance as a whole. At least not in any transitive sense when mapped to many sports. For example, Usain Bolt might have a very high AQ because of his running ability, but his AQ might not serve him well in a game of ice hockey or swimming.

Sure, but in the case of a hypothetical AQ, we could do factor analysis and pull out different things, like the strength of various muscles or muscle groups, like all pure running tests had strong correlation with things like leg muscles. In IQ, this has famously been done and found that a single factor dominates.

Or when they saw that knowledge of arcane sport rules interfered, they could look for a more pure test of ability rather than knowledge, which they did with IQ by going from tests of specific factual knowledge to Raven's progressive matrices.

And when you do that kind of work, you find that you can develop better measures that have a lot of predictive power for whole populations, even if they do not tell you, say, how many goals they'll score in their next hockey game.

IQ is definitely not spared. It doesn't take a Mensa member to realize that human intelligence cannot be reduced to a single number.

> BMI is trivial to measure conclusively

That does not make BMI a good measure.

It does for some applications, and not for others. In epidemiology you're looking at the number across broad populations, where a lot of the "three dimensions" idiosyncrasies cancel out. You're likely to run into trouble taking literal BMI constants and turning them into individualized patient care instructions, though.

Or basically: there are outliers, and those tend to complain. But the average billions cancel them out statistically.

I'm an outlier myself, and so is anyone who did some serious sports for a significant amount of time. There are other reasons to be an outlier too. But they're not so statistically significant.

ditto. Always a bit frustrating when the sadly overweight nurse looks at my height and weight, charts it, and mutters to themselves "borderline". My last visit, at least the doctor deigned to actually eyeball me and said "you look like you are quite active, we can ignore this".

Oh I'm inarguably overweight, but not to the point the BMI would indicate, considering that when i was younger and in top form i was between 29 and 30.

You are saying it is a not dreadful statistical measure.

That is doubtful, but possible

It is used for individuals. That is where it is harmful

> harmful

It's hard to conceive of anyone meaningfully "harmed" by being a BMI outlier.

The only real occassion it comes up is when some lean and uncommonly athletic person gets miscategorized as obese and get warned of increased risks to their wellness if they don't lose weight. A warning which they generally laugh at because they know their own situation.

That's hardly "harm" -- "mild social nuisance" is more apt.

> It's hard to conceive of anyone meaningfully "harmed" by being a BMI outlier.

"You are fat. You must diet."...."Oh my Dog!! I am fat!!! I will fast"

Potentially for health insurance but I get the actuarial argument, especially since higher than typical weight regardless of fat composition puts higher than typical strain on your cardiovascular (and other) systems

The harm is that are more likely to get prescribed unnecessary medications. Most people are not confident enough or not knowledgeable enough to wave off what doctors say.

It's an easier diagnostic metric. Being jacked shit house with high BMI will still suffer from health issues of merely being overweight relative to frame.

> Being jacked shit house with high BMI will still suffer from health issues of merely being overweight relative to frame.

Do you have evidence for this? (Assuming getting jacked without the use of steroids)

Well, for one, it places the same strain on the skeleton, with all the consequences that entails. Mass is mass, no matter if it's muscle or fat.

Well yes and no. Strain on the skeleton from excess muscle isn't particularly a problem unless someone is really huge or does a lot of running. The skeleton adapts to handle the load. Having more strength in the muscles that stabilize joints actually reduces the risk of joint injuries — up to a point.

https://peterattiamd.com/belindabeck/

The medical problems with excess muscle mass tend to be more on the cardiovascular system than the skeleton. And the process of gaining a lot of muscle mass can increase the risk of musculoskeletal injuries (especially if using PEDS), which is a key confounding factor when looking at population health statistics.

Wouldn't some (if not all) of that be mitigated by the increase in bone density that comes with resistance training?

The problem is not bone density. Your bones are never going to break under your own weight unless there's something seriously wrong with you. The problem is joint health.

Sure, guess I read your comment as bone-focused. That said, joints also do get more resilient when resistance training. Although, I'm aware not necessarily at the same rate as the muscles themselves, leading to issues where the muscles are capable of handling more weight than the joints can happily handle (if we are to personify joints). But, I think that issue is mostly obviated with good programming and load management.

Your heart is still moving the same weight, fat or muscle. It's the same from system stress. Experiencing more health issues from bulking even at >20 bodyfat is pretty common... blood pressure etc. At some point just being a bigger person who has to eat more takes a toll.

An example is sleep apnea, which is highly correlated with neck circumference and being “jacked” can often mean your neck grows as well. There are many “jacked” amateur and professional athletes who suffer from sleep apnea. (Something like 30% of American football and rugby players have sleep apnea.) There are a myriad of negative risks associated with it, from cardiovascular risks to dementia.

BMI is more of a screening metric than a diagnostic metric. It's not really diagnostic of any medical condition beyond obesity itself, but if a patient is outside the normal BMI range then that can be a reason to justify additional diagnostic tests for certain conditions.

While there are potential health issues (outside those resulting from PED use) to being too jacked, they're not even remotely the same severity/risk as those from carrying too much body fat.

Let's put it like this: the probability of an individual to be at a BMI of 30+ AND being very lean, while not using PEDs, is extremely low. So low, in fact, that it doesn't make sense to even look into these outliers from the societal health point of view.

Imagine a 180cm 98kg male. That would be a BMI of 30. How often do you see people of that size with visible abs? And of those, how many are the ones who've never touched steroids, sarms, peptides and hgh?

If a person's BMI is less than 30, they are going to be okay no matter what their body composition, and with a BMI of 30+ they aren't going to be okay, whether they are fat or jacked. Both obese and insanely built people put massive strain on their knees and back, both typically have high blood pressure.

Then the adipose tissue itself has various negative inflammatory effects on health, which sceletal muscle doesn't, and fat people encounter psychological side-effects of being unattractive, which jacked people don't, but PED use has its own list of well-known issues, and being THAT MUCH into bodybuilding is highly correlated with body dysmorphia alongside other physch issues.

So both are bad, and when speaking about general population health, we shouldn't really focus on body composition- BMI is good enough marker on its own

4 years ago I was 100kg @ 185cm. Never touched PEDs. All it took was being in the gym going all out for around 2 hours, 6 days a week. My body fat was 13% consistently. I tried going below 13% until it started to affect my strength.

The rest of my life also revolved around recovery and nutrition because very quickly I realized that I needed to make extraordinary efforts to allow my body to recover from the regimen. I slept 10+ hours and ate around 3300 cals daily (TDEE was massive).

Being on antidepressants at the time made eating these amounts much easier, as it seemed to turn off something in my brain responsible for me feeling satiated.

I started gym after being diagnosed with the psych issues. I really put 110% effort into it and got… big stretch marks because my muscles grew so fast. I don’t think what I was doing was ”healthy” as much as it was ”I am super depressed and heavy barbell squats is my coping mechanism”.

I just wanted to say, you don’t need PEDs to get ”scary” jacked. But you probably need to be crazy like me.

If (and that is a big if. Most people severely underestimate their body fat levels. And with some touting 3% dexa scan results, even such measurements are suspect) you really were at a bmi of 29 (which, BTW, doesn't count as 30+ from my original statement ), then congrats on your amazing genetics and work ethic.

Still, to break that bmi 30 barrier significantly, while maintaining the same level of leanness, you'd likely require some additional 'help'.

And again - it is possible for a number of gifted people, just highly unlikely. Most males can't get that jacked no matter how much and how hard they train. I'd say that even with PEDs most wouldn't break that barrier while staying lean.

My personal best was a 28 bmi with what looked like a 9% body fat, veins fully visible at the lower abs and the hips etc, and it was absolutely unsustainable for more than a year, for a plethora of reasons. Can't even imagine gaining 3 more points.

To reiterate: I'd still focus on a BMI to gauge the public health - the genetic outliers are rare

If you are not an ELITE athlete or bodybuilder... then BMI is accurate. You are coping.

I'm just big boned.

You yourself are coping about the inaccuracy of BMI, what is so hard to accept that BMI is a sucky measurement?

[flagged]

What is so hard to accept that BMI is a good measurement?

Imbecile.

Outside of elite athletes, BMI is good at what it’s for. It’s just an easy way to express the relationship between your weight and height. Everything else requires specialized tools and contains a large margin of error.

BMI (as a diagnostic tool for overweight and obesity) has some problems, but it's good enough for most people most of the time. The measurement is FAR less likely to return a false positive (due to someone being "too jacked") than it is to correctly identify some who is carrying too much body fat. In any case, BMI plus a waist circumference measurement is even more accurate, and is still an easy, accessible and useful clinical diagnostic measurement.

Not really, because you can have low body fat and low muscle and be an absolute mess

kg/m2 is akin to height and width which is 3 dimensional

This particular statistic has a ton of problems. It's impossible to disassociate the various causative pathways that land you at a BMI below 25. A ton of them involve diseases and chronic conditions.

Unfortunately, it's very hard to impossible to RCT this. And if a study has no RCT, take it with as much salt as your diet allows.

You definitely don't want to intentionally gain weight on the basis of this. If weight control is easy for you, I would personally strive for a lower BMI.

If losing weight below 25 is hard for you and your body just seems to refuse to do it, then you might be OK at 25.

What's RCT?

Randomized controlled trial.

Roller Coaster Tycoon

> This particular statistic has a ton of problems. It's impossible to disassociate the various causative pathways that land you at a BMI below 25. A ton of them involve diseases and chronic conditions.

I'd beware of using this sort of hand-waving to ignore the studies, there are also effects pushing the relationship between average health outcomes and BMI in the other direction. Your ethnic origin seems to be very important, and for ethnicities who already have a high propensity for Type 2 diabetes, higher BMI is a factor, but not a huge one.

> Strikingly, in those with a normal weight, the prevalence of diabetes was 5.0% in whites, 10.1% in Asians and American Indians/Alaskan Natives, 13.0% in Hispanics, 13.5% in Blacks, and 18.0% in Hawaiians/Pacific Islanders.

> Furthermore, when they examined the relative risks for diabetes for each BMI category by race/ethnicity, Zhu et al. reported that across all racial/ethnic groups whites had the steepest BMI gradient, followed by Asians, American Indians/Alaskan Natives, Hispanics, Hawaiians/Pacific Islanders, and blacks.

https://diabetesjournals.org/care/article/42/12/2164/36251/D...

Another potential distortion comes out of this when you consider that black and Hispanic people are the fattest in the US. Blacks and Hispanics can have lower lifespans for reasons other than BMI, such as access to health care, high-quality food, exposure to violence, physical jobs, etc...

So just these two factors complicate the picture in general (your fattest have the least access to health care and most exposure to danger and neglect), and and in the other direction specifically for white people (an increase of BMI in white people makes a huge difference in their incidence of diabetes.)

Anecdotally, I'm black, and there's a lot of thin diabetes in my family. My dad usually runs about 20-21 BMI, and is pre-diabetic. His mother, who is also small, though not quite as small, is also diabetic. As far as I can tell, the fatter people in both sides of my family are no more likely to be diabetic than the thinner ones.

Not the original commenter, but pointing out problems and complexities is not hand-waving. Nutrition science is incredibly complex. If it wasn't, obesity would be solved by now.

> Another potential distortion comes out of this when you consider that black and Hispanic people are the fattest in the US. Blacks and Hispanics can have lower lifespans for reasons other than BMI, such as access to health care, high-quality food, exposure to violence, physical jobs, etc...

Okay, but this study is from Australia, on Australians.

This kind of stat is misleading and is seen in many health metrics - blood pressure, cholesterol, etc. In fact, it's sometimes known as the "cholesterol paradox" because people with higher cholesterol have a lower risk of dying. However, it's misleading because blood pressure, weight, and cholesterol often come down as people suffer from chronic disease or malnutrition. The chronic diseases people get are often from their weight, blood pressure and cholesterol, and when this is corrected for, the all-cause mortality curves better reflect what a healthy person's numbers should be. So in reality the lowest point of the all-cause mortality curve for BMI is below 25. 25 is not optimal.

Dr. Carvalho recently made a video on this topic (he even mentions the BMI curve). You can watch it here: https://www.youtube.com/watch?v=n4h135SBebc

Thats interesting because I am healthy in other ways but my cholestrol has been high ( high ldl, total and high apob) . My trigs, a1c, bmi, homa insulin score ect are in line. No history of heart disease in either side of family.

My cardiologist has been asking me to get on statins for a while but i've been not able to convince myself to get on board to take a pill for the rest of my life.

There's something called a "lean mass hyper responder", it's a type of person with high LDL but they're still healthy. You may fall into that category. However, high apob is more correlated to heart disease than high LDL. A lot of the online doctors who say high LDL isn't bad are saying that because some people have large LDL particles, and it's apparently the number of particles that's the problem, not the amount of LDL cholesterol.

I've dug into this topic a lot sense there's a lot of heart disease in my family. I've found that eating a bowl of oatmeal once a day reduces my LDL under 130 (I've been taking quarterly cholesterol blood tests to keep an eye on things). It's probably the fiber content that's doing the work, but I haven't tried other high fiber foods yet. However, I'm not a doctor so make of this what you will.

yeah APOB is what drove my doctor to give me a prescription for statin

> Overweight, including obesity, overtook tobacco use as the leading risk factor in 2024, driven by a substantial fall (41%) in the burden attributable to tobacco use since 2003.

According to the study, it's not so much that more people got fat, it's that fewer people are smoking. A lot of comments here missed this I think.

It's rarely news when life gets safer and longer and the median person's risk of death falls. :/

Most people mistakenly think that the world is getting worse.

Mostly yes, though people did get fatter.

Imagine a chart with two lines spanning the last 50 years. One of those lines was very high at the beginning, and has generally been trending downwards. One of those lines was quite low at the beginning and has rapidly been trending upwards.

The study is suggesting that we've reached a point where these two lines have finally crossed, which we probably could have anticipated coming sooner or later.

That the most salient recent observation is a change to the prevalence of tobacco-attributed disease doesn't really change what it means for obesity-attributed risk to finally overtake it. That wouldn't have even been fathomable 50 years ago and the trendlines confirm exactly what needs urgent attention now.

And they excluded vaping.

Well, yes, because there are no large enough long-term studies that have been done on vaping that can show mortality to increase significantly (yet).

also when you quit smoking you normally end up gaining weight

> According to the study, it's not so much that more people got fat, it's that fewer people are smoking.

According to this study, sure, but countries, like France, with double the smoking rate of the USA still don't have double the health issues associated with smoking.

I'd like to see a simple bar chart with, for each country, a bar displaying smokers as a percentage of population and a bar displaying heart-disease/cancer/diabetes/whatever[1] as a percentage of the population.

My understanding right now is that countries with (for example) double the smokers still don't have double the health problems. Some may even have fewer health problems even though they have more smokers.

[1] Basically, all the diseases that lead for smokers.

I wonder if we'll ever get to a place where we hold food companies accountable for addictive, unheathy food being advertised and sold the way we hold tobacco companies accountable?

I know there is a personal responsibility involved in both, but the situation seems similar.

Things like soft drink taxes already begin to do that.

Have those stuck anywhere? I know it was trialed in a few places (Berkely for one) but I don't think it lasted.

Great idea though; just like taxing tobacco helped reduce smoking (among other things)

We have taxes on sugary drinks in France. The tax depends on how much sugar is added, in kg / hl. Funnily, synthetic sweeteners are also taxed, but at a flat rate equal to the "up to 1 kg / hl" of sugar. See [0] for the official text.

I'm not convinced this has had a great effect, since I hear there are more and more people who are considered obese [1].

[0] https://entreprendre.service-public.fr/vosdroits/F32101?lang...

[1] https://presse.inserm.fr/en/obesite-et-surpoids-pres-dun-fra...

USDA shares the blame for placing Carbohydrates as the primary food source on the food pyramid.

> USDA shares the blame for placing Carbohydrates as the primary food source on the food pyramid.

I agree, but I have no real evidence, just a feeling.

Is there any evidence?

None of this is intended to be medical advice. Consult your own practitioner.

This is publicly available, but to understand Dr. Fung's entire thesis on obesity and Type 2 Diabetes (along with his entire destruction of the prevailing mainstream treatment protocols for T2D) in particular, it is necessary to read his book, "The Diabetes Code".

https://casereports.bmj.com/content/2018/bcr-2017-221854

I've been following the protocol from The Diabetes Code for about 2 months. Objectively: 10lbs lost, key metrics are improved, medications deleted and a Type 2/inflammation related vision ailment objectively healing. I guess I need to say, I have no association with this doctor, receive no monetary benefits. Prior to that, working with an endocrinologist, my stats were deteriorating and my symptoms worsening.

Fung's book The Obesity Code received a 31% score for scientific accuracy

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

I'm kind of curious if there is any diet or nutrition related book that would score high on scientific accuracy. The field in general seems hard to study well.

If any commenting pass-byers know of any, let me know, id be interested.

Dr. Michael Greger's books (and website: https://nutritionfacts.org) boast an astonishing amount of citations of medical studies. He readily acknowledges the vast volume of literature around nutrition, with more and more studies being published every year. He and his volunteers have taken on the mission of wading through it and making sense of it.

His books, in order of publication:

- How Not to Die (2k citations) - How Not to Diet (5k citations) - How Not to Age (13k citations)

thanks for the recommendation!

Right. I can't believe you're citing a source that can be edited by literally anyone.

Also, I cited "The Diabetes Code", not "The Obesity Code", goalpost mover.

Wikipedia did very well here. There is a link in a footnote to an external site where you can confirm that Red Pen Reviews did in fact give this review.

Carbs craving is an evidence, I feel them myself and have much more difficult controlling the amounts of calories I eat when I'm eating more carbs and sugar. One person experience, especially if oneself, is a hard evidence.

It seems like, as a society, we're moving more toward "personal freedom" -- which includes "personal responsibility".

Like: we used to ban alcohol, betting and drugs. But we unbanned alcohol and betting and are moving towards decriminalization of drugs.

Not saying one way is right or wrong (I can see arguments on both sides, and I personally prefer having freedom). But it does seem the general trend in (US) society these days.

i think society should allow someone to partake in those activities because like you said personal freedom. but many if not all of those activities can develop into addiction which is a form of disease - so society should also heavily disentivize their usage. taxes, prohibited advertisement, can only get from certain places, etc

I can't wait for the unlicensed Twinkie dispensaries to start sprouting up.

Wouldnt that just hurt the people prone to addiction? If I'm not addicted to alcohol and a huge tax is implemented then I'll just stop drinking. If I am addicted my problem has just been exacerbated because my addiction is now more expensive. I guess it might stop people from experimenting to begin with.

It's not a binary thing, addiction is very dynamic, especially alcohol because of its ubiquity in the west. Nearly all alcoholics no matter how bad once had a fairly typical usage pattern, often for many years or decades before something changed and they lost control of it.

Changes to lifestyle, stress, recreation patterns, and access can all be factors in it spiraling out, and once you're there it's hard to gently wind it back. It's difficult to compare directly because a lot of the places with intentionally high taxes on alcohol also have strong public healthcare systems.

But even simple measures like municipal ordinances against selling sub-500ml containers of hard liquor show small but clear results in reducing addiction rates. In any case the consensus among addiction medicine professionals right now seems to be in favor of this sort of "soft restriction" public health policy.

Legalization hurts people prone to addiction - prohibition hurts people prone to moderation.

Do we prevent some from having a bad experience, at the expense of others having a good experience? Or do we allow some to have a good experience, at the experience of others having a bad experience?

I’m a bit of a hedonist so i very strongly favour the latter.

We can have both. We can have broad access to all manor of food and drugs AND we can have strict labelling and advertising standards. We all know the entire concept of market capitalism is based on accurate and available information for marketplace participants, yet we keep letting the dominant participants manipulate the dissemination of information for their own benefit and to the detriment of consumers.

Big Tobacco became big food: https://www.pbs.org/wgbh/pages/frontline/shows/settlement/bi....

When tobacco became problematic they bought all the food companies.

In Mexico (and many other places) they put big labels on packaged foods that have high sugar content. I spent a month there and I found it really helpful. Of course in the US, any attempts at labelling for the benefit of consumers is fought tooth and nail by the food industry.

I don't think those make a big difference. I've seen them in a lot of memes. They're easy to tune out, and are on a lot of healthy food.

Here's some more info on it https://en.wikipedia.org/wiki/Food_labeling_in_Mexico#Labels

US nutritional info panels are far easier to tune out, but many people still find them useful. Better to give people information should they want to put extra thought into their diet as opposed to keeping things obscured and making the task that much more difficult. The Wiki article says 10% of people take the labels into consideration. If 5-10 million Mexican families eat healthier diets at the cost of simple labels covering some marketing materials, that seems like a fantastic deal for consumers.

It's good to be able to easily access facts about food, yes. It's the warnings that I think are simply OK, they don't help much nor hurt much.

For instance, most people don't need to worry about their dietary sodium, and I think in the US a lot of people could discover tasty food like soups and stir fries and curries that are high in salt and moderate their animal product consumption. https://www.health.harvard.edu/heart-health/dietary-salt-and...

Edit: looking in that article it's good to avoid too much sodium, but a lot of people don't notice that how salty food tastes isn't always directly related to how much sodium is being consumed. Sodium deep inside of food isn't going to be as easy to taste as salt on the surface.

An equivalent system, the nutri-score, have been showed to be extremely effective: https://en.wikipedia.org/wiki/Nutri-Score

On the french version of the page, it indicate:

> it also noted the following associations for the products purchased:

increase in overall food quality by 7.9%; 6% reduction in energy; 7.8% reduction in salt/sodium; 15.7% reduction in fat; 17.1% reduction in saturated fat;

How are they responsible for what you choose to eat?

On the flip side, do we want to let people line their coffers by creating addictive substances that some people literally cannot stop eating?

Umm... that describes literally any food and its production. We cannot stop eating or we die. That is how it works.

That's like saying how are cigarette companies responsible for whether you choose to smoke?

Yes, I agree. Tobacco companies are not responsible for how you use their product.

Wouldn't there be major issues with post facto laws in the case of food like many other weasel worded usages of "holding accountable"? I swear, the tobbaco lawsuits have turned lawyers into junkies for grand lawsuits which has them looking to find the next big tobbaco whether the target deserves it or not.

Unlike tobbaco there is nuance about consumption as good or bad on a per person level, and there was never any obligation nor capability to police the diet of their customers. It isn't like cigarettes where ideal consumption is zero.

Need to hold "healthy at any weight" propagandist responsible too.

Well, this is excellent news. I can start smoking again!

I mean, no country had the guts to completely ban smoking...

Australia and NZ are making it very hard to take up smoking!

Even if they did tobacco companies invented vaping so who has the last laugh?

It is much harder to treat a food addiction than a smoking one.

The usual way to do that is to stop smoking entirely and eventually forget about it. You cannot stop eating. Food tastes good. We have infinite food available. The hell are we supposed to do about it?

That's just because you consider all food equally. Nobody is out here dying from a vegetable or fruit addiction.

Tell that to Steve Jobs!

We're being glib, but Jobs' extreme dietary predilections, regardless of whether they contributed to his cancer, definitely weren't motivated by anything that we'd classify as addiction.

The same - just stop eating (for some time between a day and a week). I tried (for a week) successfully and that was fun. This way you discover you have power to choose to eat or not to eat, also learn to distract yourself from hunger and forget about it for whatever time you choose to. Switching to keto first, supplementing minerals - helps a lot.

So I will second this post, but with a caveat: 'fun' is extremely relative. I was obese, 34 BMI, and did this.

My first fast, the hunger 'spikes' were extremely painful. If 'broken leg' is a 10, the pain would be was a 6 to 9. Intermittently. Around every two hours, for a dozen minutes, from the end of the first day until the end of the second.

I was prepared. A doctor was consulted before, my sister was around, I took the week off, and yes, I entered ketosis 2 days before the fast. Still, it was very difficult.

It did help a ton though, because like my parent say, once you've gone hungry once and managed it fine ( day 3-4-5 were 'normal' to me), your body learn to accept hunger.

I now leave every meal hungry, and it's fine. I went from 34 BMI to 28 in less than two years, without changing anything other than the quantities I ate. The 28 to 25 took 5 years and physical exercise.

Sounds epic. I always admire people who have actually been overweight (I haven't) before learning to manage hunger sustainably. That probably is hard.

I don't think that's true at all. The reason people are having so much success in not smoking is that a lot of people never started smoking.

Plenty of people have managed their food addictions and still are overweight. That's just the nature of it. If you think everyone who is overweight has an active food addiction, you should probably look into whether that's really true.

You're right, especially because I think being overweight is extremely easy to reach by just being sedentary.

But obese, especially 35+ (never reached that, I caught myself a hair before), imho you need a 'food addiction', which was at least in my case either an overproduction of ghrelin or an hypersensitivity to it. Which kills any sort of temporary calorie restriction diet. My solution was a 5 day fast, and it worked well enough: I can now easily go hungry ( I am right now) and leave most of my meals hungry, without feeling more than a very, very mild discomfort (from a heavily to painful discomfort before, on the level of an occular migraine).

To some extent, "treating food addiction" is exactly what GLP-1 drugs do. People who take them talk about having a much lower level of "food noise," which is kind of a silly term, but it's easy to understand what they mean.

I must have been living under a rock, first time I've heard of this.

Learn some self control.

Do you think suggesting this to someone with any other type of addiction (smoking, gambling, heroin, whatever) would do anything?

I get your point, but I think what makes food addiction somewhat easier to manage is that you can pretty easily find "substitution" products which help a lot.

I used to eat a lot of junk food and got pretty fat after an injury which also had me drop my activity level. It's not easy, but with some will power, it's manageable to start eating other things, which help lessen the cravings for the junk. After a few months, the cravings disappeared completely.

Don't know if there's an equivalent for smoking / heroin.

Smoking is extremely addictive. I don't think people are obese because of food addiction. It's more a combination of unhealthy diet and lack of exercise.

No. I went from 34 BMI to 28 by just eating less. Couldn't do much sport at 34 anyway.

28 to 25, yes, exercise needed.

The marketing and messaging for getting people to stop smoking is simple. "Stop smoking". You don't need to get nuanced, which is good because nuance kills marketing effectiveness.

The marketing and messaging for getting people to eat the right amount - "not too much! But also not too little!" is considerably trickier.

Also, you can put taxes on cigarettes, but you can't really put taxes on food...

Sure, but not all "foods" are equal. Eating 300 calories from some broccoli, eggs, and steak won't leave you with the same cravings as eating 300 calories from Snickers bars.

I also think we're not all the same when it comes to these addictions. For example, I never had a smoking problem, although I do smoke. I must have smoked 10 cigarettes in 2024, even though I almost always have cigarettes on hand (I sometimes enjoy one or two when out drinking with people who smoke). Didn't smoke once during covid, when "going out" wasn't really allowed. Now, if you let a pack of Snickers bars in my house, there won't be any left one hour later.

So if the marketing and messaging for getting people to stop smoking is simple, it can be so for food, too: don't ever eat "junk food". At all. Haven't had a Snickers bar in years, and I seem to be doing fine. I've found it's orders of magnitude easier to not start eating at all than to attempt to "only have one" and hope I won't overindulge.

> The usual way to do that is to stop smoking entirely and eventually forget about it. You cannot stop eating. Food tastes good. We have infinite food available. The hell are we supposed to do about it?

I think 99 out of 100 doctors will not tell you to stop eating.

Just

- eat less

- eat less shit

I agree and I’ve been struggling with this for a long time. I’m not super fat. I can get around good and and remember to get up from my desk and walk around. I don’t get tired on small hikes.

But I can’t seem to get weight off. I’ve tried GLP-1, appetite reduction medication, drinking a ton of water, etc.

I one point a few years ago I used to be much skinnier. The main difference between then and now is then I worked a physical job not in IT, was taking Adderall, and working long hours and didn’t have time to eat. So transitioning to a desk job I underestimated how much work it would be to make time to do physical activity and watch what I eat.

At this point I accept it may be an emotional thing for eating. I have a therapist but he doesn’t specialize in that area. Anyway I am just rambling.

There is no doubt in my mind that the alcohol consumption is much more of a contributing factor to not only the obesity but also the overall decline in health wellbeing and raise in suicide/depression. Alcohol is socially accepted poison, and I feel its consumption in any amount is significantly worse for the individual than any poor diet/exercise regiment.

keep in mind alcohol is also poor diet - beer is especially heavy in carbs, very few alcoholic drinks are light really. alcohol is like having an extra side with a meal at least, but people would I think be more aware they were overeating if it was a plate of fries.

Absolutely. There are a lot of people who get a whole extra day of kcal worth of beer in a week. Additionally people who drink a lot pretty much stop eating because they opt for the liquid lunch etc.

Per capita people drink drastically less alcohol than they did in the 80s, and Obesity rates have more than doubled in the period.

You can either drink a lot or eat a lot, but you can’t do both.

Both will really hurt you.

I saw a news article the other day that the obesity rate decreased instead of increased last year for the first time in well over a decade.

I wonder how much GLP-1s have to do with all of that, and how much more they'll do.

I do wonder how much affect it has. At least in the US most insurance companies won't cover them (unless you already have diabetes, for example) and at over $1,000 a month I can't see how the people who could really benefit from this to lower the numbers can possibly afford it.

From personal experience, it's ridiculously easy to get a compounded formulation from one of the telehealth suppliers, and it's cheap even though you can't submit it to insurance. I think I pay $200 and get two one month vials for it.

It's been marvelous for me, I was just over the edge into overweight, so no one would prescribe it for me, even though I had a borderline pre-diabetes A1C, and reactive hypoglycemia runs in my family.

My choices were gain another 10 pounds, or find a telehealth that wasn't bothered by not following the FDA rules so strictly. So that's what I did, I got a script from telahealth and now I'm smack dab in the middle of the healthy weight range (-24lb), haven't had a hypoglycemic incident since I started it, and as a bonus my IBS-D went away completely.

I've reduced my dose to the point that I'm at the dose you start out on, and that has let me keep my weight constant without losing more or gaining more. Plan to stay this way for a year and then see about titrating it even more until I'm off of it. I also followed their instructions and only titrated up when I wasn't seeing weightloss, so I never hit the highest dose, and kept my weight loss to .75-1.5 lb/week. Perfectly sustainable.

This has been miraculous, and something that multiple years of consistent dieting hasn't solved. And as a bonus, I can now do my strength training I love without feeling like I have to eat the house on the recovery day

Random question about how those compounding pharmacies work. Can you order a higher dose and then just stretch it out by taking the minimum dose to save cost? Do they automatically bill you monthly or can you skip months?

That's kinda what I'm doing. They still send me enough for my max dose reached (1.5mg/wk), but I've titrated down (to 0.5mg/wk) since I'm at the weight I should be at, so I just use a vial for a month, and toss the remainder. They send me two vials at a time.

The vials have a 6 month use by date, though evidence indicates semaglutide is stable for 1 year. I can log into the portal and tell it to skip a month, but since it's a push system, I don't get automatically billed. I actually have to do a checkin and the doc has to approve the refill. So if I have extra vials, I just skip that month's check in.

There's some indication that you don't have to toss the vial after a month, the FDA set those limits assuming it was insulin that is used sometimes more than daily. 4 penetrations of the vial's membrane probably isn't enough to contaminate it, but I'd rather be on the safe side so I don't use the vial for more than a month at a time. My partner is a pharmacist, so that part of the influence for the safer approach.

I think which is usually they start you at a small dose, ramp you up in dosage, then ramp you down when its time to come off, that way you dont suddenly feel much hungrier when it goes away because you've slowly adjusted it.

> something that multiple years of consistent dieting hasn't solved

Did you continue to track calories while using the drug?

As somebody who has successfully increased and decreased their body weight over the years (after initially being obese), if you’re able to diet consistently I don’t see why a drug is needed. My guess is whatever diet you were on was consistent for the weight you were at.

I don't find calorie tracking to be very successful. In my mental ecosystem, it penalizes spending calories on healthy foods (why eat that banana if it's just calories), and I don't do so well with a budget, constant go over just slightly.

I had better luck with Weight Watcher with "free" healthy foods and the segmentation between weekly and daily budgets. Then weight watchers tweaked their point values so much that I couldn't stick with it very well, and when I dual tracked points and calories the new WW plan had me at under 1400 cal/day, which isn't sustainable.

> if you’re able to diet consistently I don’t see why a drug is needed

It'd really really really really really really hard to stick to a diet, especially long term. GLP-1s puts eating healthy and good portion sizes all on autopilot. I don't have to plan out how I'm going to manage my hunger and my food noise, it's just auto pilot. I naturally gravitate to eating enough, but not too much, and mostly plants.

Bananas aren't really that healthy. Like you said their nutritional value is mainly just calories.

I don't think 1400 is unsustainable? it'll lead to losing weight continuously, maybe a half pound a week ish, but that's sustainable for as long as you have weight to lose, isn't it?

Yes, very likely.

https://en.m.wikipedia.org/wiki/Angus_Barbieri%27s_fast

This depends on your size and activity level. The last time I dieted, I was losing a pound a week on 2700 calories. 1400 would have been a severe crash diet.

There's physically sustainable, and then there's mentally sustainable. Based on what I've read about long term fasts, I suspect 0 would be easier than 1400.

Depends on the person. I'm an active, 6' male with a TDEE of 2600. 1400 calories is absolutely unsustainable. That's nearly 3lb of weightloss per week.

If I was shorter, female and sedentary, sure. But that's not me.

> And as a bonus, I can now do my strength training I love without feeling like I have to eat the house on the recovery day

I am interested in hearing more about your strength training on this. Do you find that eating less slows your gains and PRs?

I'm sure it does, but I'm not a good enough strength trainer to really notice. I'd say I'm closer to an intermediate lifter than a beginner, but I'm not advanced enough to really notice a difference.

Time in the gym is my biggest blocker today, not what I ate.

I am curious, if you don't mind. Have you noticed any other fringe benefits? By that, I mean a reduction in alcohol consumption or other non-food vices? Any cognitive benefits like an increase in focus or concentration?

I'm on Mounjaro for T2D, previously on Ozempic. Besides the weight loss and the blood sugar control it also eliminated my IBS as well. Before the drug certain foods, especially nuts would cause excruciating digestive issues. I can now eat them without worry. It's been amazing.

I 100% know what you mean. I went through a phase where I'd measure out 3 ounces of cashews and have that as a lunch because it was fast, and measuring meant I wasn't taking in too many calories. Always irritated my gut though, anything high in fat did it.

I don't do that on GLP-1s, partially because fat doesn't immediately send me to the bathroom anymore, but also partially because I'm not drawn to high fat meals anymore. Except when thc is involved and then some ice cream might happen.

Any recommendations on telehealth suppliers to contact for that compounded formulation? They're easy to find, but I'm not sure who is trustworthy on this topic.

Mochi / Henry Meds. Mochi is the cheapest.

I just went through the quiz at Mochi and it said I was eligible for their nutrition program but not medication. The FAQ says your BMI has to be over 30 or 27 if you have some other health condition.

Take my advice at your own risk, but nobody is checking your math.

I was 10 pounds or so from qualifying, so I fudged my numbers a bit. Didn't make sense to force myself to gain weight so I could lose weight.

Places like OrderlyMeds doesn't even require a telehealth visit, just the questionnaire and a photo.

Doesn't seem like it will matter. The core patent expires in 2026[0] and the rest expire in 2033. It seems like most will have access to at least some form of the drug affordably within the next five years.

[0]https://www.reddie.co.uk/2024/08/30/the-year-of-ozempic-an-i...

Ozempic is around $100/month in most western European countries, including the country of it's maker, Novo Nordisk.

Sen. Bernie Sanders has been recently calling out this company for charging an order of magnitude more in the US, where it is priced like a cosmetic medical product.

We're probably less than 3 years away from health insurers making GLP-1s free as a cost-saving measure.

All funds currently diverted towards executive security details. Sorry, GLP-1 denied.

I'm just thinking for myself, how much money I save, even though I'm paying out of pocket for ZepBound.

I sleep better, so I gain an hour per day. At that rate my out of pocket per month is still less than my hourly wage.

Not to mention food and shoes (yes, I'm someone who was overweight and hiked 5 miles a day...).

It appears that sentiments that downplay or dispute the health risks are growing in large social media bubbles, with strong effects on the real world. Efforts to push back on serving unhealthy food are undermined, doctors discouraged from discussing weight with their patients as a personal and sensitive issue; overweight models validate unhealthy body compositions. This surely has to please the food industry, which is as culpable as the tobacco industry in harming peoples health.

I would propose a concerted effort through mandatory levels of food quality that is served to the public (e.g. schools, hospitals), funded by a higher tax on sugary atrocities, limits on sale of sugary food and drinks to children, and an outright ban on any substance designed to create cravings.

Rather than a tax on sugary food how about we cut subsidies that make simple carbs artificially cheap?

I believe the "artificially cheap simple carbs" is a secondary effect, with the primary effect of making corn cheap due to national security reasons. So before removing the subsidies, you'd want to have a plan for managing that risk.

The subsidies predate the "great grain robbery" where farmers sold large stockpiles to the Russians, which helped Nixon secure election victory. Before that, as part of the New Deal, was the Agricultural Adjustment Act which literally paid farmers to destroy livestock and not use land in order to boost prices for farmers. Strictly speaking, I don't think this was a case of national security.

Today it's just a case of entrenched interests: large key midwestern farmers would stand to lose money, whether you have a tax or reduce subsidies. They stand to gain more by not mitigating obesity rates.

Mind you they could diversify away from corn. If consumers eat whole grains or meat instead of sugar, that's still money for farmers. But it would entail growing pains.

I think tradition is certainly part of it, but I think that take misses some important nuances. A few:

- agriculture isn't necessarily fungible. Land that is used for one product isn't immediately capable of being used for another, or at the same value (monetarily or calorically)

- A large part of corn production is used for feedstock. That means there would be systemic issues in the production of meat if it had major disruptions. That's another reason why you can't just swap corn for meat production.

- subsidies sometimes trade efficiency for stability. This isn't always a bad thing. A volatile market can make farmers lose their hat. A significant amount of farmers are generational, meaning there aren't a lot of people starting out unless they grew up farming.

- corn isn't just about food. Part of the national security element is fuel (ethanol). Again, recognizing the inefficiencies, this is more about stability. Other agricultural products can be used for fuel (e.g., soybeans for diesel) but the distribution of fuel needs and agricultural capacity is not in their favor.

- I'd put this in the "tradition" bucket but there are political concerns. Politicians have to place nice with places like Iowa because of how political primaries are structured.

> agriculture isn't necessarily fungible. Land that is used for one product isn't immediately capable of being used for another

Key word being "immediately". That's right, but substitutions do exist. Hence, growing pains.

> A large part of corn production is used for feedstock. That means there would be systemic issues in the production of meat if it had major disruptions. That's another reason why you can't just swap corn for meat production.

Globally, soybeans are more often used, and these can (and do) grow in the US. Notwithstanding, you can just keep growing corn without subsidy - meat prices would go up. That could be politically contentious, but less total meat consumption could lead to better health outcomes.

> subsidies sometimes trade efficiency for stability

Leaving aside the question of balance, pros and cons:

Farmer stability is not inherently contingent on corn subsidy. Even if we wanted to keep subsidies as a constant, you can subsidize something else.

> part of the national security element is fuel (ethanol)

This doesn't require subsidy. The US produces more than half of the world's ethanol fuel. Notwithstanding that, fossil fuel extraction has also grown through fracking. I don't see the security angle at all.

I think we disagree that soil is fungible for growing crops. Even if I were to steelman your stance, it still requires considerable inputs to do so. All of this ends up making food cost more.

Similarly, I think making HFCS more expensive isn't likely to make foods less calorically dense. What it will do is make them more expensive as manufacturers put use more expensive alternatives.

I do think your ethanol stance is a circular argument. The US produces a lot of ethanol because of the subsidies, so it doesn't make sense to point to that production level as a reason to get rid of subsidies. Fracking is a good counterpoint, but also a politically contentious one if your stance is that the US should ramp up fracking to offset agricultural subsidies.

I certainly agree that subsidies have inertia that's hard to overcome. (My favorite example is the alpaca subsidy that was implemented for warm-weather clothing for the Korean War that stayed on the books until the 1990s). I also agree they need to be tailored to the current environment.

The bulk of your point seems to be we can get rid of subsidies in exchange for higher and less stable food prices. Historically, our food is quite cheap today but I find the idea that the proposed solution to obesity is to make food more expensive not very palatable (ha). I personally don't think that is a good tradeoff because my position is it's calories and not HFCS that is the largest contributor to the obesity problem. My OP was not saying "keep subsidies" but rather "be aware of the systemic effects of getting rid of subsidies". I think there are lots of arguments to get rid of corn subsidies, but I find the obesity one pretty weak. So the simple solution of "just get rid of subsidies" will create all these negative consequences that need to be managed for something that isn't likely to move the needle much on obesity. That doesn't seem like a great tradeoff and I'd label it as one of those simple solutions that sounds great as a sound byte but isn't particularly pragmatic. Going back to the original point, if your goal is to make food more expensive to curb obesity, there are probably more straightforward and effective ways of doing so that don't have all those additional factors.

The only way that take makes sense to me is if you think there is something unique about HFCS that leads to obesity compared to other sweeteners when controlled for calories. I don't think the science supports this.

> I think we disagree that soil is fungible for growing crops. Even if I were to steelman your stance, it still requires considerable inputs to do so. All of this ends up making food cost more.

To transition, yes. This is an upfront cost that can be alleviated, food does not need to cost more after-the-fact. Trump haphazardly paid off farmers in his previous tenure, it happens.

> Similarly, I think making HFCS more expensive isn't likely to make foods less calorically dense. What it will do is make them more expensive as manufacturers put use more expensive alternatives.

That is the point, I think. Those particular foods are calorie-dense.

> so it doesn't make sense to point to that production level as a reason to get rid of subsidies.

Unless you think production levels would fall to pathetic levels on the global stage, and that this production-level is essential, I don't see why not.

> I find the idea that the proposed solution to obesity is to make food more expensive not very palatable (ha).

Specific foods, to be clear. Packaged products with added sugar would be affected. Meat does not have to be if the new policies account for it.

> it's calories and not HFCS that is the largest contributor to the obesity problem

non-satiating (nil fiber + protein) caloric-dense foods facilitate higher calorie consumption. Sugar is not the only vehicle for this, but it's part of the equation. Sugary drinks deliver lots of calories for very little satiety, for example. Other vectors are flour + fat + salt, fried foods.

I agree that "just get rid of subsidies" can be overly simplistic, but it belongs in the conversation. The point is that cheap and highly-available highly-promoted junk food creates a perverse incentive for consumers to eat more of it at the expense of their health. It's everywhere, including school cafeterias.

Any large-scale national solution invariably entails some kind of deterrence. Either junk food costs more, or is less available, or healthier alternatives are actively promoted and cheaper ($$$, I would throw education in this category too). Pick your poison.

Ostensibly, cutting spending would be more popular with voters in general than increasing taxes and spending. Also, falling tobacco smoking rates are a major success story which can be attributed primarily to sin tax (high prices), eliminating advertisement, and educating the masses.

>Unless you think production levels would fall to pathetic levels on the global stage, and that this production-level is essential, I don't see why not.

A few reasons: 1) again, it's partly a national security issue. Under crisis, "global supply" is a concern; just ask Germany after trying to turn away from Russian fuel supply 2) Infrastructure has a relatively large lead time; we can't just ramp up production on a whim. 3) It's odd that you point to global supply as the rationale while simultaneously advocating the largest global supplier severely reduce production. Again, that feels like circular logic. Ie "The US doesn't need to produce ethanol because the world has so much ethanol production." No, the world has so much ethanol production because the US produces a disproportionate amount. Remove the latter and the argument doesn't hold.

I don't think we disagree that making food more expensive can change eating habits. I think we disagree on the most effective vehicle for that.

Look at it this way: we both seem to agree that calories are the problem. Your argument hinges on sweeteners being a proxy for calories, and HFCS being a proxy for sweeteners, and agricultural corn being a proxy for HFCS. You're targeting something that is three levels of abstraction away from what you actually care about. My position is that it makes more sense to target what you're actually after: calories.

If your stance is getting rid of corn subsidies is administratively simple compared to targeting calories, I think I disagree mainly because of the administrative burden of all the other effects we've discussed.

I don't disagree that deterrence is part of an overall strategy. I'm simply pointing out that one should be wary of the tradeoffs. Policy is about prioritizing, and IMO there are likely more pragmatic approaches with less tradeoffs that need to be managed.

I'm not convinced of the strategic importance of ethanol in the grand scheme; the US produces more of it because the subsidy creates that incentive. Incentive structures can change, entrenchment just makes it less politically viable.

> You're targeting something that is three levels of abstraction away from what you actually care about. My position is that it makes more sense to target what you're actually after: calories.

It's not abstracted away as healthy eating is concerned. Overconsumption is downstream.

You haven't elucidated how you'd merely target calories through policy, but leaving that aside, a) by default people do not count calories nor would they as a measure to protect against weight-gain, b) it's redundant given a whole-foods diet, no one becomes obese from too much broccoli, chicken breast and lentils, c) for those looking to lose weight, mere calorie counting absent leveraging satiating foods and eschewing junk is woefully ineffective in practice, because of lack of sustainability. Dieters typically do lose some weight, then gain it back. Not only is it difficult to adhere to, it's difficult to eyeball calories on a plate, particularly when they're processed foods, such that they'd have to weigh everything on a scale indefinitely.

Encouraging healthier eating patterns solves several problems at once. It protects against overconsumption, and against disease, which would lessen a burden on the healthcare system. That seems quite pragmatic to me. What's at stake is certain corporations stand to make less money, and corn farmers sell less.

Whether through change in diet patterns or "just eating less" as you might posit, if on the national scale people did end up consuming fewer calories and lose weight, then they'd more than likely consume less sugar/HFCS. The end result is still that a healthier populace == selling less corn. We can't discount any and all policy on the conceit that inconveniencing corn farmers is not acceptable.

>I'm not convinced of the strategic importance of ethanol in the grand scheme; the US produces more of it because the subsidy creates that incentive.

Yes, that's the intent. Whenever you subsidize something, you get more of it. If you're looking for strategic rationale, the US relies much more on gasoline than, say, the EU. Couple that with the fact that US strategic oil reserves are at the lowest levels in 40 years, that only leaves about a month of fuel in the reserve at current usage. Meaning, there is a strategic need to have the infrastructure in place to supplement fuel supply if needed. Even if we don't need it now, the lead time for building out infrastructure is long enough that is makes sense to have slack capacity in place now.

>It's not abstracted away as healthy eating is concerned. Overconsumption is downstream.

Corn subsidies are abstracted away. They're related, but not directly considering the other uses of corn. Irrespective of that point, I think we may have lost the thread here. We don't seem to disagree on the central premise that overconsumption of calories is the root issue. The original claim was that a sugar tax would help remedy this issue. The counter-claim was that removing corn subsidies would be a better approach than a sugar tax.

My point is that the counter-claim is lacking nuance, and ignores all the second order effects. I'm not against removing subsidies, but I would want someone to acknowledge how they would mitigate the negative knock-on effects. What you've presented is a bit hand-wavy for my taste, implying we can just swap this crop for that and ignore concerns related to strategic fuel, agricultural stability, and costs. In the context of all those secondary and tertiary impacts, it seems like a direct tax (like a sugar tax) is preferential. I probably wouldn't limit it to just a sugar tax though, and would look to target other food that leads to overconsumption (including those that aren't disproportionately affecting lower socio-economic groups), and ideally making healthier choices less expensive if we're making the others more costly.

My point is that every approach has second-order effects, there's no free lunch. If you pick one approach, then you're dealing with the externalities.

> In the context of all those secondary and tertiary impacts, it seems like a direct tax (like a sugar tax) is preferential

Not to voters. Taxes are unpopular, ending a subsidy to a small powerful cohort would be relatively more popular (in terms of messaging I mean, the end result would still be that consumers pay more for sugar, but of course the govt spending less frees up spending for other things). However, farmer support is right-coded which would lead to opposition by right-wing pundits and media.

It's a toss-up. A tax could be effective, but I don't agree that it's necessarily more viable or palatable. It's probably less-so. Hence I would pitch ending or curbing the subsidy.

We agree that it's always about tradeoffs. I just think there are probably more complex and less transparent (and potentially negative) tradeoffs with ending subsidies if the goal is reducing obesity. It doesn't mean subsidies are good, but just that they are more loosely aligned with obesity than you let on.

I just don't see how it's a more effective strategy given the fact that it's a much more complicated apparatus to do the same thing (raise prices on food). Your position seems to be, stated differently, that higher prices lead to a deterrent to overconsumption and that reducing subsidies is the best way to increase prices. Logically, I can’t find a way that is a better mechanism than affecting prices directly and in a more targeted manner with less tangential effects. It reads to me as a way to find a rationale to go after a particular policy one doesn't like, rather than being focused on the problem at hand (obesity).

Most corn is actually farmed for meat production (beef, pork, and poultry) not human consumption. I doubt the farmer cares if their corn goes to a human or a cow, so long as they get the best price, and uncle sam fills in the rest.

Any politician that does that will be subject to a relentless disinformation campaign alleging they're taking food from hungry families, regardless of any factual basis or quality of outcomes.

The causality seems more likely to go the other way to me.

For almost any problem people care about enough to discuss on a forum like this, it's a fools errand to try to determine "which" way causality goes. It goes both ways. You can't isolate the cause. It's a feedback loop which is what makes it persistent and hard to solve and ergo worth discussing on a forum.

There is a middle ground, and I agree that there are some people that have gone too far.

I think body positivity, validating those choices with models that represent more people is a good thing. As a society we should not be judging someone for their choices or making medical claims about their bodies when we don't know their story.

But I also see the extremes of just ignoring it, not even wanting your doctor to talk about it. (I do realize that there are some exceptions to this like when it comes to eating disorders) I don't understand this. I want my doctor to tell me everything, hell I will overshare in the hopes that something is a thing that needs to be addressed.

I have also personally seen a subset of people that push back on anyone wanting to loose weight. I have lost about 45 lbs over the last year (still not at my target weight but I am very close, about 5-10 lbs off so really not stressing and for context I am 6'5). A friend I have not seen in a while recently gave me a hug, commented that I was loosing weight and asked me "Why". I was put off by it, because why is that even a question? You would get mad if I asked why you were gaining weight.

My point here, there is a middle ground and there is a right and wrong place to address this. Society shaming someone isn't the right choice and ignores that we don't know what is really going on with someone.

> I think body positivity, validating those choices with models that represent more people is a good thing. As a society we should not be judging someone for their choices or making medical claims about their bodies when we don't know their story.

I’m slightly overweight and an ex-smoker. For years, nothing seemed to help me quit—high taxes, indoor smoking bans, health risks, and so on didn’t diminish my desire to smoke. I tried quitting a few times for financial and health reasons, but it never stuck.

What ultimately got me to quit was social stigma, especially after having kids. The stigma around smoking has grown over the years, but it reaches another level when you become a parent. Other parents didn’t hesitate to judge me for smoking, and I realized there was no way my kids wouldn’t face social consequences because of my habit. That was the push I needed to quit.

I do believe it’s wrong to judge people for their choices, but at the same time, I sometimes wonder if we’re going too far with body positivity. I don’t have all the answers, but I’m grateful for the stigma surrounding smoking—it helped me make a positive change.

I know a few people who lost weight and got super fit out of body positivity movements.

In general, the body positivity movement I've seen is about respect, encouragement, and support. It's not about encouraging bad habits, but being inviting to those who feel ashamed and would normally avoid going to the gym, a dance class, or to ask advice about healthy eating, etc.

As usual it comes down to the increasing individualism, that rejects any overarching societal guidance in favour of judgement-free self-expression ("body positivity"). This removes any collective bargaining or collective action (some of which I proposed in my parent comment) and exposes the individual to systemic risks (food industry making people fat, medical industry giving them a pill to feel better), unless the individual is equipped with enough of Bourdieu's social capital to navigate the pervasive health risks of the modern food supply. Allowing this minefield in place is also a convenient way to maintain class, leaving the unwashed masses hampered by health issues (like diabetes), reduced cognitive function and less attractiveness.

> not even wanting your doctor to talk about it

There's been a lot of misdiagnosis due to doctors just thinking it's a weight issue. I think that's one of the reason people have an issue with doctor's handling of weight.

The other area is that it often ignores that the patient is already actively aware, and trying to combat their weight gain. The doctors are not being helpful by just stating the obvious.

Lastly, many doctors are kind of outdated in their knowledge, they'll recommend old diets that are not as effective anymore, or they won't encourage exercise, just diet, or they won't consider family history, and so on.

In those cases, your "doctor bringing it up" can actually just lead to more weight gain, because it can create increased cortisol level from stress and worries, make you more depressed, and so on, which won't help you lose weight.

I agree that what you're saying is a problem but if your doctor is not handling anything about your health properly why are you not finding a new doctor instead of saying you don't want to talk about something?

And I am not saying that your doctor needs to constantly bring it up, but at a yearly physical I would expect that anything that could be contributing to other issues or my health in general would be brought up no matter how many times it was brought up. There are exceptions to this that I would generally expect the doctor to know and you not needing to ask it.

I mean replace weight with any other thing that could (not saying it's easy or possible for everyone) change and it sounds ridiculous. I cannot imagine a doctor respecting being asked, I don't want to talk about me smoking. Or sitting all day for work, or other risky behavior. It's all part of your entire health picture.

I think it's a matter of tact, that not all doctor will have equally. How they approach the topic, how compassionate they are when doing so, and how much they pester you about it.

I have told plenty of friends and family that they are fat gross slobs and need to lose weight, and that is the cause of many of their non-specific maladies that doctors can't seem to pinpoint. Sometimes you need to sit someone down and level with them, I'm not going to pretend.

> I have told plenty of friends and family that they are fat gross slobs and need to lose weight, and that is the cause of many of their non-specific maladies that doctors can't seem to pinpoint. Sometimes you need to sit someone down and level with them, I'm not going to pretend.

Key question: are they cured now after you were a jerk? What was the ROI on relationship damage per pound lost?

It's fine because when I say this it's because the context of the conversation has been set that I'm going to tell them hard truths

You avoided the actual question: did it work?

Great question - it has worked sometimes. I don't just do it for the fats. I had a serious discussion with one of my best friends who narrowly escaped a DUI after successfully beating the patrolman's tests and lucking out when they didn't have a breathalyzer, and he stopped drunk driving. Another time I told my friend he was a fat, disgusting lard and he successfully slimmed up and hit the gym more. So it depends.

Sometimes if you just outright tell someone they are making huge mistakes in the bluntest terms it can shake them, when they know you are their friend.

You're having this conversation as if I'm against having honest conversations with your loved ones.

Actually this conversation is about what is an effective intervention for our obesity epidemic, and there's pretty much zero evidence that "tell the fats they're making a huge mistake in the bluntest terms" is a meaningful intervention at any scale that matters.

OK well if they are disgustingly obese, gross, and dying of being fat, which is 100% preventable by not eating a ton of gross shit, then looking them straight in the eye and saying "You are not only an unattractive obese blob but also about to die" sometimes works

You should publish a study on this breakthrough! The medical community would love to hear about your strong evidence for success.

Some people may need to be told that, much like some alcoholics are in denial about their condition. But many other fat people know they have a problem, are trying to solve it, and are struggling because it's incredibly difficult to overhaul your lifestyle (even with help and resources). While telling the first group of fat people "hard truths" might be what they need, it will simply demoralize the second group and might get them to stop trying. It's not as simple as you're painting it.

There are voluminous materials and studies explaining why obesity will kill you. Is there a study that compares being addicted to alcohol vs. being morbidly obese? Maybe they should switch the chicken wings for vodka

Tax won't solve anything - just make it socially unacceptable to be obese.

Interesting because Pigouvian taxes have a long and storied history of being extremely effective while your proposed solution has... zero evidence of effectiveness?

Feel free to provide it though.

It already is. If you are obese, you:

* Can't get clothes that fit you

* Are uncomfortable on public transit, in public places like theaters, etc as the seats are designed for someone much smaller than you

* Can't get into relationships

* Get social feedback ranging from well meaning (but still embarrassing) to downright cruel on a regular basis

In discussions like this, someone always says "the solution is to shame people" as if it's some kind of picnic to be fat. It's not - it's fucking miserable. And even with all that people are still having a hard time taking control of their lifestyle. Shaming people even harder isn't going to accomplish a thing.

> Shaming people even harder isn't going to accomplish a thing.

It do accomplish a thing of helping people that don't want to be ashamed to take better care of their weight before it becomes a bigger issue.

Bullshit. We already know that adding a stressor to problem eaters is the opposite of a solution!

I don't know about you but I'm paid to sit in a chair for 12 hours a day.

America got fat from a culture of fat shaming. So like, we know that doesn't work. Or at least this is not how I see the cause/effect.

To me, it appears that being fat was unacceptable and shameful culturally, but everyone still got fat, and insanely fat even. And once so many people were fat, they started to campaign against the fat shaming.

So fat shaming could actually be seen as having caused the issue.

I think being able to openly talk about the difficulty, challenges, and struggles of weight gain/loss, recognizes the people's struggle, encouraging weight loss, promoting methods and mechanisms, etc. might be more effective.

From the research I've seen, this is also supported by it. Fat shaming can cause increased stress and cortisol levels, emotional eating, avoidance of exercise (especially in public), depression and anxiety, and avoiding medical care due to fear of judgment. Which all in-turn contributes to weight gain.

I don't believe this. Other countries (mostly in SE Asia) have cultures of fat shaming and low levels of obesity.

I am not endorsing fat shaming, I just don't think your causal suggestion stands up to scrutiny.

That would reinforce my causal suggestion no?

We have two places that fat shamed, one got fat, one stayed lean. That tells us fat shaming doesn't seem to be a factor in getting fat or not.

But the place that has low level of obesity still fat shames. Where as the place where everyone is fat stopped fat shaming. So that seem to show that when the majority is fat, fat shaming tends to stop.

I'm referring to this: America got fat from a culture of fat shaming and your last paragraph. Now you're saying that it doesn't seem to be a factor, which completely contradicts your earlier claims.

I can't figure out what you're trying to say, sorry.

I still feel like the root causes are not well known. Blaming sugar is the current trend, but this article talks about weight, American have a fat heavy diet as well, which is very high in calories. Sure, cutting our sugar helps you lose weight, but did sugar cause you to eat all those calories or was it fried food? Who knows?

Then there are processed foods, is that actually the culprit? Or is it really sugar?

Then some things are confusing, someone else linked to a study that showed that "lowest All-cause mortality is at a BMI of 25". Well that's verging on overweight, so people with "healthier" BMI have higher rates of death, weird.

A few days ago a study showed that sugar intake from pastries, ice creams, chocolate and candy reduced your risks of 7 cardiovascular diseases. What's going on?

I say that as someone that's normal weight. I can understand some counter-reaction being wishful thinking, or part of body positivity movements, but objectively when I look at what we know, it's still quite fuzzy.

Having said that, I would not mind over-enforcing in this case. I'd love it for portion sizes to be smaller, for processed foods to be phased out, for sugar content to be lowered in packaged and restaurant products, for deep fried foods to be less common, etc. And ideally, for what we do know is healthy, vegetables, fruits, lean meats, fish, poultry, often the least refined as possible, to be both accessible, convenient and cheap.

Anecdotally, I feel like I can consume way more calories from carbs than fat or protein. I burn out on the other two way faster, and stay satiated longer. Though I agree deep fried is probably second to sweets.

I think there's something to be said about what we take with the food.

I mostly cook at home, and if I have meat, I'll only season it with some herbs and have some steamed vegetables or baked potatoes with it. If I have ham or similar, I'll eat it raw. This leaves me feeling full for the afternoon.

But having a similarly sized piece of meat at a restaurant, which usually comes in some form of sauce (which I don't go out of my way to eat), will leave me hungry almost as soon as the meal is over.

Anecdotally, when I stopped going to the office every day and switched to home-cooked meals as described above, I pretty quickly lost some weight.

I feel that will depend on what you prefer eating to some extent no?

I admit carbs, especially simple ones, can leave you hungry. But when you calorie count, you really start realizing how killer fats are. A slice of cheese, the oil or butter you cooked things in, a handful of nuts, it's crazy how much calories those have.

Fries for example, are so high calorie, because of all the fat in the batter and oil.

> I would propose a concerted effort through mandatory levels of food quality that is served to the public (e.g. schools, hospitals)

The issue I've found is that it's much easier (= cheaper) to have tasty-enough food which is actually "junk". I love me some broccoli or other random steamed veggies with a steak. But when I was in school, these things were horrendous. Everything was a soggy, slimy mess. So fries it was, almost every day, except when they had pizza.

And since this was in my formative years, I can understand how people learn to associate "eating healthy" with that atrocious thing nobody wanted to get close to. So they will tend to gravitate to what they remember as being reasonably tasty.

It was my case, too, until I got fat and tried to do something about it. Which allowed me to discover it's not that much more work to make a tasty meal, which I actually like better. But it does take longer than throwing two frozen burgers in the microwave and calling it a day.

One of the most effective diets I'm aware of is the coffee and cigarette diet. Anytime you feel hungry, have a coffee and a cigarette first, then eat a little if you're still hungry.

It has a much better compliance rate that other calorie-restriction diets.

But does it lead to overall better health outcomes?

It’s important to not miss the forest for the trees. Lower obesity is a generally a means to better health, not an end to itself.

I'd be curious the perspective on the downvoters.

Smoking increases hazard rates by 3x. Even the extreme obesity (obesity III, formerly morbid obesity) increases hazard rates less than this. So the risk tradeoff for picking up smoking in favor of reducing obesity is not good. It's like saying you'll stop wearing a seatbelt to reduce the risk of being trapped in a burning car; your overall risk profile is still higher.

Or is it that you don't think health is the goal of reducing obesity? If so, most of the metrics we use to deem obesity as sub-optimal are wrong, including those in TFA. Better compliance to a diet that increases overall health risk is not a good strategy IMO.

Nicotine helps control weight so it also makes sense that as we smoke less we'll gain (even) more weight.

The headline refers only to tobacco smoking, not vaping, patches, etc. I wonder how overall nicotine use (from all sources) looks

it may also help that tobacco-free nicotine products (vaping, pouches) are gaining popularity vs. more traditional and deadly administration routes (cigarettes). of course there are myriad cons and unknowns resulting from any nicotine habit, but cancer trending down is always good to see.

Excellent analysis and deduction!

I found the ABC (oz) news reporting a bit deficient on this. Leading disease risk factor doesn't have to mean its rising, it can be that smoking has fallen and now, people who would have died of COPD and Cancer caused by smoking die of COPD and different cancers, caused by morbid obesity.

Its probably just me but I found the language around absolutes and relatives a bit flakey. The overall population is rising so absolutes trend upward but leading goes to relatives, and so the rate of increase against population increase is material.

I wonder if we'll see an increase in other nicotine related issues. It's hearsay from my gen-Z colleagues but apparently there's a bit of a ZYN/snus epidemic.

Nicotine might be one of the least harmful things in cigarettes compared to tar, carbon monoxide, benzene, formaldehyde, cadmium, arsenic, etc. Nicotine by itself isn't too different from caffeine.

> Nicotine by itself isn't too different from caffeine

Yes it is

You should actually look up the literature. Chronic use is actually harmful in a lot of the same ways that tobacco smoking is. Obviously it's a huge improvement over tobacco use, but it's also a huge downgrade from abstinence as a whole.

It's not. The biggest health consequence of long term nicotine use is hardening of arteries. All of the lung problems, the worst side effects, are from smoking.

https://academic.oup.com/function/article/2/3/zqab022/624776...

Nicotine on its own frankly isn't that harmful outside of addiction. Not great for you, but it's orders of magnitude more healthy than being obese.

Zyn barely has any nicotine. In Europe most are 5x stronger but even 10x stronger pads at 50mg/g exist. This is nothing new. E-cig liquids have been as strong for a long time as well.

Excellent. I’ve never smoked but I am obese as hell.

Maybe soon it will kill me and I can finally be done with this forever worsening hellscape called life.

Honestly, fasting feels great and I just need that reminder that it does.

According to https://dqydj.com/bmi-percentile-calculator-united-states/

67% of American adults are overweight. Only 13% of them have a BMI less than 22 (center of the healthy BMI range).

How does it translate to aesthetic preferences. Is someone with a BMI of 22 so far of the US norm that they would get strange looks, or would be considered unhealthy?

I am going to assume you do not live in the USA based on this comment. Most supermodels, which I'm using as a proxy for aesthetic preference, have BMIs under 20.

I thought BMI was pretty debunked as a measure of health?

I'm 5'11" or so, and weigh approximately 180 pounds.

According to that website, I'm overweight with a BMI of 25.10.

I certainly don't look overweight, I definitely don't feel overweight, and if I picked up my exercise regime again, I'd be more likely to gain muscle weight than lose weight. And yet, my BMI would get worse.

A BMI of 25+ seems to be commonly accepted as overweight in most part of the world, at least in the medical sense. Whether it looks overweight or not is cultural. But you're right, very muscular persons are heavier and BMI isn't a good measure in that case, and it's not necessarily unhealthy if you don't have other risk factors.

> For people who are considered obese (BMI greater than or equal to 30) or those who are overweight (BMI of 25 to 29.9) and have two or more risk factors, it is recommended that you lose weight.

https://www.nhlbi.nih.gov/health/educational/lose_wt/risk.ht...

I was definitely overweight (by waist and BF%) at 5'11" and 180lbs, and going by the stats I've seen that seems more common than your case of BMI overestimating BF%.

So, since smoking can help you lose weight...

Being slim and vaping or snusing might be better than just being fat honestly

Most insurance plans in the US don't cover treatments, drugs, or surgeries that work for weight loss...

Seems like they ought to.

Can we expect those Truth commercials to start fat shamming folks since tobacco and e-cigs are no longer a problem?

Just went a month without cigarettes today, yay! Still overweight :(

We should be looking at eating poorly as well.

...in Australia might be worth adding.

Honestly I have a BMI of 23 and feel like I have a "beer belly"

If you are over 25 you just need to loose weight straight up

There are a lot of people who are "skinny fat": normal BMI but low skeletal muscle mass. This puts them at greater risk of sarcopenia and metabolic conditions as they age.

Yea sounds like me :(

BMI is a great tool for a population. It's often not very useful for an individual.

A BMI of 23 is a 5' 10" man who is 160 lbs. It doesn't say anything about body composition.

Sometimes I read this stuff and think I live in the most ridiculous bubble.

It's bizarre to me that people don't look after their health.

I wake up and I'm like, right, there are three tracks - financial (go to work, develop career, run business, do admin, whatever), physical (exercise, keep relatively fit, don't eat 4000 cal a day unless bulking), social (don't just sit at home all day and become a gremlin). There are others but that's the main.

I don't spend equal amounts of time on them but they're all there.

It seems to me that apparently other people don't think of it this way. They just sort of wake up and do whatever on autopilot and go to sleep and whatever happens to them happens. What's that all about?

We live in a bubble, the average american spends 2hrs a week with friends

I agree. I think you do live in the most ridiculous bubble.

You definitely live in a bubble but it isn't the kind you think it is

Addiction, depression, it's a cycle. Something happens that causes depression, eating gives some feel good chemicals and being a sloth is to avoid potential disappointment.

I don't think it's that complicated. When one side of that triangle ends up consuming too much of your time and attention, the other two suffer.

Many people are on autopilot. They have not been taught to be intentional about the day to day fundamentals of their lives. For the most part, I think that used to be achieved through social contact which has substantially diminished in the past few decades.

> What's that all about?

People learn what to care about and how to care about those things from others, with the most impact coming when they're young.

Many of today's parents already missed the boat on learning self-care, and don't even have the insights to share with their own children, who become even more detached from it.

They don't know how to cook food that isn't either prepackaged or some ornate gourmet meal that takes lots of work, they don't know how to eat for their health in a way that's satisfying, they don't know how much to eat, they don't know what it means to be active throughout the day, they don't know how to rest without constant stimulation so that they're emotionally and physically refreshed, etc etc

We can point them towards some study or a bit of blogspam that asserts some narrow claim about what's optimal, but that's not the way that most people learn self-care and never has been. So they mostly keep doing what was actually taught to them, which tends to bias strongly towards sedentariness, overstimulation, and indulgence these days.

and of course, school plays a large part. most of the school experience involves sitting very still, and the cafeteria menu is selected more for cost than anything.

A large part of workplace experiences also involves sitting still and being sedentary these days too

Combined with frequent treats brought in by coworkers (a colleague of mine likes to bring in breakfast bagels from McD for my small team...hard to resist lmao)

I do wonder how much influence your parents have on you living a more sedintary lifestyle in life. My father was sedintary his whole life (later in life he broke his hips numerous times) while my mom was a Jane Fonda zealot and much older now is still active. Both my sister and I have followed in my mom's footsteps tho myself much more due to my lifestyle and who/type I want to attract for partners. I use chatGPT to count my daily calories, exercise daily and gym visits two or three times a week.

Bro, have you tasted food before?

I've developed a drug habit over the past year. I'm not overweight at all but, I assume people's mental health leads them to neglect and abuse the body for quick dopamine hits. Baconator with a large coke would immediately improve my mood but then make me feel miserable after.

>It's bizarre to me that people don't look after their health.

I'm 39 years old. Once my obligations in life are done, I'm putting a bullet through my brain. Probably just another 10 years or so this point.

It's of benefit to look after my own health but at the same time, why? By the time my poor life choices start catching up to me, it will be time to go anyways. If my health deteriorates before then, then I'll just shoot myself in the head sooner rather then later.

To me I'd rather enjoy what little time I have left indulging into a little hedonism then trying to plan for a future that doesn't exist.

You need to see a professional, frankly. That is not a healthy outlook.

Have considered the possibility that you might enjoy the moment right now more if you take care of your body by exercising and eating well?

The future holds an unknowable amount of discovery and joy, for both you and your children to find together; however bleak it may seem, I hope it's not out of line to say that there's one internet stranger rooting for you to see the light behind the trees. Personally, my life goal is to visit the moon. Why? Because fuck it, that's why. A slightly-more-sustainable, useful, and poetic goal than Everest, I suppose.

If you're gonna die anyway, why not make a mark on the world, do your weird personal thing that only you could do? You might not have a statue like Ozymandias, but in my humble, naive, and young (27) opinion, chances are likely that you'll be glad you did.

https://www.poetryfoundation.org/poems/46565/ozymandias

You don't say so, but I'm guessing you're on the younger side. Mere speculation on my part, for the sake of argument. Most people who die of weight-related issues are quite a bit older, so put that in your mental model, along with this: Many things which seem simple and obvious at one point in life become hard and frustrating later on—and vice versa.

Schools don't teach this stuff and many people just don't know. In a school you automatically get the physical and social aspects (PE classes and forced collaborative projects, with a timetable you had no say in) but after graduation a lot of people didn't know they needed to expend effort to keep doing it. The first year I was working I didn't know I needed to actively exercise, or actively seek out social activities beyond just immediate colleagues.

Fortunately I fixed that early in my career. I'm sure plenty of others still haven't.

I don't think you're really acting intentionally: it's more likely that you agree with your autopilot. My reason for saying that is that there are a lot of medications with behavorial side effects (weight gain, increased risk taking) that would change those parameters for just about anyone. If you were constantly hungry, you would eat, it's as simple as that.

I have what feels like a continuously self correcting mechanism running in my brain. Like yeah, I might have a week or two or something of lounging, just punching the clock, but then every now and then I'll assess my goals and how they are going.

The question I suppose is whether having a goal driven mindset is down to free will or not. If a large number of people are doomed to not have that I think that's really sad.

Fat people and people with ADHD that affects their career reassess their goals too: often several times a day, and they usually feel awful about it. The difference is that the same switch that puts you into the week or two of lounging "mode" is flipped back an hour after they reassess, not a few months.

Sure.

If 40% of the world are walking around basically without executive function then that seems like a major disaster that we need to do something about not just give people GLP-1's and call it a day.

Like what, genetic engineering? People have been drinking themselves to death for thousands and thousands of years.

My initial reaction is that yes, you do seem to be living in a very strange bubble. And, I say this out of curiousity rather than malice, I wonder whether you struggle with empathy?

There are any number of reasons why people can't consciously prioritise those things. Maslow's Hierarchy Of Needs comes to mind.

No malice taken, I do struggle with empathy, yes. To me a lot of people seem to just make unforced errors.

There's like, someone who stands on a landmine and can't go to work, or someone who has a chronic condition that makes them feel nauseous all the time, etc.

That doesn't explain 40% of a country being obese whilst the other 60% isn't, though.

What was your upbringing like? What part of the world, what'd your parents do for work?

I grew up in the UK. We have approx 30% obesity rates so less than the US but still pretty crazy.

Single parent who worked (and still does work) low paid manual labour style jobs. Same with the estranged parent who was around for a while.

I dunno. People talk about being a surroundings thing. But then the way it has worked for me and my siblings is that for the most part we've looked at the ways in which our own parents failed and tried to improve on that.

For what it's worth we ate a lot of "crap" food growing up but just portion controlled it reasonably I guess?

> They just sort of wake up and do whatever on autopilot and go to sleep and whatever happens to them happens. What's that all about?

I absolutely agree, and commend your focus on understanding over condemnation. Despite all the justifiably condescending responses to your post, you have the right attitude towards truth.

My simple answer is that humans do not possess truly persistent (much less consistent!) consciousness, and that the concepts of "vice" and "virtue" are nothing more than imperfect social tools. Of course we can't abandon them altogether, but the questions "Where does gluttony end and eating disorders begin?" and "Where does laziness end and ADHD begin?" are in the midst of reshaping some very fundamental assumptions in our society, IMHO. The related question "Where does self-pity/envy end and Major Depressive Disorder begin?" has seen huge changes over the past 1-2 decades (in some nations), and I believe the former two will follow a similar trajectory.

In other words/TLDR: it's objectively challenging to balance competing priorities, where I mean "objectively" in an empirical, population-observation, sociological sense. Very few people have, like, an intellectual argument for not working out/eating right.

As a somewhat tangential point, I'd say your three tracks aren't the only reasonable way one could organize their life (again, assuming you have the capability to even get to that point). For example, I spend a lot of time worrying about politics, society, and my impact therein; otherwise, many people spend most of their time worrying about providing for/guiding/safeguarding their family, and a lot of young people (my past self included!) spend most of their day thinking about the social track in a much more anxious, peer-esteem-related way than you seem to.

None of these are necessarily better or worse than others, but I think it reminds of an important truth: philosophy is not solved. If you feel confident that it has, I encourage you to think back on previous times in your life where you felt the same, only for your whole outlook to change in the intervening years ;)

>> It's bizarre to me that people don't look after their health.

The obesity crisis obviously has multiple causative factors. There are plenty of natural experiments suggesting that some of these factors are beyond human behavior and more systematic or environmental (e.g., hormones in food, etc) There are probably also societal drivers like overpopulation which leads to sprawl, longer commutes, more sedentary time, greater reliance on cars.

I am not saying people should not hold themselves responsible, but we should not be quick to pin it all on individuals and should look at outsider factors also.

It's an emotional issue, not intellectual.

In addition to what others have said, daily demands on time and headspace can be overwhelming. My wife spends over an hour every day managing a chronic health condition. Raising kids well takes a lot of time every day. Some have loved ones with high needs that require care. Many spend 2+ hours commuting daily. Many work multiple jobs. Some spend a lot of time traveling away from home. Serious injuries can disrupt exercise routines and cause vicious cycles. Poor finances makes everything harder. Stress and depression can result from and exacerbate all of this.

Appreciate your health and time and focus and good habits while you can, and may you keep them as long as possible.

I don’t get why people get addicted to drugs. I just decide not to take drugs, and I have no problems! What’s so hard about that?

Trauma / anxiety is a possible ingredient; people eat to fill a void. Same as anything that is self-destructive. People try to make themselves feel better and eating does that.

Word. My mother had a pretty bad childhood. Had to take of herself since she was 16. Poverty, kids and a husband with mental issues led her to smoking. When her life was finally completely on the rails she could start to work on her addiction.

I'm convinced that every person with an addiction has a sob story. There are no happy people sleeping under the bridge.

I would say the problem is people are stuck spending most of their time and especially energy on #1 just to make ends meet. Obesity, like drug addiction is a disease of despair, and we have a lot of that in our country. Also, the longer you live, the more beat up you get. Taking care of elderly parents, dealing with shitty bosses, shitty partners, etc. It definitely takes a toll over long periods of time.

I've recently made #2 my top priority due to an eye-opening, but fortunately reversible doctor's visit recently. When the priorities are lopsided as mine were, it takes twice the attention for #2 to get balanced than to maintain the balance. I'm making decent progress though. It will take at least a year to remedy.

Heh. This comment sparked some angry commenters but in fact I agree.

Was a single parent with full time job and took evening college classes.

I watched what I ate and went out for a 30 min run whever I could. I also bicycled and did bodyweight excercises in front of the tv in what was my livingroom/bedroom when the kids were put to bed.

This is 30 years ago and I am middle aged now and my stupid menopausal hormones make me gain weight if I so much as look at a croissant. I frequent the gym several times a week anyway. That menobelly covers my once flat stomach but I am still as strong as I was 30 years ago. Even stronger in fact. I rarely see people my age, especially women, at the gym. Thats a shame. You should join. Resistance training is crucial for women my age.

Be angry or offended all you want people. Not taking care of yourself will be yours and yours only to pay.

It starts with the kitchen, we need to watch what we eat. Eat nutritious foods. And we need to move those muscles and get the heartrate up a few times a week.

And this is health we are talking about. Thin and fat free != healthy

Your body could not care less about political correctness, if you ignore it, it will lead to devastating lifestyle disease and untimely death.

I am shamelessly going to plug Caroline Girvans videos on youtube or her app.

> Be angry or offended all you want people. Not taking care of yourself will be yours and yours only to pay.

That's not what people are reacting to. People are reacting to OP's staggering inability to comprehend the vast range of human experiences.

It must be a bubble, but it doesn't seem like it to me.

What you write basically describes my outlook on my life as well. I view and act on things very similarly to how you described it. It seems to work very well for me.

I think you’re probably mildly autistic since most people think very, very differently than what you’re describing.

We need to wake up to the reality that solving the obesity crisis (if it is actually something we want to solve—enough healthy people may be happy with paying double for healthcare) may require measures perceived by modern liberals as authoritarian or cruel.

I think this because measures like what we did with tobacco—-public health demonization of junk foods and junk food consumption, banning advertisement of junk food, warning labels on junk food, and high excise taxes on junk food—are unlikely to ever be accepted by the healthy population that has no problem restricting its junk food intake to stay below BMI 30 (60+% of the population). They won’t want to pay double for chips just because obese people can’t stop themselves from eating two bags instead of one.

The only alternative is to charge the obese population on the back end—when they pay for healthcare. Obese people would be made to pay a health insurance surcharge to compensate for the additional healthcare resources they consume. This measure will be decried as “insensitive” and “cruel.”

Alternatively we could do both.

By the way—ozempic et al are unlikely to solve the crisis as some hope. Studies show average long term, sustained weight loss of 10-20 pounds. Good, but not enough to help people who are hundreds of pounds overweight—a sizable portion of the obese population that costs the healthcare system so much.

Doing anything about the obesity epidemic has the same issue as 99% of our problems: People are getting rich off of selling cheap nasty food.

You think a politician is going to go after billion dollar industries? Get real.

It is a class issue, and an issue with the type of food that is "easy" to access for exhausted people with kids, long hours, etc...

A good place to start would be addressing overeating as a symptom not the cause.

that's the point. Cheap low quality food makes people wants to eat more (because it lacks nutrition the body needs). Turning them into recurring revenue.

What a stupid take. I've recovered from a type of cancer that has made me put on 15lbs after surgery. By your logic I should pay more for healthcare because I have a disease that I was not responsible for.

Never ending war with happy people.

People are trying to make being overweight as something acceptable instead of a condition to be treated.

majority and all

"People" is doing some heavy lifting here. There are some fringe people on trying to push that but most people I see are trying to explain that the main problem with obesity is that it is a food supply and class problem.

There are also tons and tons of people trying to lose weight, and having an awful time at it :-) . Just three minutes ago I was summarizing 2024 for myself. I did an awful lot of SUP, and tried to lose weight. Results: weight decreased, then increased back when I got into a relationship that included unhealthy habits. I got rid of the factors that worked against my weight control effort and now things are looking up again. But most people in my age are married and with kids, and they are not going to leave or even fight their significant other and the kids over the family's eating habits....

Gotta set the family eating habits right from the start.

I would not call billboards for clothing featuring morbidly obese people "fringe".

"Fat acceptance" is actually quite popular. It's not fringe. Fringe is being a furry. The entire medical field walks on egg shells because of so called "fatphobia".

You are going to show me an example because people don't really know what morbidly obese means I've learned.

You also say fringe is being a furry as if there are 10 or 20 furries and not millions of them.

Probably referring to the recent Calvin KLein ad campaign. Nike also ran a campaign featuring plus size models.

I'm not so sure about that, especially with all the commentary coming out of the Brian Thompson murder.

A lot of people are angry about the fact that the US spends the most on healthcare, but we don't actually live that long - with the implication that healthcare here in the US is a racket just stealing our money and not helping us.

But, why don't we live very long, compared to other people? A big reason is probably how fat we are, and how little we take care of our bodies. The best health care system in the world won't be able to fix you if you've ignored doctors orders to lose weight for 30 years and then have some health issues associated with that.

So, while people aren't explicitly saying "being fat is great", they are implicitly saying it, by pointing to something other than our own lifestyle choices as to the reason why we have bad health outcomes relative to the amount we spend on healthcare.

People are trying to remove middle-school grade social behavior against people that are overweight. When I see someone that’s overweight I should simply see a person. Their doctor and loved ones should highlight the issue because they want them to live better. But if they’re a stranger, coworker, or anything but a close friend it’s not appropriate for someone to step in and start commenting. They shouldn’t even think about that.

Not to mention that people confuse health standards and beauty standards. Being a little rounded is of no health risk. And you can be very overweight (like a sumo wrestler) and very fit at the same time if you are both exercising and eating in excess.

Pretty sure the long-term effects of sumo wrestling are not great for the wrestlers any more than they are for offensive linemen in American football.

Sure. But the point is there are some fat people that can do things your average skinny office worker never has. I’ve seen chubby guys cycling up mountains in the Bay Area like they do it every week.

There’s an interesting article I read a while back where a woman (who was heavy in part due to muscle mass but also body fat) went to a personal trainer to improve her cycling performance. She had just cycled from SF to LA. Even though the trainer was a professional, certified and likely had a degree, he could not mentally shift from the idea that she was there just to lose weight.

To be fair, carrying less weight will make your cycling performance improve. But from what I recall he was running it like a weight loss program and assumed she’d never been in a gym before. She had filled out a form with all of her exercise history and goals. I would have expected him to work up her back squat, weighted lunges, etc. At least as part of the program.

It doesn’t matter if some fat people are active, the fat is still hurting their bodies. How are their knees doing? How is the stress on their heart? Their arteries? When was the last time they could even stand with their arms hanging down straight at their sides instead of pushed out perpetually at an angle?

When you’re fat for a long time, you forget what it’s like to be light weight, you forget how easy everything feels. Being fat is like walking around with a two 25 pound dumbbells strapped to your body everywhere you go. My fatter friends complain when we go to a dense concert or festival and I can just turn sideways to slip easily through crowds, leaving them behind. Trivial things like this is what you forget when your body has become too large.

Not to mention that said middle-school grade social behavior, if anything, will only make the problem worse.

Depends on the culture. I’m told that in Japan the shaming works. There you will get scolded by your boss for being overweight. There’s a law that explicitly brings weight-shaming into the workplace.

Not that I think it’s the ideal. But it supposedly did cause a reduction in BMI. And many of those called out said they appreciated the pressure.

The problem is that there is no behavioral solution that ever has been empirically proven to work across a broad population, over a long term.

And while "just eat less" has an intuitive appeal as a treatment strategy, alas, it's been shown again and again to be a dead end in practice, much as "just don't spend money" or "just do less heroin" don't seem be effective treatments for poverty or addiction. It is sometimes difficult to get over the bias that what seems intuitively effective in theory is not actually so in practice. But, as we're evidence-driven people, we need to look elsewhere.

Surgical interventions, and GLP-1 receptor antagonists work, but they are expensive and there is limited access to them at present.

So, as of today while I agree that it is a condition to be treated, there are no effective treatment options for a population, which is the scope of what this article is talking about. Thus the situation we're in.

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