Korea has a similar lack of obesity. It's not just genetics because Koreans tend to become overweight when living in the US.
I think it comes down to two major factors:
1. Koreans tend to walk (exercise) more. Walk (partway) during commute, walk to lunch, walk to do errands, etc. In the US people just sit in their cars. I personally find I get 3000+ daily steps in Korea without even trying, while in the US I only get about 300 daily steps or so.
2. Diet + portions. My Korean friend was astounded by the amount of fries that came with every meal in the USA and Canada. The US is the only place where fructose is substituted for sugar in most processed food. I've heard fructose inhibits the sense of satiation after eating.
So walkable cities and better food options would probably reduce US obesity.
Americans do more exercise than ever and have also reduced their sugar intake on average, but obesity continues to rise. Is it possible that food additives or something less obvious is having an effect? GLP-1 agonists are a good indicator that even minor chemical interventions can have a huge long-term effect on obesity that dominates diet and exercise, so why do we rule out the possibility of other substances doing the opposite?
Are they really? Fitness socials exploded in the last 10 years, many more enthusiasts training harder/longer, but I haven't seen noticably more bodies at the gym.
The number of gyms has skyrocketed in the past few decades, though. Back when the obesity epidemic really took off ca. 1980, "the gym" was a place inhabited primarily by bodybuilders and professional athletes. Regular folks were mostly doing calisthenics/aerobics, often at home following along with Jack LaLanne or Jane Fonda. Today, Planet Fitness is a ~5.5-billion-dollar company.
Which is why I'm curious about time/scale of effect, and what exactly is meant with "Americans do more exercise than ever".
One indicator is # of gym membership: ~30m->~70m in last 25 years, from 10% of population to 20%. Hard to say how much of that is due to gyms getting better at selling memberships because we know they oversubscribe. But per capita figures still suggest that vast plurarity of Americans, the average American, likely 1.5SD / 80%+ of population, probably don't have habit of regular exercise that would overcome effects of increasingly sedimentary life style. So should be ber surprising that obesity continues to increase.
I haven't been going to the gym in a while, but when I did there were a lot of people mostly looking at their phones and not doing much exercise. It was noteworthy when I ran on the treadmill that I saw other people actually running on them instead of merely walking.
I'd guess that many people going to the normal gyms aren't getting much out of it. Combined with the drive to and from the gym, and often getting a snack or something along the way, I have doubts that going to the gym is an efficient use of their time.
(the expensive, specialized gyms like Crossfit or climbing that cost much more are completely different)
My understanding is that GLP-1 affects appetite, and thus affects diet. And one of the reasons people quit GLP-1 long-term is because they miss eating and enjoying food.[1]
> The drugs work by activating GLP-1 receptors in the body in a way that reduces appetite, alters gut function, and may impact addiction pathways.[2] However, adherence to the drugs long-term is a challenge, as many people stop taking them after some time.
Right. There is clearly a powerful system in the human brain and body that controls our appetite and weight set point. Medications that adjust that system seem to produce durable changes in appetite and obesity, while typical changes to diet and exercise see weight revert to the mean after a year or so.
So the question is whether there are other substances in our diet that are also affecting this system. This isn’t crazy: various gut bacteria produce proteins that increase natural GLP-1 in the body. So any substance that disrupts these bacteria could easily have this sort of effect. https://www.nature.com/articles/s41564-021-00880-5
when you are walking everywhere for a few minutes at a time, it adds up rather quickly.
most americans who go to the gym spend 60 ish minutes there. they also usually eat something after.
i don't think it's food additives, because japanese are no stranger to mass produced food and beverages from food conglomerates. it's the country that gave us instant noodles.
> don't think it's food additives, because japanese are no stranger to mass produced food and beverages from food conglomerates. it's the country that gave us instant noodles.
> Koreans tend to walk (exercise) more. Walk (partway) during commute, walk to lunch, walk to do errands, etc. In the US people just sit in their cars.
People are always going on about walking, but I have a very hard time believing that the lack of low-intensity walking is a major contributing factor for the 250-pound bodies that are so common in the US (especially south and midwest). When you're overwhelming your body with fried food every day and coke at every meal, you ain't gonna keep up with those calories by getting in more steps.
People think of the 250lb and 1000 steps in the context of one meal, or maybe a 6 month diet. But 250lb is not added in one meal, or over 6 months. It usually takes a couple of decades.
Let's say that's 10,0000 days. Because I'm Australian and like round numbers and am lazy (these numbers are all very rounded), call 250lb 100kg. 1,0000 steps a day consumes about 20 kiljoule. If those kilojoules come from eating fat, you either add 1/2 a gram of fat or walk those 1,000 steps.
I know, 1/2 a gram, 0.02oz - almost insignificant, right? Now multiply it by 10,000 and see that over those decades it contributed 50kg of the 100kg we are talking about.
For the same reason exercise doesn't make a lot off difference to a 6 month or even 2 year diet. But when you are trying to explain to difference between trim Koreans and 250lb Americans those extra 3,000 steps a day explain the entire difference, then some.
I think you're doing bad math. My point is that a shitty, low-cost middle-American diet greatly exceeds the caloric burn of walking, across any time window you choose.
I mean, it's obviously better to walk than to not, but I'm claiming the dominant factor is sugar-bomb drinks and fatty foods (which isn't at all a novel claim anyway). Walking only barely chips away at that.
If you’re moving around and walking, you don’t get as hungry. Outside of a handful of cities in the us, most of the country is basically designed to limit walking
Using public transport (aka walking) means to me to burn 500-1000 additional calories per day compared to using cars the whole day. That’s not insignificant at all. Of course, you need to live somewhere where this is a possibility.
I don’t know the science of it but for me at least walking suppresses my appetite. My hunch is that by not walking the body goes into “must be sick, should probably eat some more” mode.
The first few days of a long hike, my appetite and my wife's are suppressed. We live mainly on trail mix that we consume during the day. And chocolate covered coffee beans in the late afternoon, when we need a stimulant.
The appetite starts to come back around day six. Normally I've lost about two kg by then, after allowing for trail dehydration. After two weeks or so, I'm down about 4 kg.
I hate the join the "unreliable anecdata faction" in a thread where we are talking about well-established science-backed points (eating 1000+ extra kcal of trash most days contributes to being overweight; walking 10x more every day does the reverse), but I too believe there is something magical (meaning we don't fully understand the science) about walking.
I have three kids, and after each one of them, I tend to put on 10-15kg of body mass, mostly the wrong kind. So I have three experiences of "fixing it".
The first two times, I ran, lifted weights, ate salads and dropped alcohol, all that shit... it worked, but it was hard. Hard like when I quit smoking cigarettes (before the first kid). I was hungry. Irritable. Sometimes, I'd be like "oh, fuck it!" at 1AM and make a big ass instant Japanese ramen with scrambled eggs on the side, I was so hungry.
The third time, I eventually bought one of those under-desk treadmills, because despite my vows to walk 10km per day I just "don't have time".
It took about a day to acclimate. After that, and forever more, I can easily do computer work (writing code, reading code, architecture diagrams, writing docs) while walking 3kph (slow). When I am just reading stuff, I ramp it up to 4-5kph.
There are a bunch of other things that made me feel dumb for not doing it years earlier, which one day I might blog about or something. I suspect it actually helps my productivity — including learning rate and retention — for some reason (bleeding off extra energy that my mind might otherwise use to poke me with small, fascinating distractions?). But sticking to this topic, the main point is this: I was no longer super hungry with only 2000 kcal a day.
When I would run 750kcal off, sure I burned the calories, but I was soo hungry later that I would override my caloric restriction plan, and often end up eating more extra than I'd burned off.
Not at all the case with walking, either on the desk treadmill, or in the relatively uncommon case that I get to walk 10km in the real world (maybe once a week I will walk to/from work and take some detours).
My weight dropped steadily — which, of course, it does any time I manage to consistentely burn ~500kcal per day more than I consume — but the point is it dropped easily. Walking 10km/day, I can eat at a deficit without it being so... annoying. Eating to maintain weight is also easy.
And unlike lifting weights, or HIIT, or running hard — you can literally walk 10km every single day. You can take a day off if you want, but you don't need to[1]. Your muscles don't need rest. Your joints don't wear out. It's literally the activity your body was designed for. You can do it every single day for 10 years if you want.
I should really write that blog post.
I suspect some science-type should dig into it more and write a whole book.
[1]: the only real worry is that if you have already gotten super out of shape (very fat, very low cardio fitness, etc) then you should start with less walking per day, and work your way up gradually.
Basically it's all about Calories and Americans have added 25% to their caloric intake since 1961 when it started increasing.
Its also not really magical, they didn't just add sugar, they added meat, sugar, grains and oil (replacing butter mostly) - all together it adds up to 720 kcal extra per day per capita.
Koreans eat about 1500 kcal less per day (they are also quite a bit smaller on average so it's not 1 ot 1 of course.) Japanese eat even less (like 200 kcal less) but are also even a bit smaller on average. Both countries happily eat terrible food just as much as Americans do these days, they just eat a lot less food in total.
There's an idea that American eat out more and that the calories at dining establishments about increased about 35%.
If it were walking what keeps Asians slim, you'd see more variation, imo. The small portions and generally healthier food are what keeps them slim. True that the Japanese eat fried chicken and cakes, but not as often as Americans, and not as much each time.
There's a certain positive status associated being "fat and happy" in the US.
Americans are also, on the whole, gigantic people. Tall, wide, huge frames and/or a lot of meat on the bone. Only some of that is accounted for by diet.
I think there's more to do in Japan locally, or at least more general social/physical freedom, which I attribute to low costs and high mobility. Nature in the US is generally privatized, far out of the way, or has limited access or parking. If you travel by walking in the US, middle class people think you're poor or your car has broken down. There's a bit of a stigma in some cases and places against not being sedentary and large (or, having to move and sweat for anyone).
It's really quite simple to me. I don't quite understand why folks seem to argue about why the US is obese and Japan isn't. It comes down to one thing but I suspected aided by another three things:
In Japan a mindset of just enough seems to be prevalent. They do not seem to be as prone to glorifying excess in all ways like us Americans tend to be. I think this is a / the key aspect which is supported by these:
Americans are not active. Japanese people tend to be active and walking absolutely contributes to this.
Americans eat low quality food. We eat a lot of food with added sugar. We feed candy to children in sugary water-fat for breakfast. We eat processed and ultra processed foods regularly even when we primarily prepare meals at home.
Americans are anti-conformist. Japan is very conformist. This relates to social pressure(fat shaming, diet) and social activity cohesion (exercise, dieting).
It seems quite evident at even a glance why one country would be overweight while the other tends to be fit. In the US our culture rewards excess. We value cars more than people. We care about profits over people, too, really. Things like healthcare and food come to mind here.
Only 25% of Americans are getting the recommended aerobic activity. Which is 20 minutes per day of moderate activity (walking).
It is difficult to comprehend how little most Americans walk. In many suburbs, the local store is more than a mile, which would equate to a 40 minute round trip walk. How often do you walk for 40 minutes when you can drive in 8 minutes. Of course, delivery services only exacerbate the issue, as you're not even walking through the parking lot now.
Japanese people fry all kinds of food. They have plenty of soda as well, and there are plenty of Americans who struggle with obesity despite not drinking much soda.
It 100% has to do with walking/biking and portion sizes. Low intensity exercise throughout the day is as if not more effective than high intensity exercise for burning calories and keeping your metabolism from crashing.
I know a person with sort of an odd type of diabetes that requires multiple different ways of treating to keep her blood sugar low. She was taught to walk daily, not to help her blood sugar today, but to literally help it tomorrow. Her data seems to back this up.
Whatever the cause, there seems to be a causal relationship with brisk walking and lower blood sugar the following day.
Food in the US seems designed to make people obese.
When you look at ingredient labels in Japan or Germany, you see a short list of what you would expect, plus maybe a preservative.
In the US, you see an entire chemistry lab: artificial colors and flavors, bizarre substitutes for real sugar, oils that a hundred years ago would not be considered fit for human consumption, and so on.
Granted, this is hardly accurate/scientific - try out a solid hour walk on a treadmill.
A lot of steps for a pittance of calories [based on whatever hand-wavy math it's doing, admittedly]. We're frustratingly efficient. I forget exactly, it was something dumb like half a candy bar.
I've heard people say "you won't outrun your mouth", in this context... and others.
It's true. I've managed to drop my body weight ~half, it happened by controlling what I ate; not how I exercised. When I stopped skateboarding due to an injury, I ballooned. I stopped eating like that over a decade later, I shrunk.
In that time I also got older, moved, and went to college. It's worth considering what's easier/more likely/realistic to maintain
I think that pittance of calories is only the surface benefit. Consistent activity keeps your metabolism much higher, meaning you burn more calories throughout the day even when you aren’t moving.
Absolutely, very good to keep things burning. It's also good to not need to burn them.
We can be remarkably efficient with the right conditioning. I eat once/day and would do less if not for literally boredom.
I do next to nothing physically all day. I'm fine, I just don't need a lot of upkeep. I have all the metabolism I need!
My health may be suffering for it, but I enjoy getting back a solid chunk of the day. Eating is such a time sink... now it's exercise too?!
I know it's nuts, I have an unhealthy relationship with food lol. Even the social side, it's hard to explain but people get mad when you don't want to eat with them.
Put a morbidly obese person on a treadmill for a solid hour, and they'll likely spend a fair amount of time in zone 4-5. Walking is excellent exercise for some, not so great for others. Generalizing here is pointless.
Comment sections summarized excellently in four words. None of this was presented as universal truth, so I'd appreciate some leniency like I'm giving to you
My post provided a personal anecdote. What does yours have? Criticism we'd all be better off without.
It's clear the effect exercise had on me, it was keeping my eating in check. I can do that too at intake. I didn't even need a miracle drug.
I just stopped eating so much, but here I go slipping into moral judgement. I'm trying to help people, not reinforce a lifestyle.
Apologies for my rudeness, I'm afraid I let a pet peeve get the better of me. I often read health and wellness content on Reddit. There you'll find highly ranked comments expressing opinions such as "you should never eat below 1200 calories", or "walking on a treadmill burns a pittance of calories".
In my opinion, these sorts of observations are uninteresting at best, and misinformative at worst. Hacker News, as you may well know from your nearly three year comment history here, is a place where detail and nuance are roundly appreciated.
The walking may not be what actually loses the calories but it probably also affects how you look at your own fitness. It gets a lot harder to walk when you're heavy, and you'll notice quickly when you get start getting winded just going to work every day.
I recently wore a FreeStyle Libre for 10 days and one of the most positive things I learned from it was 10-15 minute walk after a meal significantly dropped glucose levels. It would reduce the spike in the range of 5-10% immediately. After I noticed that effect, a quick Google search presented many articles confirming it.
I strive for 7k steps per day since Covid hit March 2020. Some days I may fall a little short if really tired or sore from golf or coaching little league the previous day, but most days I easily achieve it or go well over. I surely don't think 7k is an unreasonable goal for ANYONE - it just takes a little bit of mentality change and effort that just seem taken for granted in the USA from what I have observed last few years.
Things like parking near the rear of parking lots when going to stores. I am amazed now at how often I see people wasting many minutes in their cars just to wait or "hunt" for closer spots when they could have just parked in back and be walking into the store already. Or parents at the park sitting and reading their phones for an hour while their kids play in playground. Teenagers riding electric scooters/ebikes instead of walking or regular bikes, etc.
I was at my in-laws over Christmas and everyone sitting around eating one of the many appetizers to choose from and drinking alcohol, I decided I wanted to go for a quick mid-afternoon walk just for some fresh air. I remember sort of being giggled at when I asked if anyone wanted to go, with a few bewildered looks on some faces. Again it is a change of mentality that needs to happen if obesity is going to be addressed in the US anytime soon. Now, with these drugs available, I'm afraid it will be even harder to get to the root of the problem.
My brisk pace would be about 120 steps a minute, with 80 cm step (I have long legs), that is about the speed I can sustain for longer time without any sweating.
I don't know the proper sources, but I've read in several places that the Netherlands continues to have rising obesity despite making exactly those sorts of reforms over the past ~40 years.
Netherlands is a bicycle country. There are fucking bicycle highways and extensive safe, multimode traffic design patterns everywhere. I've ridden them from Amsterdam through the countryside to Belgium.
And you haven't been to Los Angeles, Texas, or Florida if you call Netherlands a "car country".
As like most places, you cannot generalise a country.
Netherlands has bike lanes _everywhere_. People use it.
The cities (Randstad) encourages bike commute for everything. Driving a car around is almost cumbersome. Traffic, parking etc. Bikes are easier.
The countryside, life in farms and farmhouses are obviously more car friendly and in need of a car for better quality of life.
Food in the Netherlands has both extremes. Fried food, and pre-processed food? Check.
However, you can also find healthy option almost everywhere including vegetarian/vegan options, non alcoholic beverages everywhere, and portion sizes are normal compared to American sizes.
I used to live in the US, and now in Netherlands and do own a car for those weekend trips and occasional long drives across Europe. I would not categorise NL as a car country. Majority of the times, one does not need a car to get groceries.
Well, the local diet isn't particularly great, with a strong preference for preprocessed food (kant en klaar). And it could could be argued that the quality of the fresh produce coming from their greenhouses is also suboptimal, from a nutritional point of view..
Average Japanese walk 2000-2500 steps more per day than Americans. India has walkable cities, but still they don’t walk, and they have lower longevity despite an even lower average bmi.
Yes, I lived in Japan for a few years and those are the exact same two conclusions I came to, with the only additional one being much less added sugar/high fructose corn syrup. Food is generally much less sweet there.
> I've heard fructose inhibits the sense of satiation after eating.
You’re pretty much on track until this. The idea that a specific subtype of sugar has slightly different effects on the body might technically be true, but it’s a small drop in the bucket when compared to the huge increase in calorie intake in general. When this idea started circulating, it seemed like a food company misinformation campaign.
Mhhh apple contains fructose and my doctor suggested it to calm down big hunger without overeating (which it does), but i don't know if there are differences when it's pure vs inside an apple
Realistically, if you eat smaller servings and walk more, it's easier to have a healthy weight.
The last time I went to Japan with an American friend, she commented that the portion sizes in Japan were so small. Combined with all the walking from using trains (we'd easily get more than 10k steps per day), we both lost weight during that trip.
When I lived in Japan everyone who would come visit me would look at restaurant menus and ask “why are the small and large beers the same price? Who would ever buy the small?”
Locals would say matter of factly “you only order the large when you want more.”
Also many restaurants offer Tabehoudai and Nomihoudai, “all you can eat and drink” respectively.
All the servers would come to see when the Americans would order nomihoudai and request a pitcher of beer.
“Okay, one pitcher for the table.”
We’d always get a laugh when we’d say, “Actually, one pitcher for each of us.”
It really shines a light on the excess of American culture.
Japan does have a “drink to excess” culture too, but it largely seems to be more with intent. (Also, in my travels I have found harder alcohols, 35%+, and shots culture are mostly a US characteristic.)
If I’d eat out with only my Japanese friends and we’d get a tabehoudai/nomihoudai we would only consume until sated, usually only ordering about the same amount as a normal menu item, but take advantage of the “all you can” to try new foods and drinks we were unsure if we’d like.
With my fellow American friends we would certainly abuse the privilege by drinking and eating beyond excess without necessarily even setting out to do so.
Walking less is not the cause of the obesity, more like the other way around: if you don't need to walk, you can afford to overeat until you're obese. Also the pleasure of walking and exercising must be replaced with something else.
But exercise has very little effect on weight compared to diet. It's a known fact, even for the fans of counting calories. Just see the tables of inputs and outputs.
Eating less and avoiding sugar and processed food is mostly enough, if not to be slim, at least to keep you reasonable healthy.
> But exercise has very little effect on weight compared to diet. It's a known fact, even for the fans of counting calories. Just see the tables of inputs and outputs.
Also, some studies suggest that up to some threshold, exercise reallocates those calories from autonomic functions rather than actually adding to total expenditure [1]. It's been further speculated based on this that some of the health benefit of exercise might simply be a result of taking energy away from anxiety/stress responses.
I don't get it. The exercise doesn't help lose tissue. the caloric deficit does, and as parent said, that is way easier to achieve through reduced intake.
People often find exercise easier to modify than diet, or even for exercise to make following a healthy diet easier. The process of building muscle can create a caloric deficit.
> But exercise has very little effect on weight compared to diet. It's a known fact, even for the fans of counting calories.
I recognize that this is conventional wisdom, but it hasn't been borne out by my own results losing well over 100 pounds / roughly 40% of my body weight over the course of several years.
I've counted calories strictly, with the same methodology and same limit, and documented weight regularly, both during low-activity low-altitude winters and medium-activity, high-altitude summers. The results I got, over the major windows in which I got them, were as follows:
I'm defining "high" activity here as "regularly exercising to physical exhaustion", "medium" as "regularly climbing up hills that cause me to breathe heavily but don't exhaust me", and "low" as "regular walking but nothing that strains my body meaningfully".
This is now data collected over years of weight loss and multiple seasonal changes in location and activity, and I find it difficult to explain this within the context of standard weight loss advice. Exercise at altitude seems to burn far more calories than it "should", by a factor of four or five times.
I walked a mile or two every other day on average across this period, meaning the only difference is a roughly 15 to 30-minute walk up a steep slope roughly every other day. A typical calculator will tell you this "should" burn on the order of 100-150 calories, but the data suggests it's closer to 500-1000.
I'm not a doctor, so I don't know why this is. I've largely ruled out:
- Diet, which is conserved across locations fairly well (I cook most of my own food using widely-available ingredients)
- Seasonal effects, unless they happen to produce very sharp discontinuities at the exact time I relocate each year
- Emotional state, since these results have been robust to both positive and negative emotional states in both locations
- Temperature, which is near-constant year round (because I live in warm places in winter and cold places in summer)
- Groundwater, because I drink almost entirely bottled water and not local water supplies
- Major underlying medical causes (my bloodwork is great and I don't have any reason to think I'm sick)
I have a working hypothesis that the studies that established calorie burn from exercise (which I believe largely did it by measuring CO2 exhalation) were missing a great deal of the actual energy cost, because the costs of anaerobic respiration take place over hours following exercise and not just during it. But I also can't imagine people with actual medical expertise haven't thought of this before. A negative correlation between altitude and obesity rates is well-established, so something is going on.
In any case, the data is the data, and it points very strongly towards altitude and exercise, synergistically, being almost exclusively the source of my own weight loss.
I wish this was understood more. To burn 1K kcalories takes considerable effort. To not ingest them, avoid that pizza. Hell, pizza +beer or coke probably is way more.
I dont get the point of saying excercise doesnt make you lose weight. It increases your caloric need, so if you dont eat to make up for it, then ya it absolutely helps.
I struggle greatly to diet hard enough to lose weight if im sedentary. Its extremely easy when doing 3 1hr strength workouts a week, and lik 20 mins of cardio a day. Like its a struggle to eat enough to maintain weight.
> Realistically, if you eat smaller servings and walk more, it's easier to have a healthy weight.
Yeah, many years ago as a student I spent a summer in Manhattan. The diet probably couldn't have been more different than Japan, but the combination of walking a ton compared to the suburbs where I grew up, and the fact that as a poor student in a very expensive city my portions were smaller out of necessity (e.g. my snacks were usually fresh fruit sold outside of a store/bodega) I got much healthier.
This is a stark contrast to North America where there are generally no trains to walk to catch, but rather simply a few steps from your door to your car.
My point being that the design of our society right down to the topography of our physical spaces is not set up to encourage walking.
We can’t even agree that obesity is a problem, instead choosing to talk about beauty in all shapes and sizes and other woke nonsense (to be clear: I consider myself a liberal) that masks true objective facts about health.
If we could agree on a goal, perhaps we could then have real conversations about how to get there. But instead we are so fractured and our governments so inept and conflicted that we subsidize the food that makes us sickest.
> My point being that the design of our society right down to the topography of our physical spaces is not set up to encourage walking.
There are places where it's downright hostile, with areas with no sidewalks or crossings.
> But instead we are so fractured and our governments so inept and conflicted that we subsidize the food that makes us sickest.
There's actually a somewhat sane rationale for the agricultural subsidies. For the longest time in human history, famine was always looming, and the best policy to avoid it was to store excess calories in case of a bad harvest year.
Whether or not that still applies in the US can be debated though.
it would make more sense if we subsidized all foods like that, but right now we subsidize a few crops like that.
the food subsidy probably makes sense but not to the degree and bluntness of american policy. one of the instigations of nationwide school lunch was actually to provide a baseline level of demand for farmers and make cycles less severe.
GLP-1 Agonists are very interesting drugs. There are ongoing clinical trials for their application in neurodegenerative diseases because they seem to have, among others, excellent neuroprotective effects, they are great at lowering inflammation. There is a good paper about that. I think it's misleading and ridiculous to say that Japan does not need Ozempic. Not all obesity is simply caused by eating habits. There is a very important factor that has to do with oxidative/nitrosative stress and inflammation that may as well have to do with other underlying diseases, syndromes, etc. and that we are just starting to understand. The science is not "settled" with obesity, as much as we've progressed with understanding it, and it's really weird to me for someone to use such a clickbait title...
[0] https://doi.org/10.1177/20420188231222367
Have you or someone you know ever willingly made a lasting and meaningful lifestyle change? Chances are it was very difficult. Food choices and behaviors are especially hard as they are sometimes cultural and deeply rooted in people's psyche.
Intelligent people have died from diabetes and other obesity related illnesses, not because they couldn't understand calorie math or what carbohydrates are, but because they couldn't or wouldn't change their eating habits in the long term.
If by lifestyle you mean behavioral disorder, It seems to me that the science from the last 10 years is starting to point in the opposite direction. If I may recommend, there is a great presentation by Dr. Robert Lustig called "Fat Chance: Fructose 2.0".
[0]: https://www.youtube.com/watch?v=ceFyF9px20Y
I am very annoyed that even a food scientist put very different food cultures into 'western' food then he meant American diet . European food cultures are way too diverse to even combine it.
And Italian diet has a similar simplistic philosophy. French food does not. Both can keep you slim.
It’s dangerous and misleading when reporters conflate controlled scientific studies with anecdotes that haven’t proven true when properly studied:
“I had learned there are massive health benefits to reversing obesity with these drugs: for example, Novo Nordisk ran a trial that found weekly injections reduced the risk of heart attack or stroke by 20% for participants with a BMI over 27 and a history of cardiac events. But I also saw there are significant risks. I interviewed prestigious French scientists who worry the drugs could cause an increase in thyroid cancer, and eating disorders experts who worry it will cause a rise in this problem. Other experts fear it may cause depression or suicidal thoughts. These claims are all fiercely disputed and debated. I felt trapped between two risky choices—ongoing obesity, or drugs with lots of unknowns.”
So, I know this isn't the point you were making--and I also certainly am not saying this correlation could mean what it would look to imply--but a little part of me read your comment and went "huh: so if the Japanese people 'don't need Ozempic', are they also already experiencing the side effects?"... and, I correctly hazily remembered, they are: "In 2017, the country had the seventh highest suicide rate in the OECD, at 14.9 per 100,000 persons, and in 2019 the country had the second highest suicide rate among the G7 developed nations." (per Wikipedia).
There are many reasons including prevalence of fast food locations, ultraprocessed foods, food marketing, car culture, social tolerance, and sedentary lifestyles. So much would have to change in America, including attitudes, to make a dent.
PS: Ozempic is not for weight management, it's for blood sugar control. Wegovy is a higher dose for weight management and not covered by Medicare discriminating against all causes of obesity without nuance.
Japan has 1000x more accessible food within walking distance than America does, plus vending machines EVERYWHERE. I think it’s mostly smaller portions and not eating sugar in huge quantities.
>America doesn't need vending machines. It has UberEats, DoorDash, and Domino's pizza to deliver ultraprocessed shit.
Japan has those in vending machines. That can't be the deciding factor.
>Also, Americans don't do walking.
Walking is a very low effort activity. Good infrastructure usually means that you do little walking and a lot of standing around, this can't account for such a massive difference.
Japan has Uber Eats and Dominos also and they're very popular. There are literal cafes in Tokyo where you can get Uber Eats delivered to and eat there.
>There are many reasons including prevalence of fast food locations, ultraprocessed foods, food marketing, car culture, social tolerance, and sedentary lifestyles
>Japan doesn't have carb-heavy ultraprocessed foods
Without a doubt they do. One of their most important foods is rice, I don't think there are many cultures eating more carb heavy. For the processing, maybe, what is the actual difference to the US or Europe?
>social tolerance of obesit
Maybe? Although hard to quantify, certainly many Americans want to loose weight.
>or massive quantities
Japan certainly is not suffering from any food shortages and surely you can eat however much you want there.
You're tilting at windmills if you think Japanese foods approach the level of caloric density and unhealthiness of burgers, burritos, french fries, Doritos, and other shit Americans eat.
The stereotypical lunch for a salaryman is ramen, which is just is carbs served in a broth just dripping of fat. Go to a popular teishoku lunch hole-in-the-wall and you'll see[0] a kara-age set (fried chicken and rice), chicken nanban (fried chicken with a fatty sauce, and rice), or maybe a katsudon (fried pork on rice). The veggies you get are some pickles and then a pile of dry shredded cabbage.
The stereotype of Japanese food abroad is it's all just grilled fish and sushi but there is a LOT of fried food involved.
I'll say US portions are absolutely out of control though, I think that's the biggest thing. When my Swedish friends went to visit the US they ended up just ordering one thing at every restaurant and sharing it, and the waiters would just laugh at them.
The sizes are different -- in America, it is pretty hard to even get a small cup of coffee -- but carbohydrates are carbohydrates: the caloric density is the same.
But you are just saying that things are different because they are different. What happened in the last 70 years to make obesity a mass epidemic in the West?
It clearly wasn't the mere existence of unhealthy foods, the Japanese have tons of unhealthy food as well. You can get a burger there without any issue.
US corporations managed to make food addicting by using science to formulate food in such a way as to trigger a massive spike in dopamine followed by a massive drop a short time later. Combining that with an individualistic culture that leaves many lonely and anxious, it’s no surprise that people depend on substances to make themselves feel better. The average american puts themselves to sleep with a 2 litre of cola, a bag of chips and a pint of ice cream while playing games on their cellphones way late.
If you saw a population of people injecting heroin into their veins and getting frail, would you say you have a frail ness epidemic? No. What you have now is a food addiction epidemic. You should treat it as you treat any other addiction.
The US has already strongly reduced the use of a very addictive substance in the past by making it culturally unacceptable in the case of cigarettes. Japan has the same culture already with food, where there is strong cultural pressure to not abuse food. Perhaps it is time to bring back shame towards overeating?
The US has also seriously reduced the use of sugar over the last decades.
I agree that overeating should be shamed, but was that needed 70 years ago? To be honest I don't believe the cultural issue. Which percentage of US citizens believe that they should loose weight? Likely a very large proportion.
Of course they’re more healthy, they eat less & walk more.
I just returned from Japan, and the difference in quality of life due to urban density, reliable public transit, and walkability of every city I visited is staggering. There really is no comparison to the United States. Everything you could ever need to live is within walking distance - seriously. This is the way people are meant to live.
Except for the minor issue that this density plays a significant part in Japan's well-below-replacement-popluation birthrate.
You may have noticed, walking around Tokyo, the lack of children. I certainly do every time I'm there -- I live about two hours away in a bedroom community, where you absolutely do need a car to get around.
Most Tokyo families have one and only one child.
Out where I live, where 1000sqft+ houses are the norm, three or more is not uncommon.
That's a fair point. I hadn't considered it from the perspective of having space for children, though I don't personally think the density of Tokyo is prohibitive.
I'm curious about another thing: You mention 1000sqft+ homes being the norm where you're located, is that considered a larger than average home in Japan? I can't find a recent figure for average dimensions of a Japanese home. The average in the United States, by comparison, is apparently 2273sqft (reported in 2021).
For a single-family dwelling, 1000 sqft seems fairly normal in Japan.
It’s also fair to mention that the lot sizes are drastically smaller: 1/16 of an acre is on the larger size here, and you’d be hard-pressed to find anything bigger that isn't in the middle of nowhere.
For context, 1/16 of an acre is around 2500 sqft, so that's smaller than the average American house.
And, if you have kids and move to the middle of nowhere... great, now your kids have nobody else their age to play with.
Japanese homes typically don't have backyards, and the small yard you do have is typically not fenced-in, which kinda sucks with young kids.
Obesity stats in Japan are aggregated across Japan not just Tokyo. It's true that outside of Tokyo, most of Japan drives, and is a lot less transit centric. But it's also true that most Japanese cities and towns are smaller and there's a larger culture of walking to a corner store, the local grocery store, the drugstore, a soba-ya, the shrine, the park, or other places, unless you're out in the boonies. And adults often move to Tokyo for work which means they stay fit until they become old enough to move back to the burbs to have kids. It's also very common for rural Japanese to walk along the side of the road to get places and get picked up by a friend/family with a car if the bus is taking forever to take them back.
I agree too many non-Japanese who just visit judge the whole country by Tokyo which is a mistake. But there's a much bigger culture of walking and standing in Japan than there is in the US. Heck, the US has a culture of parking as close to the store/restaurant as possible in the parking lot of any commercial area to minimize walking. It's hard to beat culture. Of course Japan is also a culture where obesity is a lot more frowned upon, the doctors chastise you much harder for it, and as a collective society people feel much more pressured to stay skinny. Japanese also eat much smaller portions and find that acceptable. And Japanese in rural, more car centric, areas often are heavier than urban Japanese.
I really don't think the small lot sizes are causal for Japanese not having kids, rather I think it's the other way around. Fewer folks in urban areas are having kids, dropping demand for anything larger than a 2LDK, so the market is responding in kind.
ie. Japanese take their trash home from stadium and theaters.
Meanwhile in America we throw the trash out of the window of their car into the parking lot while parked 10 feet away from a dumpster.
I am sure somewhere in Japan there are obese people and those who throw their trash into the parking lot but they are the exception not the norm where it is reverse in America.
But if it takes a drug to help drive down obesity I have no problem with people taking it, but we've got to address the cost which is ridiculous and unacceptable.
(American that has been living in Japan for a number of years here.)
There are a few factors that make Japanese people skinnier on average:
1. Genetics (compared to westerners, not to Hawaiians like the article said)
2. A culture of fat shaming. My brother in law often pinches my belly publicly whenever he sees I gained a few pounds. Others enforce this through other means: calling out your friends, creating social pressure, your doctor pointing out you gained a pound.
3. Diet, in the sense of diet, not cuisine. People very much watch what they eat. It’s easy nowadays to eat super high calorie foods (rice, ramen, etc.), but most people either don’t eat these every day, or eat in small portions. There is also less fat and sugar than the US, offset by more salt.
4. Small portions. Portions are generally like 2x less than what you’d find in the US.
5. Exercise is built-in, at least in the cities. In big cities (not just Tokyo) people use public transportation, go out for lunch, walk to the grocery store. If you don’t drive, you exercise.
The significant thing I see here in this article is that eating and food is part of the education system, with children having good, healthy meals prepared for them at school that everyone eats, including the teachers.
This has a lot of advantages beyond ensuring kids are eating healthy food and healthy and able to learn at school, it also teaches kids how to eat well, and gives a big helping hand to lower income parents that might not be able to afford to feed their children well.
This is something that I would love to see my country adopt.
I need it but my doctor cannot write me a prescription for it unless I get diabetes. The joke is that I'll probably end up with it at this rate, and the absurdity of my situation isn't lost of them either. My options are to visit a weight loss clinic importing it (legally) from the US and pay out of pocket, look into Xenical which has only recently been approved in Japan or re-evaluate my diet + exercise routine for the hundredth time.
This is exactly my point. There are many patients that do require GLP-1 agonists to realistically lose weight. It's ridiculous to say that a country doesn't need it just because fewer people are obese.
The article seems to suggest that low obesity rates are the result of a particular style in Food, compared with western foods. This is obviously not true. Mass obesity was something also not known in western countries before the 50s, so western food before that behaved similarly. If you are looking for the cause of mass obesity it can only be in the divergence that happened in the mean time.
I wouldn’t say so. Article shows that the biggest factor are your eating habits. In case of Japan they are engrained in school, with methods formalized by law.
More and more ultraprocessed foods. We never had such ready access to food filled with sugar/fat/salt and engineered to taste maximally good. Stuff like soda, potato chips and chocolate bars are barely 150 years old. Frozen foods are basically 70 years old.
How does this not apply to Japan as well? Surely soda and candy exists in Japan, they are even internationally known for having a diverse candy industry.
And the USA is eating less and less sugar since around 30 years.
Candy bags in Japan are small, 50g. Drink vending machines contain 50% green tea of different varieties. Domestically sweets are big, usually with sweet bean paste and so on.
> The article seems to suggest that low obesity rates are the result of a particular style in Food, compared with western foods.
I think you're missing the point of the article. It's not claiming that the mere existance of unhealthy food is what's causing obesity; it's the societal norms and behaviors developed around food (and exercise).
Of course ultra-processed food also exists in Japan. Same for sugary drinks, sugars and sweets. But it's undeniable that there's a culture of acceptance of junk food in the US, and a confusion that some of it "must be good for you" -- e.g., fruit juices, cereals.
There's so many historical differences between Japanese and American societies that could be part of the cause -- many of them listed in this thread.
To give you one example: breakfast in the US is typically full of carbs, sugars and fructose: cereals, fruit juices, bread, honey, maple syrup. There's a common belief that they're healthy, and you need that "energy punch early in the day to keep you going".
That couldn't be further from the truth. All this carb and sugar-heavy meal does to your body is to give your metabolism a glucose spike, followed by a rush of insulin, and eventually a crash [1]. This roller coaster leaves you hungry and craving soon after. Rinse and repeat for 30 years (together with other bad habits), and you're one stop closer to obesity and diabetes.
The American culture of "snacks" is another example: we're inundated with granola bars, dried fruit, veggie chips -- all "organic", "natural", "full of vitamin". Portion size is another one; go compare to portion sizes in the US vs. Japan. Or the common habit of eating fast and until full, while in Japan is 'eat slow, until 80%'. The list goes on.
Now, you need a social scientist to understand WHY it happened this way over the past 70 years. It may have been the food scarcity during WWII, or how baby boomers grew up, the rapid industrialization of American society, or a myriad of other confounding factors.
Whatever the case, it's clear that this is wrecking the metabolism of millions of Americans, and it'll get worse before it gets better.
ps: I'm using Americans instead of Western society, because 1) that's the reality I'm familiar with, and 2) I think this is more prominent in the US than in the Western societies at large.
Source: born and raised abroad, but living in the US for the past 20 years, with a Japanese-descent spouse. This gave me some perspective on how different cultures develop a relationship with food.
We are getting fat because we stopped eating legumes and whole grains like we used to.
100 grams of uncooked lentils is 300 cal only and will make you feel full for 12 hours
Japan is an incredibly paternalistic society that makes heavy use of peer pressure to enforce social norms. As the writer notes the government literally taxes all your coworkers if you are fat. It sounds unbelievably humiliating. Im happy this works for the japanese but personally have zero desire to live a society like that.
I think the intent of the article is to express that the obesity epidemic should be treated like a problem of culture and society and not an individual.
Eastern societies have different ways of dealing with things than Western, and that’s ok. A person should not feel humiliated, but that’s a relative feeling by culture - the law seems to be working for them.
I am obese myself - whenever I visit Asia (China, Japan, Vietnam, India etc.), the difference in diet and daily walking lingers on for a bit back here in the US but I regress to the ‘cultural mean’ here very soon. At least I know I can change my habits when the right support system is around me.
I’m the same with cigarettes. I picked up smoking again after moving to a country with a strong coffee culture.
I’m older, less stressed and (hopefully) wiser than I used to be but still: I stop, but keep coming back to it for a couple of months after a longer break, because this behaviour is so deeply ingrained in my upbringing and in the culture of my new home. And there are so many socially accepted triggers. I am aware that ultimately this is my own responsibility but it’s hard.
I know that I can’t fully compare obesity to nicotine addiction, these are all complex states/behaviours but I feel like the social and cultural aspect is similar in some ways.
Familiarity with the environment matters so much. An example would be the percentage of Vietnam war veterans who suffered from heroin addiction during deployment but ceased using after coming back home (it was ridiculously low compared to people who lived and used in the same country.
In the west it’s becoming frowned upon to observe that someone is fat (obese). Doctors have to tip-toe around the issue lest some patients become offended[1]. Some patients take it as fat (obesity)-shaming rather than what it is advice to seek being healthier. Some see being fat as something to celebrate. I don’t think I would celebrate any medical condition I had, be it fat, skinny, one-eyed, one-legged, etc. We can of course learn to cope and live with the conditions, but celebrate? That’s backwards to me.
> Doctors have to tip-toe around the issue lest some patients become offended.
As someone with a couple doctors in my family, that's BS if talking about any competent doctor. No, doctors may not say "You're super fat and better eat less", but that's because they're generally not assholes, not because they're "tip-toeing" around obesity. On the contrary, for many decades most doctors would say the same thing: "You're overweight. You have bad lab numbers (e.g. high A1C, high cholesterol, etc.) You need to diet and exercise."
Of course, that advice obviously made no difference at a societal level (Americans only got more obese) largely because of things pointed out in this article: cultural impacts of things like standard portion sizes, favored cuisines, ease of walking instead of needing to take a car everywhere, etc. swamped any once or twice a year advice of "you're overweight and need to diet and exercise more".
There may be some of that, but there is also lazy medicine. I have several woman in my life that are above average weight/BMI for reasons that have nothing to do with their lifestyle or habits. One is a body builder. The other had their metabolism destroyed by a drug treatment. Both often receive the same, useless, non-actionable advice from most doctors they meet: exercise more, lose weight, eat less.
This would be reasonable advice for most people, but falls flat when a doctor completely ignores a patients circumstances.
This kind of lazy advice is commonly given to women, and more so to women of color. As a result, I’m very leery of describing all cases of disgruntled patients “sensitivity”.
By women of color do you mean African Americans? Soul food is notoriously unhealthy and probably why Black Women are the most obese demographic in America. Changing diet would absolutely be necessary, though the deeper problem is their surrounding cultural norms.
Nobody sees being fat as something to celebrate. Fat people don’t like being fat. Source: I’m obese.
The thing that you are misunderstanding is that people don’t want to be humiliated about their weight. It isn’t that they want to be fat, but that they don’t want to be thought of as disgusting or “less than human” for being fat.
In fact, most people who struggle with their weight have worked harder to try to lose it than you can imagine. If you think “just eat less and move more” is something they’ve never heard before, you’re living in an alternate universe. It’s not always quite that simple; people have baggage, trauma, genetics, and so on.
It’s not that they’re proud of being fat. It’s that they’re proud of who they are despite their weight, not because of it.
The issue with doctors isn’t that they can’t tell patients they are obese and need to make dietary changes or lose weight; it’s that people will come in with unrelated issues and doctors will refuse to look past their weight to diagnose what the underlying issue might be, using weight as an easy answer to blame it on. Sometimes it’s weight; but sometimes it isn’t.
I am sympathetic to what you say. I agree with it all. Nonethless, I see where people want to celebrate it --now this could be industry taking advantage of folks and it's some perverse indoctrination, but it's there in commercials, on social media, etc.
I think it’s just a response to many decades of literal shaming. I have so many friends that were put on unhealthy fad diets by their parents because they were overweight kids, and that led to them having eating disorders when they got older that many of them still struggle with, hating themselves the whole time.
The goal of those ads (which I agree there are too many of today) is to help people hate themselves a little bit less. There’s a reason obesity is often comorbid with suicide.
> The thing that you are misunderstanding is that people don’t want to be humiliated about their weight.
But shaming is effective. There are of course fat Japanese people, but for the average person, shame is an effective deterrent against weight gain. That makes sense. Food doesn’t act on people’s rational senses. It targets pleasure centers. The cold logic of non-judgmental medical advice is powerless to do anything against that. Medical professionals, after all, are nearly as likely to be overweight or obese as the general population. Shaming, by contrast, targets a different, more primitive part of the brain. People will change their behavior in an effort to avoid shame in a way they won’t for abstract good advice.
Lots of things are effective that are also bad solutions, especially in a different context.
So you’re right, shame works. But, for the sake of argument, if it leads people to suicide, eating disorders, or depression, while obesity is no longer technically the problem, you’ve just created another problem.
Shame works for Japan (for now, at least) because they are a wholly different society than ours, based on a wholly different set of morals and upbringing.
But is a Japanese salaryman happier than an obese American? Most are miserable, for most of their lives, and simply don’t talk about it to anyone outside their close circle, if at all. Remember that mental health in Japan isn’t really a thing that gets discussed very much, by doctors or anyone else.
It’s just trading one thing for another.
We’ve learned a lot about reinforcement learning from training animals, and specifically that positive feedback tends to lead to better results long-term, even if negative reinforcement may lead to quicker changes in the short-term.
I’m not convinced the same ideas don’t apply to mammals like us.
Moreover, what gets lost in the shame / blame game is the concept that people can work really hard at changing themselves and still have a long way to go. That is, if someone is 200 lbs overweight and has spent the last two years losing 100 of those lbs… someone who sees them in a “shame” society would still shame them, with zero context given to the fact that they’ve had a massive success over the last twelve months that should be celebrated even if they’re not where they want to be yet.
Without positive feedback, it’s exceptionally difficult to “stay the course,” and that is the point. Shame only gets you so far.
Supporting someone on their journey to a healthy weight gets them much further, and if you genuinely care about someone, that should generally extend to their mental health as much as their weight, imho.
> But, for the sake of argument, if it leads people to suicide, eating disorders, or depression, while obesity is no longer technically the problem, you’ve just created another problem.
Part of the problem with discussions in many societies now is this false equivalency. Yes, some people might be driven to suicide due to shaming, but this is not the vast majority of people. However, NOT shaming people about their weight leads to a much larger portion of the population being fat and unhealthy, which has incredible downstream health and societal impacts.
So I disagree with your equivalency here - shame is a good social tool for the majority, and while we should certainly be on the lookout for the extreme minority who have mental health issues, we should not be throwing out good general social tools just because of a few edge cases.
The issue with this thought process is that its not possible to silo a shame culture around just the things you think should be shamed. Once you accept that the government encourages shaming people for things you think people should be shamed for you need to accept that other people have the power to get the government to shame you for things you dont think you should be shamed for too. For example in the US if the GOP came into power and shame policy was seen as acceptable theyd immediately institute a shame policy around abortions. Suddenly youre in a full blown thought police society
What about the converse example of yours, eg: if there is a shame policy around being pro-life and perhaps suggesting on some specific week criteria after which abortions should not be allowed?
What you're calling "thought police society" is basically another way of saying that "there are social norms in a particular society". This is true anywhere.
You may not like the social norms of a particular place and time, or think your rival political tribe is from the dark ages (I recommend going outside to touch grass if you're in a Western country and believe this), but the base point is that any group of people that has any sort of group cohesion has preferred social behaviours and disliked antisocial behaviours.
I dont think the government should be enforcing social norms. I prefer the US style of weak social norms where there are less consequences for breaking them.
> So you’re right, shame works. But, for the sake of argument, if it leads people to suicide, eating disorders, or depression
But do those hurt the median person, or does that social policy just increase those problems at the margin? If the median person is made better off overall then it’s worth the trade off.
And is the Japanese salaryman more or less happy than the obese American service worker?
This also ignores a very basic premise in medicine: nobody will willingly go to a doctor they do not believe has their best interests in mind. It’s one of the reasons the Hippocratic oath exists.
I think it's just the pendulum swinging back the other way after it swung this way during the 19th to 20th centuries.
Being fat was considered appealing in ye olde times, because it indicated to your peers that you had more access to food. Being lean became popular (again) in more recent times, especially with advances in entertainment like cinema and fashion magazines.
Now that entertainment is lambasted for seeding unrealistic (and in some cases even harmful) expectations, so too has popularity for leanness waned.
The pendulum will swing back again, of course. Before being fat became appealing, the ancient Greeks and Romans certainly preferred lean figures, judging by all their marble statues and other cultural artifacts.
Someone who thinks that giving health advice to an obese person and fat shaming are the same thing has no business being in a job that requires them to give people advice. Obese people know the difference very well, no matter how often others try to gaslight them into believing that they are the same thing.
> Eastern societies have different ways of dealing with things than Western, and that’s ok.
This is basically my point. A lot of the policies the writer points to arent transferrable to the west imo because they rely on eastern values that wouldnt fly here. In some ways the estern values are better, in some ways the western ones are, nothing wrong with that.
Learning from and translating these values/mentalities/ways of seeing things is an interesting and valuable problem nevertheless.
(I know that these are complex and wicked problems, and using the word “translating” might sound like an oversimplification, but humans are incredibly adaptable)
It doesn't stop at obesity though. The prevailing mindset of "hammer any nail that's coming up" also applies to mental conditions, ideas and behaviors going against the status quo, including radical innovations and diversity in general.
I feel very strongly that government sanctioned shame culture is very bad for society. I really dont think you can say that is objectively wrong, even if it comes with downsides.
That's almost bordering on orientalism. The fact that everything you do has a social dimension, that the way you live impacts the people around you is a true fact, not an eastern value. It's simply that we in the West ignore this at our own peril because we ideologically pretend that every man and woman is an island. That what any individual does has no impact on their surroundings, and for that reason that society cannot impose on our "private decisions". You can actually map out obesity spreading within families and communities like a viral disease.
That's why they have a 4% obesity rate spending almost nothing, why over here half the nations are obese despite spending hundreds of billions on individual livestyle fixes. They have a correct understanding of how societies work in this regard at least, we've given up on it. This is not about subjective cultural values.
Maybe there's a reason why these social pressures exist? I'd MUCH rather live in a society that shames people for being fat than one that bends over backwards to accommodate obesity. The social and financial cost of 42% of all adults being obese in the US[0] must be so high as to be incalculable.
Id be happy to see a tax on fat people due to the externalities they place on the healthcare system. Im not happy to see policy that uses peer pressure though. I dont think the government should be shaming people for questionable activities that arent illegal. I really dont think the government should be in the business of shame at all.
> Id be happy to see a tax on fat people due to the externalities they place on the healthcare system.
What about dumb people? Or people with Down syndrome? Or people who use a wheelchair? Or people who were born with a missing limb? Or spina bifida?
Why limit it to “fat people,” other than because society says it’s simply okay to shame them more than others?
And before you say it’s a choice: it isn’t always. Kids don’t get to pick what their parents feed them, and while you can make changes in adulthood, if you don’t have the tools or skills, good parents (or any at all), and so on, you’re in for a rough time.
I'd argue the way American culture is constructed (drive everywhere, less opportunities to walk, folks are socially isolated) in a way that actually puts people in a situation where they are much more likely to be overweight.
So the costs are ones we as a society are putting on individuals are coming back to bite everyone in the ass.
Of course there are tons of other ways that Japanese society makes it easier to be skinny than American society does. Im just saying that some portion is the shame culture, not sure how much and not sure if its possible to figure that out, but I do know that Im not interested in trying that method.
There’s pretty solid evidence that lifetime healthcare spending is actually lower for obese people, even in European countries with better allocation towards younger populations. In the US, it’s definitely cheaper to have people dying young before they get that third hip replacement and two rounds of chemo.
> one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832.
You should at least consider the possibility that you’ve unfairly jumped to assertions about “cost” out of another layer of paternalism that is not warranted by the facts. Like the whole “muh tax/healthcare dollars” may actually be backwards and having them live longer might well end up costing you more.
That is the essence of the CBO paper that was discussed yesterday too: curing the obese doesn’t really reduce lifetime healthcare spending, because the US healthcare system barely spends anything on anyone who isn’t an AARP member anyway, and reducing obesity is going to lead to a lot more AARP members in 10-20 years. Which is a good thing, but also not going to be a net financial benefit, especially when you only are paying for seniors to begin with and don’t see any of the healthy-population benefits.
This is the problem with all these discussions around obesity, everyone treats it as a moral failing and automatically assumes every other factor falls into line backing their ideal moral stance etc. And money doesn’t really care about morality, it’s quite cheap to have people die early before they get the third knee replacement and the second round of chemo.
People have been doing the “ugly people = worse/morally inferior/less deserving” since the dawn of time and people today have somehow convinced themselves they’re immune. But morality doesn’t necessarily line up with practical reality, in this case finances.
Thank you, I have thought a bit about the tradeoff of more heart attacks vs. longer lifespan in terms of lifetime spending. Good to see the literature on it.
In fairness, it's also a longer lifetime with more socially-productive time etc - obesity has a somewhat higher cost-intensity-per-year than a comparable fit citizen, probably. But we already live in the society where very little is spent on earlier care - because the US spends very little on early care of anyone who's not an AARP voter. So is that a meaningful reduction in total spending?
That is my interpretation of why the semaglutide budget effects are dire etc - well, Medicare doesn't spend anything on the fatty who dies at 50, and if they live to 80 and get cancer it's a lot more expensive for Medicare in the long-run actually. The proximal cost of the drug almost doesn't matter itself ($700/mo is w/e in terms of what we spend on seniors, and obesity is expensive both short-term and long, right?) it's more the long-run budget effects.
It's already generally a shift upwards in Euro societies with more egalitarian age distribution of spending. Then you consider the US's favoritism for seniors... and the fact that ultimately Medicare foots a lot of it (minus the substantial amounts they can claw back ofc). They are the ultimate "sick pool"/adverse selection, right? Yeah, the USG's budget numbers probably look really bad if we cure obesity actually, even if it wasn't expensive.
Related to your comment, I read a post today from an apparently over-weight person who has lived in Japan for a while.
> I've been in Japan for 15 years (visiting for 20) and for most of this time, doctors had no problems calling patients "fat" right to their faces. Now things have changed, though, and doctors are coming up with a bunch of diff. euphemisms. Last week, one hit me w/ "You're... blessed with size."
Are you referring to the Metabo law section? I'm not sure if I overlooked something but I don't see anything about co-workers paying a tax. Are you referring to the potential fine the company pays?
For what it's worth. I've worked at a Japanese company since the program was introduced in 2008 and don't recall that happening. I'll have to ask some of my former co-workers about it next time I see them.
upon further investigation I might not have experienced it because I was under the ago of 40 when I worked in Japan
https://en.wikipedia.org/wiki/Fat_tax
I don't think you can make the case that nations' BMI is inversely correlated with peer pressure. For one it's difficult to measure, and that tax for example is a new phenomenon. The US has been an early leader in obesity trends, by way of pioneering mass produced junk foods / fast foods and seeing mass adoption early (and you can make the case for other environmental influences like being a nation that began to be built for driving rather than walking).
Other countries who clung on to "old ways" longer had the benefit of seeing the outcome of US approach in this respect and there is little resistance/pushback to both cultural trends and policies meant to deter obesity.
All of which to say I don't think Japan's relatively better health outcomes has to do with exceptional peer pressure. Many European countries are more culturally individualist (though less than the US) and still come out better than the US.
The other point I would argue is that there are social pressures everywhere, the expectations are merely different. You can also distinguish some by political divide.
By way of junk food (sweetened drinks are junk, boxed cookies are junk). Added sugar is one way to facilitate consumption of excess calories, the other is flour + added fat + salt, absent fiber and protein. (and also deep frying).
Because I run a lot, and was steadily gaining weight. Stopping eating all desserts, pies, boxes of cookies, candy, soda, etc. resulted in slowly losing weight. I still eat high fat foods, chips, cheese, etc.
High fat foods aren't necessarily junk foods, and presumably your intake of chips is moderate/low. They are not satiating and calorie dense, but of course drinks are the worst for that, they offer nearly 0 satiety for the price of calories. Cheese is relatively satiating, milk protein and animal proteins are in general.
Ozempic and its popularity is a clear proof what's wrong in the West! Not only Japan doesn't need it, most of the world doesn't, but in the West, we treat symptoms, not root causes!
Ridiculous. They have plenty of their own quick and convenient food readily available in convenience stores. Lawson, Family Mart or 7-11 are walking distance everywhere. A significant number of (typically underpaid, overworked) people don't cook for themselves in their tiny apartments and rely on these for basic needs.
The key is walking distance. The Japanese live in their cities, we Americans live in our cars.
They absolutely do. The freezer section of a supermarket in Japan is full of frozen kara-age, tempura, croquettes, fried spring rolls etc so that the overworked housewife can just reheat them quickly in the morning and pop them in the bentos for their kids/husbands along with a generous heaping of white rice.
I have understood that there is lot of not exactly healthy food available in Japan. Including fried chicken. Portion size is probably smaller in general with offset lot of this.
I think it comes down to two major factors:
1. Koreans tend to walk (exercise) more. Walk (partway) during commute, walk to lunch, walk to do errands, etc. In the US people just sit in their cars. I personally find I get 3000+ daily steps in Korea without even trying, while in the US I only get about 300 daily steps or so.
2. Diet + portions. My Korean friend was astounded by the amount of fries that came with every meal in the USA and Canada. The US is the only place where fructose is substituted for sugar in most processed food. I've heard fructose inhibits the sense of satiation after eating.
So walkable cities and better food options would probably reduce US obesity.