
Genetic Predisposition to Obesity and Medicare Expenditures [pdf] - gwern
https://www.gwern.net/docs/genetics/selection/2017-wehby.pdf
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ggm
This feels like a short footstep into bad science-policy outcome. I don't for
a minute doubt the science side has good numbers for it's weighted outcome
probabilities. I think its going to be widely mis-used, mis-quoted and mis-
understood.

Language in this area of health is a poison pen. Intentionality (you chose to
drink the coke, you own the diabetes) and de-empathising (you were born fat
and poor, I don't have to help you) are the two stand outs I hear a lot from
people I know in the USA who have personal struggles with health costs, and
consequences and mostly have conquered them. Down here in a world of public
health, the genetic exposure risk is pretty directly about aboriginal and
islander communities who are drowning in fetal alcohol syndrome, early onset
diabetes, other diseases. This kind of report should (I think) help, but I
suspect is going to hinder as it becomes a giant baseball bat in the policy
debate.

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bello
> the genetic exposure risk is pretty directly about aboriginal and islander
> communities

Is it, though? Families and communities share much more than genes with each
other, including big lifestyle choices. So we can't deduce that easily that
genes are to blame.

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perlpimp
There has been discovered partial link between biome and obesity. Likely it is
not based on single gene but rather total sum of factors.

~~~
perlpimp
[https://www.youtube.com/watch?v=uO6l6Bgo3-A](https://www.youtube.com/watch?v=uO6l6Bgo3-A)
#itc

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dmichulke
After reading the first few comments two things stand out:

1\. Genetic Predisposition is _always_ a factor (basically for everything) and
therefore has an impact on prices and ultimately "fairness" (whatever your
definition). One can have basically the same argument about intelligence and
salaries.

2\. It is also _never the only_ factor.

Once we start to acknowledge the above two facts, we can start discussing
percentages

\- To what extend does Generic Predisposition affect Obesity?

\- What other factors exist that affect it similarly or more? (Gender,
smoking, alcohol, white vs blue collar, leisure activities, marital status,
salary, age ...)

Only after that we should discuss whether it's fair: It's highly unlikely that
anyone is in the worst of all above categories and a simple cap on expenses
(or a progressive negative tax) may help to soften the blow to those cases
while still incentivizing everyone to live a healthier life.

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notadoc
Bad food habits, food choices, culture, and very low activity levels have far
more significance to obesity than genetics. This is obvious if you just look
at historical obesity rates, it was virtually non-existent a few decades ago.

But yes, the obese consume massive medical resources as any doctor or
clinician will tell you. At some point you have to acknowledge this and find a
way to adjust for that massive cost increase. Allow insurers to set premiums
based on BMI, tax BMI, or have a tax credit for healthy BMI, tax junk food,
all of the above, etc. Get creative, but you have to find a way to pay for the
cost of being fat. Otherwise, obesity and the myriad related illnesses is
going to bankrupt the entire US health system.

~~~
yequalsx
People are susceptible to suggestion and manipulation. As evidence consider
that 40 years ago it would have been considered insane to suggest that k-12
teachers be armed. Opinions, and behaviors can be manipulated and a grand
scale. Foods can be designed to increase likelihood of addiction. It is well
known that everyone has a limited supply of willpower. Given all this it is
not reasonable to put the blame solely on the individual.

~~~
merpnderp
But 40 years before that, it wasn't uncommon or abnormal for teachers to be
armed. We need to get back to whatever glued society together 40 years ago.

~~~
Consultant32452
My dad was on the rifle team in high school, carried a rifle to school and
stored it in his locker during the day. Now you can get expelled for making a
gun shape with your finger and thumb. I don't have any helpful conclusions to
offer, I just find the situation puzzling.

~~~
jjeaff
In rural communities, people were still bringing their hunting rifles to
school (leaving them in their truck on the rack in the back window) up until
and for some time after Columbine.

I even remember kids accidentally bringing their rifle maybe as late as 2001
or 2002. They were just asked to go home and drop it of, if anyone noticed.

I would wager that at those same schools today, a gun drawing or finger
gesture of a gun would not get you expelled.

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eanzenberg
How exacty is obesity genetic when mass obesity is a recent phenomenon? Your
bias shows when logic is absent.

~~~
jjeaff
Simple. Some humans likely were always predisposed to obesity. But as a
species, we have never had enough easy calories to get obese.

It doesn't matter if you have a genetic predisposition to alcoholism if you
have never even had a chance to taste alcohol.

~~~
dilyevsky
Is Americans' genetic makeup so different from the rest of the developed
world? How bout West Virginians vs New Yorkers? I mean ffs WV has 38% obesity
rate vs ~25 NY and they are less than 10hr drive from each one another,
genetic my ass!

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jjeaff
Help me understand your logic. You are saying that because two locations have
two different rates of obesity, that means genetics plays no role in obesity?

Even if someone has the hypothetical sweet tooth gene, they are still going to
be more likely to be obese in the poorer location that has less access to
healthy food and less reason/necessity/possibility to walk everywhere.

~~~
awalton
> You are saying that because two locations have two different rates of
> obesity, that means genetics plays no role in obesity?

This really, really needs some explaining from GP. All evidence in the history
of genetics tells us that if you put a population in relative isolation (say,
West Virginia or one of the other deep south micro-societies which are
predominantly economically insulated from one another with very little social
mobility), adaptations and recessive traits become more prominent and
pronounced and eventually speciation occurs.

Let me run this one by you: Put a bunch of poor people from Ireland and
England (which were already isolated populations subsisting on a lean largely
starch-based diet, which pushes selection pressures towards genetic
adaptations that preserve starch-based energy) into a society-based island
that is Appalachia, start applying very cheap garbage food made largely of
factory starches and sugars by the train-car load since the late 1940's when
the processed and packaged food industries needed an excuse to keep going
after WWII, and social pressures like the reduction in need for dirty coal,
mineral mining and manufacturing such that all that most of these people can
afford to eat is the cheap processed stuff, and you wonder why previously rare
diseases like obesity are so common among these people? You wonder why over
time these adaptations may have had a chance to take hold as some of these
individuals are able to diaspora or escape abject poverty and pass on their
obsolete adaptations as we move forward into a post-food-scarcity society?

HackerNews is so filled with people who lack even the most basic sense of
human empathy - I wish I could say I'm so surprised, but it's almost looked
upon as a badge of honor by some of these people...

