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Rising rural BMI is the main driver of the global obesity epidemic in adults (nature.com)
118 points by tokai 60 days ago | hide | past | web | favorite | 169 comments



As the article states, once automation hits a rural area, people there spend less energy than in cities.

Very much observable in the US, where rural and suburban population never WALKS. You need to supply artificial sources of movement (aka sports) to make up for the delta.

In cities, you walk more by default - your baseline energy expenditure is higher. Take the stairs to the subway, walk to work, get out for lunch ... all of that counts.

Driving around in your F150 and have everything as a drive through? You're the slob from the movie "Up".


For whatever reason, I was struck watching the special on PBS, "Woodstock: 50 Years Later".

Everybody was thin. It was sort of amazing when you stopped and really noticed it, then contrasted it to what you see on a day to day basis out on the streets. There just weren't any overweight people to be seen, at least nowhere near approaching the magnitude you see walking around today.

There's got to be some cultural component to all this too. I'm not sure the built environment is really all that much different than from what it was when I was a kid in the suburbs. It's as if people just collectively stopped using their bodies and started consuming more calories.


The demographics is worse than what is seen in the streets, because of the correlation between overweight and outdoor activities. The CDC facts are that 39% of the American adults are obese and 75% are overweight (including obesity). So overweight is the norm, and thin people are the exception. As the tendency is stable, I wonder if a "hidden minority" lobby will emerge in a few years, claiming that TV speakers and movie actors are too thin to represent the average citizen.


Young people still tend to be significantly less overweight. https://www.stateofobesity.org/obesity-by-age/

However, you do see more overweight people on modern films than in the 50’s. What’s really odd some characters where supposed to be noticeably overweight, but they don’t seem that way to modern eyes.


Curious - do you have examples handy of characters like you described who were "overweight for the time" but don't seem so today?


Even going back just to the 90s, characters like George Costanza were meant to look noticeably overweight but look fairly typical by 2019 standards. And Homer Simpson weighed a very specific 239 pounds, a weight that seems much less extreme now.


On the extreme end there was John Candy (https://www.imdb.com/name/nm0001006/mediaindex?ref_=nm_phs_m...), he used to be "the funny fat guy" but if he were to cameo (and be alive) today I don't think he'd stand out like he used to.


Lumpy in Leave It to Beaver. Augustus Gloop in Willy Wonka & the Chocolate Factory (1971). This one is really interesting when you compare the 1971 character to that from the 2005 version. If there was a new version made today, the might need to make him even bigger.


In the film, "To Sir, With Love", the boy called "Fats" would be probably average nowadays, even in the U.K.


I haven't seen Friends, but supposedly Fat Monica had to be made fatter and fatter as she appeared over the years.


They even changed the baseline overweigh and obesity metrics to have less people designated as a problem.


Source? Was 24.9 not always considered healthy? I've read studies where 20 to 22 BMI has the lowest mortality rate, and it seems reasonable to add a little padding on either side for such a roughly measured metric.


I wonder if the industrialization of food and agriculture and the increase in processed foods is part of the reason


I can only speak from what I saw all around me growing up in the US, but people were eating some comically terrible stuff back then. People grew up on white Wonder bread and shoveling raw sugar out of the bowl onto their cornflakes, etc.

I don't think it's the industrialization so much as the quantity.


I remember the 90's "part of this complete breakfast" was cereal, toast, and a glass of orange juice, and my parents thought they were eating healthy. I think people are just more aware now.


I mean a bowl of Cheerios, whole wheat toast, orange juice, and a banana is what I had every morning before school. I would consider it a pretty healthy breakfast, even by today's standards. I guarantee you most people eat much worse than that.


It's definitely better than pop tarts and chocolate milk but I still wouldn't consider that healthy. Switch the juice for water and cheerios for a source of protein and it would be much better

> bowl of Cheerios

carbs and added sugar

>whole wheat toast

better but still carbs

>orange juice

glass of sugar without fiber

>a banana

better than juice and added sugar, but still natural sugars.


That's big old pile of carbs. There's no fat and little proteins, only in the milk, which will have even more sugar.


Is raw sugar at least marginally more healthy than processed additives like HFCS?


At present, we believe that the following conclusions are warranted. First, there is no unique relationship between HFCS and obesity. Second, there is broad scientific consensus that there are no significant metabolic or endocrine response differences or differences in health-related effects between HFCS and sucrose. [0]

As others have said, it's an issue of quantity. Consuming 10-30 grams of sugar daily - table sugar, corn syrup, high-fructose corn syrup, or otherwise - does not cause obesity and health problems. The World Health Organization recommends no more than 10% of one's daily calories come from sugar. [1]

The average American consumes ! 125 ! grams of sugar a day, with empty carbs accounting for up to 40% of caloric intake [2]. This 40% includes the simple, 'empty' carbohydrates found in processed breads, cereals, condiments, drinks - which are converted to glucose by the digestive system in minutes.

The amount - not the quality - of sugars in our diet is the problem.

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3649104/

[1] https://www.who.int/nutrition/publications/guidelines/sugars...

[2] https://www.thediabetescouncil.com/45-alarming-statistics-on...


The problem with HFCS seems to be it's ubiquity and low cost, not its chemical makeup.


My current understanding is sucrose gets converted to glucose and fructose pretty much instantly once it hits your stomach[1].

The difference is, no one dumps a dozen teaspoons of sugar per serving in home prepared food and drink. Where drink and processed food manufacturers carefully buffer their recipes to accommodate the equivalent amount of HFCS.

[1] Read though that low end processed foods and drinks often contain very high levels of fructose.



It's hard to notice when you've grown up here, but any Euro who visits the US will tell you how sweet our milk, bread, and other basics are. You can think you're eating healthy and still be having lots of sugars in your diet.


Yeah but just walk around Hamburg or London and you'll see equally as many overweight people. Hell, if you look carefully in a lot of developing countries you'll see more overweight people than you expect. I'd suspect it's slowly becoming a global phenomenon.


I am from the US, and I often wish I could find half-sweet (or less) versions of things, even things I only eat rarely as a treat.


Maybe they should replace all of the "low fat" items with "low sugar" (and just reduce the sugar rather than replacing it with artificial sugar).


and just reduce the sugar rather than replacing it with artificial sugar

That's the key. I have a low-sugar protein powder but rarely use it because it's too sickly sweet with sucralose and I have to bury it in a ton of other ingredients.


I was surprised to learn than 50% of Europeans are also overweight (vs 75% or so in the US). It doesn't feel that way. It's crazy.

https://ec.europa.eu/eurostat/statistics-explained/index.php...


Anecdotally, Asian pastries, even local versions of western desserts, taste less sweet and rich for whatever reason.



Keep in mind that nicotine is an appetite suppressant. Some people wonder if the reduced number of smokers contributes.


You made that conclusion from that?

Go to almost any music festival, especially ones people love to hate on, and you will find lean young people from cities

Your conclusion can only be coincidentally accurate. Hot trendy folks go to music festivals. The BMI of whats considered hot has only gotten thinner since the 1960s.


Music festivals require a lot of walking, dancing, etc. which actually contributes a significant portion of daily activity. So I would actually conclude that being physically active is part of being a hot trendy person. There are tons of people who travel to festivals as a lifestyle.


right, so the point is that you can't look at photos from a music festival from the 1960s or 2019s to understand what society looks like

OP's whole point is that everyone must have been lean and fit just because they were in a 50 year old documentary - about a music festival.


It is interesting. I remember thinking the same thing looking at old photos - everyone was slimmer. I grew up in the 70s.

40 years later we’ve got laws against large sodas, sugar, vending machines. And maybe it is just the easier availability of all those calories - but I remember getting giant cokes at Carls Jr. in the early 70’s, the school cafeteria food was lots of carbs and fat and you could eat ice cream every day if you wanted to.

We all know that “Studies say exercise programs don't work because people don't stick to them.” But I think it misses the subtle difference between exercise as a planned activity and exercise thats built into your daily life. When I was young, we played in the streets every day. I walked or rode my bike to school. For my kids, that almost never happened. Everyone is inside. We drove everywhere.

But we also know no-one can stick to a diet. So “eat less” isn't the answer either.

So, whats the answer? Personally, I think its both. So, the answer is to build a little more exercise into your life. Walk to work or bike or learn to dance. Try to eat less - Maybe only eat 2/3rds or 1/2 of each meal. And avoid carbs since it stimulate hunger later.

But, it would be great to have an actual fact-based answer as to what has happened.


> But, it would be great to have an actual fact-based answer as to what has happened.

This would be inconvenient to the business models of Big Medicine and Big Food.

Good places to start an investigation are the official advocacy for replacing saturated fats with deodorized vegetable oils [1], the holy war against sweet forms of sugar (mix of fructose/glucose) instead of waging war on starch (chains of non-sweet insulin-stimulating glucose), the advocacy for chemical non-caloric sweetners (sucralose, etc), the contamination of the food supply with imitation foods (orange drink vs. orange juice, etc), and considering whether fortified grains is really the nutritional panacea it is supposed to be.

[1] https://news.ycombinator.com/item?id=10536349

edit: added "non-caloric" and "sucralose"


I don't think it's possible to exercise your way to weight loss. A handful of Oreo's will negate an hour workout. Simply cutting out as much added sugar as possible will drop weight quickly on just about anyone. Cutting out sugar isn't really a diet but more of a habit change. I'm not saying don't exercise, I'm saying both are necessary for results.


Cable television got huge in the 80's. Prior to that, there was just less consistent incentive to sit in front of the TV.


Ha ha. You youngsters make me laugh. Sitting in front of the TV was almost universal when I was a kid mid 60s - mid 70s. There might only have been 3 channels (4 if you lived in a big city with a PBS or independent) but we all sat around and lapped up that crap.


I cannot speak for the US, but in the UK in the 80s sure we all watched telly, however kids programs were on from 3pm to 5:30pm. After that it was go outside.

I don't think you were having multiple channels with 24hours programming for kids.


Like I said, 3 channels, ABC, NBC, CBS. We watched a lot of stuff that wasn't necessarily developed for children, but at the very least wasn't overtly "mature". The US FCC kept a tighter rein on what was on TV at the time. No swearing, no nudity, not much overt violence. You can see the effects of this in the shows that have survived as "classics" today. "The Brady Bunch" is non-controversial pablum, for example. Get home from school at 3:30pm, flip on the TV to watch whatever local TV host ran a few old Warner Brothers or Terrytoons animated cartoons. Maybe watch "The Lawrence Welk Show" or one of the regional pro-wrestling leagues that predated WWE or roller derby or some re-run, then network news, then Prime Time! The Brady Bunch, Charlie's Angels, westerns, lawyer shows, cop or detective shows, medical dramas, network and local news at 10 or 11pm.

I will grant you I'm smearing this out over time. Prime time shows in the 60s weren't the same as during the 70s, local TV cartoon hosts disappeared by about 1975 (no more Binky The Clown, or Cactus Jim or ...), and certainly what got re-run before network news and after 10 or 11pm local news changed.

This is totally ignoring the 6am - 12pm Saturday all-kids programming. Mostly badly-animated cartoons, some weird live-action ("Land of the Lost"), but all aimed at and advertised to children. You could waste all Saturday watching crappy animation, then reeling around because you had lost your stereoscopic vision.


That might seem like the case, but television time among men went from about 12 hours a week to 20 hours a week from 1965 to 1995, and from 9 hours a week among women in 1965 to over 18 in 1995.

Among children, it's more dramatic - with kids watching 4.5 to 5 hours a day in the 90's.


I mean, that could also be the result of some selection or survivor bias.

Such as, documentary producers had enough footage to exclude it from anyone who was not photogenic. Or the obese people who attended Woodstock didn't live to their 70s.


There certainly is a cultural component -- you'll see it if you live in San Diego and travel to the rest of the country.


It's kind of a cultural component but it is also the weather and the kind of people the weather self selects for. I lived in Del Mar for college a while back and a lot of people who trained for triathlons or liked to surf lived around there. In general people wore less bulky clothes and were more active. Even if that was not your profile at all, you were more likely to be self-conscious about not being healthy.


[flagged]


Lots of people are overweight purely because of hormonal/genetic factors, and couldn't lose it no matter how hard they were willing to work. Plus, depression is a contributing factor to weight gain, so maybe think twice before trying to shame people into losing weight.


> "Lots of people are overweight purely because of hormonal/genetic factors"

Yes. That's true. But that's not why the obesity rate is so high. We know this.

As for depression, fair play. But let's not forget that many insist exercise is an effective way to deal with depression. Let's also be mindful that excess weight causes hormonal changes that are also mood-altering. So perhaps your cause v effect - at least in a good number of cases - is in reverse?

Finally, I never said shaming, nor did I imply it. What I said was, if we're going to normalize certain behaviors for individuals then we should not be surprised when those things spread "virally" throughout the rest of the society. So, to your point, when we normalize food as a means for self-medicating depression we're not doing anyone any favors.

To clarify. I agree with your thoughts in general. However, they are the 20% (at best). What about the other 80%?

I also like to add, we're doing it "your way" and frankly, it's clear to see, it's not working. The medical costs associated with T2 diabetes is massive. In nearly all cases, T2D is generally preventable.


> when we normalize food as a means for self-medicating depression

I don't think literally anybody is normalizing that. Everyone knows that's unhealthy. You won't get criticized for pointing it out.

> Finally, I never said shaming, nor did I imply it.

> Mention anyone else's unhealthy habits (e.g., weight or lack of exercise) and you're label a bully.

You specifically mentioned not just habits, but weight, as something to be criticized. I think we've gotten pretty good as a culture about encouraging the right habits, but the weight itself is what many people have limited or no control over.


> " Everyone knows that's unhealthy."

For the last couple hours I watched a few dozen+ people order 20oz+ high-sugar coffee drinks from that place with the green logo. The everybody you're talking about is not here, nor is it at my local supermarket when every week I see people load up on soda, cookies, etc. People that clearly don't need the calories. So where is this awaremenss and knowledge?

> "the weight itself is what many people have limited or no control over." Yes, I realize it's a fairly complicated issue (e.g., gut bacteria likely play a role). However, that doesn't mean we normalize unhealthy decisions (like the ones I've mentioned above) and then cry about the cost of healthcare. We can't openly promote "love your body no matter what" and then purposely fail to add "and btw, you're going to die younger." We can't deny the value of exercise and replace that with "beat your depression with ice cream. it's ok..." That's just not working.

Yes. Agreed. Some people have medical issues (e.g., some neuro meds are notorious for putting on weight) but that's not everyone. That doesn't explain the obesity rate. And that certainly doesn't prevent humans from "gravitating to the norm."

p.s. For the record, I drink my coffee black. And there's a good reason why I've learned to do that.


I think this context might help:

"1 in 5 kindergarten children in NYC is obese."

"Nationally, healthcare expenses related to obesity is $1.72 TRILLION, which is almost 10% of the GDP."

https://www.wnyc.org/story/nyc-free-lunch/


This is incorrect. Hormonal and genetic factors can have a minor impact on appetite and metabolic rate. However all people will lose weight if they consume fewer calories than they expend.

Eating less isn't "work". It's literally the opposite of work. (I understand that some people find this emotionally difficult.)


https://www.health.harvard.edu/staying-healthy/why-people-be...

> Research suggests that for some people, genes account for just 25% of the predisposition to be overweight, while for others the genetic influence is as high as 70% to 80%.

Using Google also isn't "work", and neither is being considerate of others who don't have your exact same set of strengths and weaknesses.


I'm not sure what point you're trying to make? For every person there is a level of energy input below which they will lose weight. Genetics plays a role but even in extreme cases the impact is no more than a few hundred kcal/day.

Being considerate is great, but making excuses and pretending that the laws of thermodynamics don't apply doesn't help anyone.


There is a tough spot especially in light suburban where it is very very hard to walk. Nothing is setup for it. So you'd have to be kinda crazy to walk (sidewalks nonexistent, road crossings not really available etc). Once you get really rural - you can go hiking more easily unless its hunting etc season


It's an improvement, but hiking is still walking-as-an-activity, instead of walking-as-transportation, meaning that you're not increasing that baseline energy consumption.


Cycling still works to commute between most suburbs and small town centres. (I should know; I used to live on unincorporated land half-way between two towns of ~12k people.)

For really rural areas where there is no “town center”—perhaps just intentionally park your car a good distance from wherever you’re going so that you have to walk the last bit of the way? (Sort of like the campaign a number of MTAs have going where they encourage you to get off one subway stop early and walk from there to your destination.)


>Cycling still works to commute between most suburbs and small town centres.

You'd be borderline suicidal to do that regularly in the US.


I cycle regularly in Cambridge, MA which is the most bike friendly city in the US. It is still extremely risky, whenever I need to drive with cars on the same road. American drivers simply aren't accustomed to accounting for bikes on the road.

I fear for anyone who bikes in a city without the infrastructure for it in the US.


I live in a smallish town (~14k in the limits). For the most part, cycling on major highways is merely unpleasant, there's a nice wide shoulder. Less important highways have less shoulder and less traffic. There's parts of the highway that I avoid, and parts where I won't go, but those are the parts with parallel streets in town, not the parts between towns.

It's also not so uncommon for their to be a trail with similar connectivity to the highway (lots of rail trails do this). I can ride to the next town/village over with about ¼ mile of actual highway riding. That's pretty recent, what with a casino paying for lots of trail and a new bridge being built on the US route, but there you go.


> You'd be borderline suicidal to do that regularly in the US.

That is very much location dependent. You are right that some locations are extremely poorly designed for this. The cost/benefit of improving the designs isn't always obvious.


Totally agree, I should have italicized between most suburbs and small town centres in the quote.

Biking to work in Mountain View was a pleasure and seemingly very safe. I'm now in a rural area with unmarked roads that barely fit two cars. The state highway between me and the nearest town has a paved shoulder that might be a foot wide. If I ride on it I commit the mortal sin of riding against traffic because I have a wife and kids and need to make eye contact with everyone coming my way before I even think of trusting them.


Seconded. I used to bike frequently when I lived in a small town. Now that I live in the suburbs of a big city my bike sits unused--there is exactly one place that I normally go to where I would feel safe biking and I drive past it enough that there's no reason to bike there.


Before I started working remotely there were 5-10 people who biked to work daily


This is the key part

>commute between most suburbs and small town centres

I commuted to work on a bike every day in Mountain View. If I tried that from where I live now it wouldn't work in my favor.


They commute into a major city on a bike


Agreed. I have two main paths between my home in city A and work 11 miles away in city B. Neither has bicycle paths, and only the longer one (about 18 miles) has shoulders worth mentioning.

I've almost hit bicyclists because I couldn't see them (their fault; black clothing with no reflectors) on both of those routes. You coudln't pay me enough to bike to work.


It is not their responsibility to ensure you drive at a pace such that you can stop before striking an obstacle that was hard to see. Should we require pedestrians using the road (like the one without shoulders) to dress in bright colors as well?


Frankly, yes. To paraphrase from a meme - the biker in black has to be lucky every time. A car only has to be unlucky once.

In a vehicle-bicycle/pedestrian incident at the posted speed limit, no matter who is at fault, it's the bicyclist/pedestrian who will be dead. If someone wants to be alive, as well as correct, they'd do well to make themselves as visible as possible.

But that's too practical a view to hold here on HN, I realize that.

EDIT - I just realized this is likely in response to 'their fault' in my original message. I stand by it though. Riding a bike at night on an unlit 50mph rural road with no reflectors while wearing black is, as the GP said, suicide by car.


You didn't mention night in your first message.

You'd still be criminally at fault, and if you can't stop in time for a cyclist you're over-driving your headlights, but the cyclists would be well served by buying a back light for visibility. Keep in mind that wild animals can't, and they'll have roughly the same visibility as the cyclist.


Yup, and there are thousands of animal strikes every year in my state alone. Every three days or so there's fresh roadkill on the side of the road when I drive into work.

Night, day, twilight - a bicyclist can only increase their likelyhood of surviving their trip by adding reflectors and wearing bright clothing.


In a lot of states, a cyclist riding at night without a rear light is also breaking the law and at fault.


Yep, and I've still managed to avoid hitting all of those I've encountered by driving slower at night in places where I can't see as far ahead of my vehicle.


I'm not disagreeing that it's your responsibility to not crash, but as noted farther up - people hit wildlife all the time.

It's pretty rare for somebody who hits a deer to be charged with reckless driving, so it's not like there is actually an absolute responsibility to never out drive your headlights.

Besides the legal aspects, anyone riding a bike after dark without any illumination is being irresponsible. Whether the car is at fault or not, it's not going to be the guy in the car who dies from it.


So far. Just hope that you're never distracted at just the wrong time. It only takes a couple of seconds to overrun your headlights, even at lower speeds.

A car with high beams cresting a hill behind you. A car with high beams cresting the hill in front of you. An animal. A drink. A radio station change. A text message.


But a light or bright clothes won't change that situation - if you're distracted or are coming up to the top of a hill reflection won't save the biker.


It’s the difference between having 4 seconds to avoid a collision, and having 30 or more (I’ve seen a few well outfitted bikers over a mile away before).

Reflectors make that big of a difference; they don’t look or move naturally, and thus play well to our night vision strengths, even to a distracted driver.


I agree that bicyclists should outfit their bikes to be visible in the conditions they will encounter. But it it's also our responsibility as drivers to maintain a sense of the unseen hazards of our environment so as to avoid killing people who aren't as savvy as us. I wouldn't personally cycle without lights or reflectors but the fact that tons of people do means that if I'm not sure then I must assume there's someone out there.


Also, sometimes people are walking in dark clothes on the road. Maybe their car broke down. Maybe they're trick or treating. Maybe they were out later than expected. Regardless, demanding other people dress like the world is a construction site so you can drive fast is impolite.


It's practical in the same way that a bulletproof backpack is practical for school. The person introducing the element of danger bears the responsibility for handling that danger responsibly.


Reflectors are required in all 50 states. Active lighting is generally required after dusk. If you don't have these then it's hard to blame "reckless cagers" for not being able to see you.


> I've almost hit bicyclists because I couldn't see them

This is absolutely your fault. You're driving too fast for the conditions. You're the one who can't see what's ahead; you're the one who has to drive slower.


It's not that you can go walking in a rural environment but that in an urban environment with no car you have to go walking.

There's a baseline amount of exercise you're going to get regardless.


Depends on the type of rural - it doesn't feel like "hiking" to be wandering around your neighbours fields, or walking along the side of a gravel road.


Exercise is good, even necessary, but it doesn't really help you with weight loss since your body compensate for it in other ways.

It's what and how much you eat that matters.


Not sure why this is down voted, excerpt from the abstract shows that they view nutrition as the main reason for the gap.

> There is an urgent need for an integrated approach to rural nutrition that enhances financial and physical access to healthy foods, to avoid replacing the rural undernutrition disadvantage in poor countries with a more general malnutrition disadvantage that entails excessive consumption of low-quality calories.

It's pretty widely accepted that nutrition trumps exercise in weight loss. I will say that my observations align with OP, urban lifestyles tend to be less sedentary then suburban/rural. But my observations could also be skewed by age differences, which presumably this study controlled for (didn't read the whole thing).


Some anecdata:

I spend a decent amount of time in a small (~3k) town in the American west that's the largest place for about two hours in any direction. It has one grocery store. Prices and selection in this (non-chain) store are genuinely appalling. Fresh fruit and veg is expensive and generally low in quality. As a result, nobody but the occasional out-of-towner fisherman buys it, so there's no incentive to stock more/better stuff. It's kinda like a slightly scaled up version of the basket of brown bananas in the bodega: a desultory corner of the store where there's visible dust on the apples.

What do many folks buy instead? TV dinners. Lots of them. It's not uncommon to see a cart in the checkout line that's nothing but about twenty TV dinners, cheap beer and maybe a loaf or two of wonder bread. Not everyone lives like that, but it's common enough that it's rare for me to leave that store without feeling kinda sad.

So, yeah, food deserts aren't just an urban problem.

n.b. on reflection, a partial counterexample: the Walmart in the nearest larger (~20k) town, despite having more produce and similar goodies on offer, also does a very brisk trade in TV dinners. Access to nutrition is probably relevant, but there's got to also be broader cultural/economic/wellness issues at play.


How many Dollar Stores are in your town? Here is very interesting podcast outlining how Dollar Stores kill supermarkets that carry necessary products like produce.

https://www.npr.org/sections/money/2019/04/26/717665452/epis...


> It's pretty widely accepted that nutrition trumps exercise in weight loss.

I've lost and kept off about half my bodyweight, so I feel entitled to the opinion that that's horseshit dreamed up by marketing to tell people what they want to hear. There is one definitive way to lose weight, time tested and provably infallible: consume fewer calories than you expend.

Now certainly there are some factors involved in both sides of that equation that can be adjusted by what you eat, but take it from a food addict that weight loss is most definitely more about how much you eat.


I think we're in agreement... I use nutrition to mean "the calorie intake side of the equation".

I hear a lot of people use the word the same as I do. It's not that I'm arguing "100 calories of kale will effect your weight differently from 100 calories of powdered sugar" or any other fad-diet nonsense. But I would certainly argue that one of those options will lead to eating fewer calories over the course of a day.


Not my experience, let me explain:

I notice that I have a baseline of appetite, hunger. Going below that makes me deeply uncomfortable. At the same time, I know that I don't need too much exercise to come to a calorie neutrality or slight deficit - but I can't reach that energy expenditure with a sedentary lifestyle.

If I do a 30min run every day, plus walk to work (another 30min), I spend enough calories so I can eat comfortably (still healthy).

A tracker like the Apple Watch helps to see this in action. Closing your rings in the city? Easy. Closing your rings while car centric? Hard.

People should not need to diet. They should spend enough calories to burn off excess food. Note I am talking about healthy BMI, not Instagram fitness model levels. Dad bod, etc. Not morbidly obese.


>> People should not need to diet. They should spend enough calories to burn off excess food

This is bad advice, it's been shown over and over again that in the long term people don't manage to lose weight by exercising. They give up, don't exercise enough, overestimate how many calories they burnt, over-compensate by eating more and/or unhealthier ('because I earned it after taking a run'), etc.

You don't have to 'diet' to lose weight, just try to eat a little less each day, and watch what you are eating. Only 100 calories less than what you need each day, and you'll steadily lose maybe ~3KG a year.


Metabolism increases can also affect you long after a workout, and building muscle instead of fat is also beneficial for the system as a whole. These cannot be recreated with just diet.


However, exercise is the largest driving factor in health _not_ weight https://www.hopkinsmedicine.org/news/media/releases/treadmil....

For weightloss _diet and exercise_ is the way to go: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4429709/.


>Objectively measured physical activity may not be the key determinant of unhealthy weight gain in children.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044163/

>Prospective studies, however, find little evidence of the more physically active members of a population gaining less excess weight than those who are the least physically active.

https://www.ncbi.nlm.nih.gov/pubmed/21832897?dopt=Abstract

>TEE adjusted for weight and age or PAL did not differ significantly between developing and industrialized countries, which calls into question the role of energy expenditure in the cause of obesity at the population level.

https://academic.oup.com/ajcn/article/93/2/427/4597724


> However, exercise is the largest driving factor in health _not_ weight

Citing a bunch of studies about obesity changes nothing about the fact that _exercise_ is more important to health outcomes than _weight_.

Another source for you: https://care.diabetesjournals.org/content/27/1/83

> There was no significant trend across BMI categories for mortality after adjustment for fitness.

Being skinny isn't being healthy, being _fit_ is being healthy.


>Citing a bunch of studies about obesity changes nothing about the fact that _exercise_ is more important to health outcomes than _weight_.

This is pretty funny. They directly address and contradict the point your trying to make. Even the source you posted contradicts what you are trying to argue. Nice try though


Is that research for level of activity in general or for "exercise"?


In my experience diet is necessary to lose weight, but exercise makes dieting a lot easier.


>If I do a 30min run every day, plus walk to work (another 30min), I spend enough calories so I can eat comfortably (still healthy).

An Olympic level athlete might burn 30 kcal per minute at their best. I would bet a regular person burns at most 15 kcal per minute while running, so that's 450 kcal for a 30 min run, and maybe a couple hundred more for a walk. People consume that in a single large sugary coffee or soda drink. You can't ignore inputs.


30 kcal per minute would be very difficult to sustain except for a very short burst of time (like 2-5 minutes) in a peak performance scenario (such as an end-of-season race that the athlete is very well tapered and rested for).

My personal numbers for my regular training runs are about 11-12 kcal per minute. I can exceed 15 kcal per minute for very hard workouts or racing but I cannot train appropriately while doing that regularly. I'm a relatively seasoned runner but I don't focus on 800m-1500m which is where it might be possible to see numbers exceeding 20 kcal per minute.

In order for this to make sense for the purposes of lifestyle modification, you also have to subtract the calories that you would have burned had you not been exercising. IE if you had not run for that 30 minutes, you would still have been burning calories, either completely sedentary BMR or some other NEAT. This makes it even a worse deal to exercise for the sake of burning calories.


I dont think they are ignoring input. Of course, when soda and lots of sugar is still part of your diet all bets are off - those are the basics that have to be fixed first. This has been repeated and emphasized over and over. However, in addition you can‘t just ignore the benefits of exercise and the extra budget of a few hundred calories it provides daily.

I recommend to get an Apple Watch (or any good fitness tracker) and a smart scale. After some time you can pretty easily and reliably predict your daily weight development simply based on your most recent diet and exercise.


Having an extra negative 400 to 500 calorie offset on a daily basis can be incredibly helpful considering a lot of creeping weight gain is caused by a caloric surplus of only a couple hundred per day.


From the looks of many Americans I’ve seen, their problem is a lot more than a couple hundred kcal per day.


A couple hundred kcal per day for 10 years is about 200lb.


Thank you for putting some perspective on this! It's a huge aggregate in the long run.


It doesn't work like he says. You can't just sum up the number of calories and convert it to pounds of fat. If you eat a few hundred calories too many you will rise in weight. But increasing your weight means your metabolism will increase. In the end you will reach an equilibrium were your weight is high enough that your metabolism equals your intake, and you will stop gaining weight.

Let's take a 5"10 male aged 25 weight 170 pounds. According to some calculator they will have a basal metabolism (how much you use if you stay in bed all day) of 1850 kcal / day. Lets say they eat 450 kcal / day too much. i.e. 2300 kcal / day. By running the metabolism calculator backwards we find that they stabilize on a weight of 245 pounds.

Thats a seriously overweight, to be sure, but it is also well below 200 pounds of extra weight.


Yes, there are 2nd order effects, and there are also a bunch of assumptions in basal rate calculations, and conversion efficiency etc. Your assumption that the current day surplus doesn't carry forward (i.e. that as someone gets heavier they done increase intake to account for increased basal metabolism) is also a pretty strong one.

Anyway I could have been clearer, but my point wasn't to suggest that you would end up exactly 200lb heavier, but that your calorie surplus adds up to roughly 200lb - exactly what happens to it depends on a lot of things.

This is response to someone who suggested they hadd seen a lot of clearly obese people who couldn't have got there on a few hundred extra kcal per day - however that doesn't seem accurate.


650 calories a day is easily the difference for a lot of people's freedom of diet choices/ eating what they want. And this is a very moderate level of activity/exercise. Why are you so intent on discounting it?


I’m claiming that number of excess calories consumed easily surpasses a realistic level of exercise, based on eating habits I see.


>People should not need to diet. They should spend enough calories to burn off excess food.

It's unlikely a 30m run and a 30m walk is going to burn off their excess calories.


Not my experience, let me explain:

Experience and anecdote does not substitute for real scientific evidence. Research suggests that your body compensate for any activity expenditure to maintain caloric burn within that specific range. This is known as constrained total energy expenditure.

I notice that I have a baseline of appetite, hunger. Going below that makes me deeply uncomfortable. At the same time, I know that I don't need too much exercise to come to a calorie neutrality or slight deficit - but I can't reach that energy expenditure with a sedentary lifestyle.

If I do a 30min run every day, plus walk to work (another 30min), I spend enough calories so I can eat comfortably (still healthy).

A tracker like the Apple Watch helps to see this in action. Closing your rings in the city? Easy. Closing your rings while car centric? Hard.

I don't trust smartwatches and other devices to track caloric expenditure accurately given that they seemed to have constantly overestimate how much I burn.

This does not dissuade me from making sure that I get at least an hour of exercise everyday.

People should not need to diet. They should spend enough calories to burn off excess food. Note I am talking about healthy BMI, not Instagram fitness model levels. Dad bod, etc. Not morbidly obese.

I agree that people should not do anything special, but here we are in a food environment that makes this difficult.


> Not my experience, let me explain:

>> Experience and anecdote does not substitute for real scientific evidence. My research suggests that...

Can you cite your research. It's hard to criticize someone for giving an anecdote then going on to cite 'your research without citing it.


Here are a few

>Objectively measured physical activity may not be the key determinant of unhealthy weight gain in children. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3044163/

>Prospective studies, however, find little evidence of the more physically active members of a population gaining less excess weight than those who are the least physically active.

https://www.ncbi.nlm.nih.gov/pubmed/21832897?dopt=Abstract

>TEE adjusted for weight and age or PAL did not differ significantly between developing and industrialized countries, which calls into question the role of energy expenditure in the cause of obesity at the population level.

https://academic.oup.com/ajcn/article/93/2/427/4597724


Basically. "Abs get created in the kitchen not in the gym" I wasted dozens of hours of my life trying to jog off a horrible diet.

I have heard some anecdotes of professional athletes who have horrible diets. I believe Chad Johnson survived off of multiple Mcdonald meals a day during his career. Those are unique cases of individuals having the required genetics and being able to spend hours a day with elite trainers


> The amount that Olympic swimmers eat is legendary... Michael Phelps —- he of 21 gold medals and counting -— made headlines when he boasted of his 12,000-calorie-a-day diet:

> > Breakfast: Three fried-egg sandwiches with cheese, lettuce, tomatoes, fried onions and mayonnaise. Two cups of coffee. One five-egg omelette. One bowl of grain. Three slices of French toast topped. Three chocolate-chip pancakes.

> > Lunch: One pound of pasta. Two large ham and cheese sandwiches with mayonnaise on white bread, plus energy drinks.

> > Dinner: One pound of pasta, an entire pizza, and even more energy drinks.


Honestly none of that looks all that bad considering he probably burned 9000 calories a day with exercise.


You don't need special genetics. All it takes is a continuous sink for calories (sustained aerobic exercise) that can be freely replaced with extra food. That means doing something other than sitting all day, driving home, and watching TV for four hours before bed. Also not going to happen with one hour a week on a treadmill or any of the low intensity fad exercise trends.


Rugby players eat huge meals, because playing Rugby genuinely burns that many calories. The problem they face is that once they stop playing Rugby, they tend to put on weight due to being used to the large meals.


McDonalds isn't implicitly a horrible diet. Burgers are made of meat.


The important corollary to that is if you want to look good with your shirt off you should probably spend some time in the gym as well.


> It's what and how much you eat that matters.

It's only how much you eat. Conservation of energy still applies, and 3500 kcal are still a pound of fat. It doesn't matter where the calories come from, they always end up either burned or as fat.

The "how much" is regulated by negative feedback. Whenever you eat sugar, insulin is secreted, which ends the craving. Whenever you eat fat or protein, leptin is secreted, which causes a feeling of satiation. Leptin is secreted by fatty tissue, so the fatter you are, the earlier you are satiated. As a result, everyone has an equilibrium weight at which he will eat exactly enough to replace the expended energy.

But that's not what's happening right now. We tend to constantly gain weight. Slowly, but without an apparent limit or any kind of feedback. That's where the "what you eat" comes in. Something is fouling up the feedback mechanism. Maybe something that causes the release of neither insulin nor leptin. Something we now consume in bulk, but didn't use to. Maybe we shouldn't do that.


As with most absolutist statements, the truth is somewhere in between--the inverse is true there as well. If you don't do anything to keep caloric expenditure constant and just restrict intake, your body will reduce expenditure to match the reduced intake.

And to the person you're replying to's point, where the walking/stairs/etc. involved in city life might serve keep that expenditure constant for someone who's otherwise sedentary, that's not the case for someone driving everywhere and topping out at 1000 steps a day.


> your body will reduce expenditure to match the reduced intake.

There's a floor to how far your body can compensate for reduced intake - starvation. There's not such a simple ceiling to stop you from eating back up to what you exercise.


> your body will reduce expenditure to match the reduced intake

No, it won't. You need about 2000 kcal/d just to maintain body temperature. That's assuming a constant heat output of 100W. A bit less is surely possible, muss less isn't. Reduce food intake below that, and you will lose weight. Because physics.


Lots of people maintain or even gain weight on under 2000 kcal/day. BMR varies greatly with the size of the individual.


And to the person you're replying to's point, where the walking/stairs/etc. involved in city life might serve keep that expenditure constant for someone who's otherwise sedentary, that's not the case for someone driving everywhere and topping out at 1000 steps a day.

Research shown that those expenditure doesn't matter. Your body adjusts. Nevertheless, we should create an environment that encourages everyday physical activity.


You are correct for weight loss. The only reliable way to lose weight is to consume fewer calories.

However, when it comes to supporting your current weight, it is fairly easy to hit equilibrium with exercise.


Disagree. I just climbed the highest peak in this part of the state. Assuming my FitBit data is accurate I was 2,500 calories behind that day--the next day I ate normally. That's more than half a pound of weight loss. It's not my first time up there, either.


You disagree with the idea that eating matters more than exercise because your literal climb to the top of a mountain shaved off an extra Big Mac meal in calories?


Most Americans aren't climbing a mountain a day to overcome terrible eating habits.


Exactly. Burning e.g. 500 calories on daily basis is much more strenuous on both your body and your agenda than cutting 500 calories from your diet.


You're commenting under an article showing scientific evidence that this is not true :)


Baseline energy expenditure may be changing, but weight loss/gain is 80-90% diet. Sure, rural folks aren't moving much, but let's address that they may live off fast food, drink too much alcohol/sugar, eat too many processed carbohydrates, and generally don't have access to healthy vegetarian-heavy cuisine and the education that many city-dwellers use improve their health.

Case in point: I drove on a road trip through the southern USA recently. In rural areas, you had highways with truck stops and gas stations with tons and tons of very tempting fried, sugary, tasty treats. I saw barely anyone eating a vegetable-based dish that wasn't fried. Salads? Forget about it...There's a reason it's called The Stroke Belt, and why Southerners are known to eat poorly. Look at even Jim Gaffigan's routine on Southerners, he aptly characterizes their ridiculous diets, poking fun at biscuits and gravy, for instance.

So, while exercise is important, really just look at the foods on offer in rural areas. It'll be less healthy by default.


As someone who's visited rural Texas a large number of times throughout my life, another factor has to be food. There's little cultural emphasis on healthy eating. "Work hard, play hard" extends to food. Nobody would think twice about having barbecue with a Dr. Pepper every day. On top of that, a large portion of the available restaurants in small, remote towns are fast-food, which again, isn't stigmatized like it is in more urban areas. The handful of local restaurants will be barbecue and/or tex-mex.

These factors combine to make unhealthy-eating a simple matter of habit for a large percentage of people in those areas. Even if you really do work physically hard every day, it's not enough to cancel all that out.


City dwellers are increasingly working from home and getting everything (including weed) delivered, so the "slob" characterization might not be as strongly associated with F150s as time wears on.


Yeah exactly this. I have cousins that still live in rural America and yes they drive F150s and yes they are considerably more active than the average city dweller. There’s just more (manual) work to do on a farm. Hence the pickup.


But you can just as easily have pretty good produce delivered. It's no excuse


NEAT seems like one of one of the more underappreciated determinant of weight. I remember when Google Fit ranked a user's pedometer activity along a histogram of the city average and being blown away at the variety in how much and how little people moved. Or the difference between big east vs west coast cities, or suburbs or cottage country. My friend went from fit highschool jock to borderline obese after quitting sports for school while retaining athlete diet, then promptly trimmed up after a summer working in the kitchen where his pedometer regularly passed 60k per day. Figetters burn dramatically more calories as well. On the other hand, there's also a surprising amount of high BMI postal workers and warehouse fulfillment workers. Whereas I rarely see large food delivery bikers or kitchen workers.


While this maybe true, many of the people I know that live in rural areas locally have jobs involving manual labor rather than sitting on their ass in an office all day (like myself). I'd be curious to learn how commuting and travelling in a city with a desk job compares to not being as active while travelling but working a job involving manual labor. I'd honestly be surprised if people living in the city did more exercise overall


My family lives in rural areas and a lot of people there do manual labor jobs but are still overweight. I think it is more of a cultural thing around food. When I visit, I am always shocked by how much food people eat. The amount of exercise needed to overcome eating 4k calories per day is not going to be provided by any job.


I've noticed this myself.

I simply walk more when I'm on a trip for something. Because often, I'm either going to cities or I haven't taken my car.

When I'm home, I'll drive to where I need to go. Then it's just whatever few steps I need to take around my place. Not even really trying, I walked over 6 miles total in a day while in a city for an event where the main activity is sitting down and playing cards.


>You're the slob from the movie "Up".

Which character are you talking about?


I bet they mean Wall-E


Yes! Got my Pixar movies mixed up - thanks for the correction!


Was wondering why you were picking on poor Russell.


I live in what most would consider a very suburban area in the deep south and am forced to walk as a primary mode of transport. There is a bit of walkable infrastructure where I am, in between an middle class and more run down neighborhood, and while it doesn't happen as much as it did when I lived in some worse areas, there's almost a stigma to walking as a mode of transport. I've had people shout at me, etc. or even offer me a ride at night even when I'm on a leisure walk, presumably because they don't expect a young white guy to be out walking at night.


Sounds like you should cycle.


I think you meant to say WALL-E, but your point still stands.


I can so see that personally -- I live in what would be an urban area in the US, but I can park nearby and I have parking at work, so I mostly drive. When I was a student 10km on a bike was not much. Now?

My parents live outside of town, but they get exercise because they have to walk their dog. Otherwise they probably wouldn't get any either.

It is pretty scary, and while I know I could exercise I don't.


Couple more factors:

- much easier to access gyms or play pick up games in the city

- poverty is higher in rural areas


"Data on how BMI in rural and urban populations is changing are needed to plan interventions that address underweight and overweight."

Specifically in the U.S., isn't it true that the population landscape is rapidly shifting from Rural => Urban? I intend to read more to see how this may/may not be a confounder in this type of temporal analysis.

Tldr: If the rural population is decreasing, then your denominator is smaller and estimates of disease proportion would increase over time.

These confounders are commonly addressed in systematic reviews - just haven't found it specifically in this one.


Agree with this observation. This might simply be a burn-off effect. Consider a simple model. Fact one: Obesity is disproportionately concentrated in the less-educated. Fact two: Urbanization is disproportionately concentrated in the highly-educated.

Well, what we would see over time is faster rising obesity in rural areas than urban areas. But that's simply a manifestation of the sorting effect. The underlying populations (the educated vs. uneducated) have not fundamentally changed, just relocated.

Without considering this we might be spuriously fooled into misunderstanding the causality of obesity. Under this model, rural living itself has absolutely nothing to do with rising obesity. It's merely serving as a proxy for a more important variable.


Yes and no. The Census Bureau defines "urban area" as contiguous census blocks with a density above 1000 people per square mile. That means many places that we'd call "suburban" or "exurban" are counted as "urban." During the 20th century, you saw two trends: movement from rural areas to urban areas, but simultaneous movement from cities to suburbs: https://www.researchgate.net/figure/Percentage-of-US-metropo.... Since 1920, we went from 35% of metro area residents living in suburbs to 70% in 2000. At the same time, the percentage of people living in "urban" areas went from 50% to 80%.

A little back-of-the-napkin math suggest that what we think of as the "urban" population (people living in cities) shrank from ~35% in 1920 to 25% in 2000.


> population landscape is rapidly shifting from Rural => Urban

Perhaps percentage wise, but the overall population in America is going up as well. As a result, rural areas aren't really declining, the population increase is simply mostly happening in the urban areas.

The rural area I live in is, instead, growing significantly (a rural definition of significantly) as people age out of urban areas and use the millions from their property sales in CA to purchase a summer home here.


There are very large sections of the rural US in decline, in the northeast, midwest, and south. Far more than are growing, which are mostly in the Rocky Mountains and west of there.


Anecdotally, I feel like young, ambitious people are the most likely to leave rural / suburban areas for cities.

If the younger, more health-conscious folks are likelier to leave, it makes sense the people left behind are older and less healthy.


Obesity also impacts the impoverish more than those financially better off. Gentrification is pushing many of these peop!e further and further out. The automobile focused design of the areas they move to combined with less access to private automobile ownership confines some of them to their homes with trips out being limited to only the most important errands as it costs money to hire transportation.


> Tldr: If the rural population is decreasing, then your denominator is smaller and estimates of disease proportion would increase over time.

This wouldn't happen from the denominator decreasing per se, but from the emigrants being skewed healthy. Which is pretty plausible, given that you'd expect emigrants to skew eg younger.


You would expect emigrants to be people who are productive enough to afford the increased costs-of-living of a city, which usually (but not always) implies health—at least insofar as severe unhealthy usually restricts productivity.


I just moved from the middle of a walkable city to the country and indeed I've put on some weight. Key factors:

* I used to walk and cycle as my only means of transport (well, 99% of it at least).

* This is kind of a desert for decent food. The local shops have candy, chips, cakes, beer, and some almost-rotten bananas and apples.

* .. well actually that's about it. Though everyone else being heavier probably hasn't helped on a subconscious level.


I think when everyone is heavier, it sets a lower bar for attracting a partner. That's a big factor.


The food in those areas is also insanely sugar and fat oriented. It made sense back when people were doing hard farming work 15 hours a day and needed the calories. But the cuisine didn't change, if anything it got sweeter. When I'm traveling, I run into difficulty finding low calorie dishes when passing through rural areas and now basically simply don't eat there. It's infectious: the asian cuisines found in rural areas has nothing to do with actual asian food. Expect deep fried chicken drenched in actual sugar syrup in most dishes. Because nothing else will sell so the restaurant owners adapt. It's not surprising to look around and see so many people that are waddling around, driving around stores little electric cart things, with pasty acne riddled skin, thin hair falling out in clumps, and generally looking like they are at death's door despite being under 40.


https://www.youtube.com/watch?v=x4sRsb0a30Y

The hacking of the american mind.


It keeps being said: you must eat only what is needed to fuel your body for the activity you are doing in an average day.

By the time someone acquires the maturity to accept this, their lifestyle has been too deeply established for change to be possible.


We need a study to tell us that increasing average body mass drives obesity averages more than urbanization?

In related news, eating too much too often is more a cause of weight gain than how much screen time you get.


The very second sentence of the link:

> This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity

The study's findings are that the rise in overall weight is attributed primarily to rural areas, contrary to the current consensus that it's driven by urbanization. Let alone not reading the link before commenting, it seems you didn't even read the full title of the post.


It specifically locates where most of the body mass increase is coming from.


Some thought Once Upon A Time In Hollywood (Tarantinos homage to the 60s) was unrealistic because everyone was skinny.

I was like, no - that’s what everyone looked like.




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