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Obesity Is Weighing on Education, Productivity and the Economy (bloomberg.com)
43 points by pseudolus 13 days ago | hide | past | web | favorite | 77 comments

I have a friend and she believes that obesity is a made-up disease by doctors to marginalise fat people (she calls it fatphobia). She refuses to acknowledge that obesity actually causes health issues, instead she defends obesity by citing that even "fit" people are victims of heart diseases etc. And then she makes it sound plausible by talking about how we should focus on complete health like mind + body. I went to one of her talks about it and almost all attendees were obese. Just to be clear, I don't deny about her points on fatphobia (i.e. how society rewards fit and good looking people more than fat people), but she completely loses me when she talks about how nothing is wrong with being super fat. (Btw I used to be very fat growing up and once i got my first job i have stuck to a fit lifestyle so to me it is completely against everything that I did to get rid of my obesity)

> by citing that even "fit" people are victims of heart diseases etc.

Yes, but with waaay lower incidence as thousands of studies (0 issues on reproducibility here) show.

> by talking about how we should focus on complete health like mind + body.

Sure, as long as she realizes that the two are interconnected and that at some point you'll have to do something, for real, for the body too.

Also in this case, there is an astronomical amount of research that shows the benefits of being in the "fit zone" irt body composition and of living an active lifestyle.

And for you, my sincere compliments for having turned around your life and changed your lifestyle, you rock.

Can she not see that very overweight people are literally just not able to get around daily life as easily as physically fit people? She must be able to see that other people do things easily that would make her very out of breath? And can she not see that more physically fit people are more comfortable without the extra weight? I would have thought you could see all these things plainly even if you disbelieved all the things doctors told you.

Can she not see that very overweight people are literally just not able to get around daily life as easily as physically fit people?

Fat-rights people just take that as evidence of a conspiracy of “thin supremacy”, similar to how some people see “white supremacy” everywhere they look.

You mean like the size of seats and doors and things? I can understand that point of view.

But I mean things where there is no design being imposed. Like I can stroll down the beach if I want to. An extremely overweight person cannot. Nobody's imposed anything that makes that harder for them except their weight.

They must think to themselves 'it'd be nice to walk down the beach... I wonder why I can't do that without being uncomfortable when these other people can...' and realise that extra weight brings quality-of-life limitations.

Not everyone who is obese is at that level of being unable to do things, to be fair.

I recently lost weight (~30 lbs) taking me from the threshold of obesity (30 BMI) to the threshold between overweight and normal weight (25 BMI).

While I certainly find it easier to be physically active now with less weight, I was still able to do multi-hour hikes, bike rides, and other physical activity before at the higher weight.

And if your lifestyle is such that you drive everywhere and don’t do much physical activity besides short periods of walking I can certainly see not really considering being even heavier to be too much of a drain on your lifestyle.

That is a very harmful belief that your friend has. It is unfortunately quite common.

I have, though, wrote a few things that people should keep in mind when discussing obesity, elsewhere in this thread.

Summarized: Willpower is not a panacea, mind is not above biology; Most people have not conciously chosen to be fat; Ostracizing fat people creates harmful effects and echo-chambers -- constructive criticism is much more effective; Do not forget the part that medical disorders can play in obesity.

Of course, this applies only if you actually want to help fat people. If your (not you exactly but people generally) only point is to bully, then the effort of providing constructive criticism is not worth it, the end result being unappealing (i.e. not getting an explosive reaction out of the person you're bullying).

In any case, if you want to help, do not approve of such lifestyles (i.e. fat-acceptance), but do not bully. People may need psychological support and even medical in case of an illness. If you want to harm people, just don't.

That seems little different from the opposite end of the spectrum where anorexics form "support groups" to encourage each other to be anorexic. I don't know if there is a right way to deal with it. Maybe you could ban those groups from online platforms, but that won't stop them from doing it "in real life." These people probably need mental healthcare, but there's no humane system in place to force treatment on them (and forced treatment probably wouldn't be effective anyway.)

> but that won't stop them from doing it "in real life."

Ban them on online platforms, ostracize them in real life.

It may sound harsh, but it's not, considering all the people you'll save from them.

Is this really the best solution? I feel like this only feeds the "conspiracy" more. In my view, it's always better to let people spread their (false) views, and just make factual information easily available to counter them.

A lot of people who are attracted to such extremism are not in a rational frame of mind anyway - ostracising them in real life only serves to send them deeper into their rabbit hole.

> "ostracize them in real life."

Are they not already though? I suppose it's always possible to go even further, but I'm not convinced that would work. Perhaps it would be instructive to consider how obese people are treated in countries where obesity rates are low. Are fat people ostracized to a greater or lesser degree in those countries?

I'm really starting to think there's some environmental factor going on that at least in part explains the current obesity epidemic. A person in the 70s who would have the exact caloric intake and exercise as a person today would have been several BMI points slimmer[1].


A good place to start is to read Michael Pollan's Omnivore's Dilemma[1]. I was amazed at how much of our current food originates as corn. Corn is good at fattening cattle in record time, and seems to be having the same effect on humans who eat its derivatives.

[1] https://www.goodreads.com/book/show/3109.The_Omnivore_s_Dile...

Another explanation could be the people in the 70s had a healthier gut microbiome. I don't we think know enough to say for certain but studies have found gut bacteria affects metabolism and can be linked to obesity and diabetes.

Probably to due with less calories spent in manual work. Like walking instead of driving, washing clothes and utensils instead of using electronics, etc.

Calories spent from exertion are generally negligible unless it's a very intense focused kind of exercise done for a long duration. Run a whole mile and all that gets you is one free apple.

100 calories per hour mean an additional 571 calories per day if you spread it across the whole 7 days.

When your body needs 2600 calories per day just to stay at the same weight it is very easy to lose weight by cutting them to 2000 calories. When your body only needs 2000 calories then you need to cut them down to 1400 calories for the same result which may be impossible from a psychological perspective.

One free apple a day over decades makes quite an impact.

You need to eat about 7,700 calories too much to gain a kilogram of weight (https://www.livestrong.com/article/304137-how-many-calories-...). So, eating 25 calories too much each day gains you that kilogram in a year. If you keep doing that between ages 10 and 40, you ‘gain’ 30 kilograms, and chances are you end up obese.

You can counteract that by burning about 25 more calories each day. To do that by walking, you need to walk about half a mile extra each day (https://www.livescience.com/8931-calories-walking-burn-depen...)

The difference in the amount of calories I burn on days when I go to work, and am mostly sedentary, and days when I'm at home puttering around constantly, is massive.

At least as tracked by my Fitbit it can be upwards of 2000 calories difference, and 10-15k steps.

It's unlikely that your TDEE is 4000 calories when you're at home puttering around. These fitness trackers are extremely unreliable at estimating caloric expenditure.

Whether it is accurate in absolute terms is less interesting than what it reports in differing trends. Every indicator that it reports is vastly higher on the days when I am not in the office, chained to my desk. Just being on my feet, walking back and forth all day, up and down and round and round, is a night and day difference.

The composition of a diet makes difference.

May it be that it shifted to increased share of heavily processed food. Also, it can be related to changes in the way we grow, feed or fertilise cattle and plants. This can lead, some doctors say, to leaky gut and inflammation; many of us may suffer from those without being aware of it.

I agree. Feels like multiple environmental factors might be at play.

Lately I’ve been wondering about exposure to PFAs on all sorts of packaging.

I am inclined to agree. At least one study (that I have found) has showed a clear influence of pesticides and pollutants ingested by or exposed to the mother to the child's probability of being obese.

Liu Y, Peterson KE. Maternal Exposure to Synthetic Chemicals and Obesity in the Offspring: Recent Findings. Curr Environ Health Rep. 2015;2(4):339–347. doi:10.1007/s40572-015-0068-6


I thought it was common knowledge by now that 'caloric intake' is mostly useless as a predictor for obesity? Mostly useless, because it says nothing about the amount of energy the body has to expend to metabolize the foods that contain them, and it completely disregards systematic metabolic changes resulting from dietary choices.

Some bodies burn more calories at rest. Some bodies burn more calories when working out. All bodies burn available fat when they take in fewer calories than they burn. It's a physics thing.

A physics thing that is mostly useless if you look at caloric diet success ratio. People feel mere calories restriction as torture. If you want them to keep a diet, you should pay as much attention to what they eat as to how much they eat.

I have an unfounded belief that people do not actually use up most of the calories they eat, they are excreted. Everyone, including both normal-weight ("thin") and obese people eats ingests more calories than is needed by the body given the sedentary lifestyles in modern society, yet some do not gain weight as quickly. Additionally, given how efficient human bodies are, meaning how much work you have to do to burn an apple's worth of calories, it is impossible to suggest that everyone of normal weight burns all excess calories.

I have a well founded belief that obesity cause is sugar and its close relatives. There's no mistery about that. Obesity is almost unknown before sugar is introduced in a country's diet.

Current epidemic is caused because sugar is not only available but practically unavoidable if you consume prepackaged food. It's added to all kinds of food, some of them, like mayo, bread or sausages, totally superfluous. Meanwhile some "experts" keep talking about dietary fat and calories.

I try to take the stairs when I can. But the stairs in many buildings are unpleasant fire escape concrete things. It'd be nice if the stairs were expected to be used, and be part of the design rather than something the fire code demanded.

Fire stairs are like that because they have to maintain a fire rating between them and the rest of the building. Some places have connecting stairs but they're expensive to install and take up rentable square footage.

Surely adding art to the walls and some nice flooring wouldn't negatively affect the fire rating.

Any flooring with low flame spread and low smoke developed and high slip resistance as measured by standard tests by a qualified testing agency is typically allowed by life safety codes. Other flooring isn't.

Hanging art on the walls of egress stairs is typically prohibited by life safety codes. Egress stairs are required to be maintained as egress stairs. The requirement isn't based on theory. It is empirically derived from experience among fire fighting agencies encountering corpses and/or impeded fire-fighting operations when egress stairs are adapted for non-egress uses such as habitability and/or storage.

The blanket prohibitions exist because ordinary people ordinarily don't have experience with emergency events and modifications to life safety systems may effect the well-being of other building occupants, fire-fighters, and the general public.

Interesting, thanks.

No, but would spending the money to do that enable the building owner to rent space at a higher rate than they would otherwise? In other words, would there be any return on that investment? Probably not. If it's someplace like Google or Apple, where the company owns the building they're occupying, they might consider doing it because it would be nice. If it's an owner who's renting out the building to tenants, they aren't going to spend any money they don't have to.

The building I currently live in has carpeted stairways with painted walls. It's far from an art gallery, but I think it still demonstrates that you're right; stairways in commercially viable buildings do not need to be nearly so ugly.

I'm lucky enough to enjoy the feeling of a place not being designed for common pedestrian use[0] but it certainly would be welcome to at least have some thoughtful art in there.

[0] https://en.wikipedia.org/wiki/Psychogeography

I believe the original paper from OECD:


>> We provide comparable evidence on the patterns and trends in obesity across the Atlantic and analyse whether there are economic rationales for public intervention to control obesity. We supply new evidence on such rationales taking into account equity issues as well as efficiency considerations, which are organized around the following categories of market failures: productive inefficiencies, lack of information or rationality and health insurance externalities. We argue that there is support for intervention targeted towards the young on equity grounds. While the evidence that the allocation of resources is (or will be) significantly distorted by the rise in obesity is less clear-cut, there are signs that this is the case due to time inconsistent preferences and because of the resilience of product and labour market imperfections, especially in some European countries.

That we're unable to exert enough self-control to avoid eating ourselves to death paints a dim view of humanity.

The majority of people simply have no excuse not to manage their health/weight.

Even more so for parents or anybody else with dependents. It's plain negligent.

Humanity is pretty dim already. This kind of situation is quite complex, from socio-economic factors, education, access to healthy food (including taking the time to cook), to medical issues that are often mentioned but usually dismissed (as I've described in another comment, you can quite easily get uncontrollably obese with an antipsychotic or antidepressive medication -- and given the society's speed of development and ever increasing work requirements, it's not hard to see why a lot of people would have mental health issues) (not to mention actual hormonal disorders that can actually prevent a person from being able to feel full).

In my opinion, it's helpful to look at the human body as a biological machine. The mind itself is at the mercy of it's vessel, the brain. Thoughts are electrical impulses enhanced with chemical neurotransmitters. A change can quite literally cause a person to change their mind (literally, i.e. a hard-vegan and animal rights activist having a stroke and becoming a caricature of a meat eater, in worse cases a complete replacement of someone's personality and memories).

The human body is not below the mind, rather, they work together. An incident can initiate a never-ending cycle that ends in obesity and ultimately death.

Self control is not the panacea people think it is. The concious mind cannot override most if not all built-in impulses. Can you choose not to have sex? No. If you ask "why would I", that is already heavily influenced by the impulses built into the structure of the nervous system. A basic part of human existence. If you get over that part, sooner or later you will experience mental health issues beyond your control and ultimately forget your initial idea of celibacy. I have used this example and not eating, or excretion of waste, as technically sexual activity has no influence on the body's homeostasis and internal proceses.

Some people have a different priority list, including overeating. I do not think that ANY obese person has ever conciously made the decision to overeat and be miserable, sick and die earlier.

In any case, I agree with your part about parenting. It is incredibly negligent. Not introducing a child to the concept of overeating will in a lot of cases prevent obesity. However, some people are biologically predisposed to have less self control. This does not have to imply obesity and overeating.

On my own example, I have never smoked a cigarette, taken any psychoactive substance, or drank alcohol. I know that had I done any of those things, it would become an obsession to me. My father is an alcoholic drug addict who smokes a lot. My mother is just a heavy smoker. Some people cannot control themselves, and the long-term success rates of drug rehabilitation and AA/smoking quitters show that.

Sitting kids in a chair for eight hours a day and feeding them three times a day on refined carbohydrates has predictable effects.

School breakfast programs are good - many children would not eat anything in the morning otherwise - but feeding them the kind of garbage that is typical eliminates most of the potential benefits. No human being should eat cereal or pop tarts, really at any time.

>> School breakfast programs are good - many children would not eat anything in the morning otherwise

Is there any scientific evidence that shows this would actually be a bad thing? I know the amount of evidence that intermittent fasting like e.g. 16-hours a day without food has significant health benefits has been piling up in the last few years. But I haven't seen any research that backs up the 'common knowledge' claim that 'breakfast is the most important meal of the day'. As far as I'm concerned it's just a marketing trick from food companies, just like the stupid idea that you need to 'feed your body' with small snacks throughout the day.

Breakfast for adults without a medical condition is certainly unnecessary.

Not sure about kids though. They are still growing and modern nutrition has helped kids grow taller and healthier than past generations who had intermittent access to food.

Eggs and a glass of whole milk would probably be a lot healthier than pop tarts and skim milk with cereal though.

Evidence about intermittent fasting has the same problem that evidence about breakfast does. It’s extremely difficult, if not impossible, to do proper experiments with control groups.

Different people have different metabolisms, lifestyles, phenotypes, etc. I doubt there is a one size fits all solution. Best I’ve been able to come up with is if you see yourself getting fat, eat fewer carbs and saturated fats and excercise (cardiovascular) more.

There's a lot of children that don't really eat, outside of the school-provided meal programs. There's a lot of poverty, that most of us are probably not familiar with the real dimensions and depravity of.

Obesity isn’t reason, it’s a result from other problems like loneliness, anxiety or not very stable life circumstances. Fighting these will reduce obesity. No proof of that, just my personal theory. Also in local supermarket I could call minority of the products healthy. 600 grams of very unhealthy cookies for 0,99€ should have sugar tax of another 2€ on it.

I don't know about this. I don't think it is that uncommon to meet fat, but also happy and well off people. Especially in office jobs, where you have to actively fight free company snacks, sugar water and lack of personal time for exercise. I do agree on your supermarket point though. I wouldn't go as far as to punish eating bad, people should be able to do it if they want to, but when you can split your average supermarket offering into 10 % actual food and 90 % candy cosplaying as food, something's off IMO.

I think the point was that obesity is a symptom, not a cause. And then there's the implication that "try harder to be thin" isn't an effective remedy, at least not so far.

yet again society pays the price whilst corporations selling sugary drinks reaps the benefits

Society is not forced at gunpoint to buy those drinks.

Society was not forced at gunpoint to buy cigarettes either, but with masterful marketing, corporations exploded cigarette smoking from 100/capita/day in 1910 to 5000/capita/day in 1960.

Humans are not random decision-making machines. The ease of manipulating our consumption decisions is well documented. If you think your decisions aren't affected by external manipulations, it just means you haven't noticed.

Even 100 cigarettes per person in a day is not believable least 5000 - people did not smoke more than 10 packs per hour in 1960 or ever.

*per year

editing mistake from changing source from this graph


to this graph


In this case it looks like merely switching between different methods of tobacco consumption due to changes in the society. Cigarettes win vs pipes and cigars both in price and in time requirements.

No, there's no need for that. People are taught and molded to do so from birth. Ever see a toddler with a soda? You think they bought it?

So if our free will can’t extend to soda we clearly need new discussions on guilt and individual responsibility. We’ve been molded since birth.

it's worse than gunpoint: they use subliminal advertising https://www.campaignlive.co.uk/article/marlboro-coke-kfc-use...

This would imply that humans are completely unaffected by environmental factors.

Then buy sugary drinks companies.

How does banning cars and making cities more walk-able effect obesity?

I think in real life we have a lot of variables related to solve the obesity problem. But I agree that reduce using a car and make everyone use a bicycle/walking will reduce the percentage of obesity. We have to think more.

It entices people to do some physical exercise each day. That (my theory) doesn’t make them lose weight, but makes them gain less weight.

A negative correlation between obesity prevalence and ‘active transportation’ certainly exists. Check the charts on pages 11/20 and 12/20 (page numbers 805 and 806) of http://www.cycle-helmets.com/walk-bike-obesity-rates.pdf

I'd guess that nobody knows because we can't do experiments like that without a ton of confounding variables.

is it an obesity epidemic or humans converging to a biologically pre-determined weight. it's not that people are overeating but that decades ago they were undernourished. Maybe adult humans were meant to weight 200+ pounds

If that was the case, there wouldn’t be diseases that stem solely from being obese. And joints wouldn’t fail faster on obese people, and hearts wouldn’t fail faster on obese people.

We weren't "meant" to be any weight, we just evolved in an environment where food was scarce.

right. and now with abundance, humans weigh more

I guess it depends on the definition of "meant". Depending on your religious beliefs, you may believe humans were "meant" for this or that. Objectively, we can't say that humans were "meant" for anything.

We exist. Our actions have consequences. Take control and perform the actions that result in the consequences you want.

That line of thinking is incredibly harmful. It is unsubstantiated and plays into many obese individuals' idea about the world being run by thin people who have conspired against them.

Obesity is caused by food choices, it's an optional state you don't have to be obese that's a fact, yet a lot of people think its a fatality and a bad draw from the genetic lottery, when nothing could be further from the truth.

The only way to cure the obesity epidemic is public education, and inform people. A whole food plant-based diet is the best diet identified by science so far in terms of treating obesity, and even heart disease and diabetes yet the public is still in 2019 going on 2020 largely unaware.

If you want to learn about this in a very relatable and none-formal way, this YouTube channel Krocs in the Kitchen from an american couple is quite fun (they lost 800 pounds combined) - https://www.youtube.com/channel/UC9vIrPTF0znhis-gsFB8l8Q

> A whole food plant-based diet is the best diet identified by science so far in terms of treating obesity


I think the best diet science has identified in treating obesity is cutting out processed foods. Whether it's processed plant or animal food.

Heart disease and diabetes comes from sugar and carbs, all of which are plant based.

The key is word Whole, a whole food plant-based diet is the only diet documented to reverse the progression of heart disease.

The reversal of heart disease with this diet has been proven decades ago - https://nutritionfacts.org/2011/10/14/heart-disease-there-is...

No one knows the exact cause of diabetes, there could several causes. Processed foods are not whole foods. White flour, marguerine, processed sugar, cheetoes, that's a not a whole food it's not comparable to potatoes and bananas.

Here is the opinion of one of the leading experts in Diabetes, Neal Barnard - https://www.youtube.com/watch?v=S51D07bvlPY

He mentions that diabetes seems to be linked to an excessive consumption of fat, that inhibits the absortion of sugar.

He has studies published showing that a whole-food plant based diets in some cases has made the person stop taking insuline altogether.

Low carb is the only diet know to reverse diabetes. Previously type 2 diabetes was thought uncurable and only a managed disease. But Dr Unwin has been helping to change NHS policy and reverse type 2 diabetes. Over 60 patients to date!


We know the cause of diabetes, it's elevated insulin over time. We know what elevates insulin, it's carbohydrates. We know fat doesn't raise insulin.

That website, nutritionfacts.org is quite wrong in several places. I read some of the articles, it's not that good I'd avoid it.

I'm tired of subsidizing people who are so intent on harming themselves, while at the same time blaming everyone/everything else for their behavior. I get that people need to be the hero of their own narrative, but requiring the rest of us to subsidize and approve is just too much.

Obesity should automatically put a person into a different risk/cost pool for health insurance. The price of procedures should be higher to reflect the higher cost and risk of treating people who are obese.

> Obesity should automatically put a person into a different risk/cost pool for health insurance

That already happens, though.

> I'm tired of subsidizing people who are so intent on harming themselves

Fair point, however you also subsidize smokers, drug addicts, etc.

I find your comment to be overly negative, instead of trying to solve the problem your propose to punish people financially, which won't work for two reasons, one of which is that poor people on average weigh more, and second is that you will reinforce bad behavior (i.e. overeating) and conspiracy theories that the world is out to get fat people.

My opinion is that a significat number of people who are overweight have a psychiatric condition, that can either directly cause overeating, or indirectly (i.e. medication such as antipsychotics, including "modern" ones like aripiprazole, drastically increase appetite).

As a fat person myself, I find it helpful to criticize obesity, as a complete fat-acceptness state of society would be very harmful. However, please, do not settle on punishment that at most could benefit normal-weight people financially, as we do with the justice system. Instead, try education and constructive criticism. Also, some fat people need healthcare to be able to lose weight -- like me (Coushing's disease).

Had your plan to deny me health insurance (by making it too expensive) been implemented, I would not only be fat forever, it would ruin both my life, lives of people around me (a stupid example: people in a bus being uncomfortably close to a obese person who is simply too large), and in the end achieve nothing.

As a software developer, I can provide more value to the society alive and healthy than sick and possibly dead, even including the additional cost of health insurance, adrenal gland surgery and medications and care.

Think before you ostracize. What you're proposing is not healthy and helpful criticism, it's a totalitarian conspiracy against a group of people, some of whom need your help.

The non-obese are the ones being punished. They are having to foot the bill and subsidize. Putting the cost onto the people who make the lifestyle choice is just being fair.

I fully support the choices people make, but these choices come with costs that people need to take responsibility for.

You seem to have skipped most of my comment, only replying to the first paragraph.

Have a look at this comment that may further illustrate my point about your assumption about "choices people make" being incorrect.


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