One of the greatest failings of our "modern" healthcare system is that there's no plan to address this crisis. Obesity is the gateway to what seems like an infinite amount of health complications - not to mention the additional burden on the health care system itself when they get sick. I fully acknowledge that it's a difficult subject, it upsets people, and it's uncomfortable. The greatest healthcare advice our leaders can give us right now is for everyone to exercise a little more and lost a little weight. Isn't this the perfect time for that? We're coming out of a pandemic and we have the actual data that showed that obese people were uniquely susceptible to bad outcomes from this disease.
>One of the greatest failings of our "modern" healthcare system is that there's no plan to address this crisis. Obesity is the gateway to what seems like an infinite amount of health complications
What are they supposed to do? Obesity is caused by American's terrible lifestyle. Healthcare systems can only do so much to compensate for a bad lifestyle. Stop drinking alcohol, and start walking everywhere instead of driving.
For one, we can start to treat city planning as a healthcare issue.
Limit zoning restrictions that currently make driving everywhere the most convenient choice, stop all freeway expansion projects, and make as many walkable, bikeable, friendly neighborhoods as possible.
If people want/need to go outside and walk or bike to accomplish their daily chores, they won’t need to think about exercise as much because it’ll just be an automatic part of their routine. The best kind of health outcomes are based on societal changes, not personal responsibility (“you need to go to the gym and punish yourself” has been failing us). And people will be happier too, if they are more connected to their community (after the initial grumbling about how “hard” it is). It’s so hard to walk/bike around in the US that I don’t blame people for not doing it more (as an avid walk/run/biker myself).
That doesn’t mean we get rid of all current development and suburbs, but just eliminate the current restrictions which enforce that lifestyle, and let people’s communities start transforming slowly into healthier ones.
Working out more and eating less is a pain. Rezoning and rebuilding is fun!
Jokes aside, an environment that softly pushes people towards better choices has a far, far better chance to push them towards these choices than an oppresive self-discipline regime. In the long term, only the former works.
My point was that making it a personal choice seems to be failing us. We’ve been telling people to do that for decades, and they’re not — make it a societal choice so that it’s individuals are automatically enrolled in a system that promotes their health rather than forcing them to sit in a car seat for hours per week
I find it fascinating, from an social science perspective, that in other critical areas of society social shaming is encouraged, but when it comes to human fitness we will invent PhD theses worth of reasons for why that's not allowed.
I 100% agree with you though, the physical structure of (most) US cities makes this difficult if you yourself don't prioritize it, or you can't afford to.
It's also a huge glaring actor/observer asymmetry issue, you think between the 50's and now human beings innately changed to be lazier, more prone to overconsumption? Why opt for blaming the individual multiplied by 70 million rather than looking at the conditions of their shared environment?
>you think between the 50's and now human beings innately changed to be lazier, more prone to overconsumption? Why opt for blaming the individual multiplied by 70 million rather than looking at the conditions of their shared environment?
Subdivisions basically didn't exist in the US in the 1950s; they were only just being invented then. People lived in smaller towns and cities and walked around a lot more. Even in the 80s, kids were walking around outside a lot, without adult supervision. Now that's basically illegal in most places, so kids stay in their suburban homes all day playing video games.
And, as usual, you can compare to other countries. In other places, there's less of a car culture, people walk around a lot more, and there aren't many obese people.
I'm not certain but I think we're in perfect agreement here. The environment in which people live has changed and I think that should be the obvious first target to change.
I think this urge to blame people for the effects of their environment seen in the one of the parent post is an example of a very dark part of our attitude toward change. It is very easy and tempting to short circuit into ridiculing positive changes in favor of instead attempting to fix it by punishment/shaming ("People will literally rezone entire cities rather than saying we need to eat less food and workout more")
The "you are beautiful no matter how you look" social campaign probably doesn't help here. There are literally visual cues that you 're doing something in excess and your doctor tells you to lose weight but Instagram says it's ok to be obese. I wonder if there's a limit to it, is it still ok to be twice your normal weight overweight?
Do you live in the US? Fat people are routinely discriminated against in employment and healthcare. A few Instagram influencers and ad campaigns don't negate that.
I have never met a fat person who wasn't aware they are fat. I do know two people who have failed to lose significant weight even after bariatric surgery physically restricted how much they could eat.
After even the most extreme medical intervention fails and you are still obese, what can you do? Stay inside your home forever so that thin people are not forced to look at you? Never eat a piece of cake in public? Never go shopping, never date, never dance?
Of course not. In the end the only choice is to live your life anyway, in spite of your reduced opportunities and the judgment you receive from others.
If you're brave, you might even dare to post photos of yourself on Instagram.
> I have never met a fat person who wasn't aware they are fat.
"Today, 7 in 10 Americans are obese or overweight, but only 36 percent think they have a weight problem. In other words, close to half the people who are overweight or obese don't think they're overweight or obese."
I live in Europe. For employment that demands physical stamina it makes sense that fat people would not be favoured at the extreme level of obesity. My healthcare provider differentiates between overweight and obese and you can't treat triage as discrimination. There's a whole lot of middle ground between staying in your home not eating cake and promoting yourself on Instagram. Date and dance as you see fit.
The kind of discrimination I am talking about is refusing to hire fat people for desk jobs (or not promoting them, or paying them less) because of stereotypes that they are lazy or lack self-discipline or simple distaste for the way they look. [1]
Categorizing a patient as overweight or obese is not discrimination. Dismissing their health concerns or providing lower-quality care because they are fat is. [2]
When you say "we've been telling people to do that for decades" I'm assuming you're referring to the accumulated scientific wisdom that says eating healthily and getting exercise is good for your health, and not the trillions of dollars spent advertising addictive sugar water, alchohol, cigarettes, sugar coated cereals for kids, subsidized beef and corn syrup and attacking every health recommendation as lies if it threatened someones profits?
It might actually be worth telling people to eat healthily and excercise as a consistent message before we abandon the idea.
Exactly this. Not sure how much of the scientific messaging reaches the lower socioeconomic subsets of society either, I don't think kids' obesity is because they 've tried everything to lose weight and can't help themselves or rather their parents don't really understand the intricacies of how processed food works. There's something that defies intuition about a 50g mars bar having the same calories as a 300g potato even if most people vaguely understand that 'sugar is bad for you' but can't really put it in perspective, what does that mean in practice? The dosage makes the poison.
The whole concept of "workout" is absurd considering how much effort and energy we spent in removing any physical challenge from our day-to-day life, especially considering how bad for the environment (global warming) the consequences are.
I am not saying that people should have to work hard for the simplest things in life, but just designing cities around short walking distances and cycling vs. driving even the shortest distances would mean better health and nicer and healthier cities.
On the contrary, people have been saying we need to eat less food and work out more for decades. The "just educate people and they'll make better choices" approach has not worked.
Has worked for me. I find the UK food labels on most products quite informative as a rule of thumb. I remember initially being very surprised at some food contains when I started paying attention and how very small things like Mars bars can have so many calories comparatively of course. I think there's something sinister about not wanting the consumer to know what your product contains.
This thread is full of people commenting along the lines of "I have been able to manage my weight successfully, so other people must be fat because they're lazy idiots."
HN is full of people who will accept nuance and complexity in technical discussions. Why not in this area as well, where individual biology, cultural expectations, economic incentives, and environmental factors intersect with personal choice?
The very point I'm trying to make is that human nature has not changed in the past 120 years. What has changed is the social and technological context in which we live.
Take a group of people from the 1900s and drop them in to the US in 2022, they would likely experience obesity at similar rates.
It's not that people made more virtuous choices in 1900, it's that food was scarcer, less palatable, and more nutritious, and physical activity was a part of daily life.
A busy suburban parent in a 2-income household did not need to squeeze in time to make a home-cooked meal and a Peloton workout around a 9-5 desk job with an hour+ car commute.
I think you should really think about the connection between public infrastructure and public lifestyle choices. If you think that infrastructure cannot both positively and negatively affect its populace then I'd find that a very interesting opinion on a board of primarily engineers.
When things like tax revenue-per-acre starts adding up, it’ll also be more affordable to live in denser areas.
By removing zoning restrictions, some communities will start becoming more walkable & mixed-use than others. Since it’s more cost efficient, it’ll be cheaper to own a townhome in a dense area than an equivalent townhome in a sprawling area (after the market equalizes & we can keep up with demand, because it’ll be sky-high for those walkable townhomes at first). But if zoning is reduced, supply will start to catch up.
People in sprawling communities will start needing to pay more for taxes for things like road maintenance etc since they have much higher costs per person than a dense area, further starting to push people to favor dense areas. Are people willing to pay the actual cost of living in remote areas like suburbs?
It’ll happen slowly at first, but just removing the current laws that prohibit that sort of development may actually enable those changes to happen automatically
everything's possible it's hard for me to imagine how it would work in some sprawling places like texas eg. houston or austin
I could that happening new/growing suburbs outside of cities like that though like as you say if they commit to a sane design/zoning before it's to late
> and start walking everywhere instead of driving.
This sounds nice until you actually look at most of America. Cities are designed around cars. I'm in a rather walkable city and the nearest grocery store is a mile away. That's not too bad, but other places I've lived it is 5+. Buses are bad (hour+ between pickups) or non-existent. It gets difficult to do all kinds of chores, visit the doctor or whatever. Even using a bike my grocery store shopping becomes a multi-hour experience that I have to do more than once a week where a car is 30 minutes and once every week because I can carry more. The experience is completely different in a city where I would rather actually walk than take a car. I don't think this is an uncommon experience either. What I'm trying to say is that it isn't great to just tell people to start walking but rather to recognize the design and incentives places by that design. The burdens that it creates. If you want people to walk more for their commutes then you need to design cities for walking. I've lived in many places in America where sidewalks are non-existent. If you live in these places and walk you either have a death wish or a DUI. But rather, build it and they will walk.
>This sounds nice until you actually look at most of America. Cities are designed around cars.
Right, and that's the problem. These cities are a product of choices that Americans have made over many decades, and now they're paying the piper.
>If you want people to walk more for their commutes then you need to design cities for walking.
No, Americans need to choose this for themselves, but they don't and they won't. They don't move to places like this, they don't demand it of their elected officials, they instead just buy big SUVs and move into subdivisions. Americans have chosen this lifestyle, and now it's costing them dearly.
Have you visited the U.S.? Suburban sprawl has made it a 1-2 hour walk one-way to a grocery store in many places (if you can walk there at all). In many places there isn't even a sidewalk.
Visit middle America. Specifically, visit The South. You'll find that many regions in The South do no have sidewalks. If you're also only visiting major cities then you are likely not to see these differences in architecture. It is easy to form a selection bias. No one here is saying that there aren't plenty of walkable cities in America, but we are saying that you'll find a substantial overlap between non-walkable cities and obesity. If you don't visit rural America, you won't see what we're discussing. Or don't attempt it.
Since most people are familiar with California I'll provide this reference which breaks it down by county. First graph is adults, second is low income children 5-19, and third graph is low income children 2-4. You will notice how the high obesity rates highly correlate with regions that are difficult to walk around in and are more rural.
Sure I've being to rural America and I know what you are talking about. But only one in 5 Americans lives in rural communities, vast majority lives in an urban setting. I was just suggesting in my comment that one can use uber to haul groceries.
Yeah, go watch the Not Just Bikes video and you'll see that what he's talking about isn't rural. But of course, you won't really see the issues unless you try to walk. When I was 19 I was living in Orange County (CA) and my car was in the shop. What was normally a 15 minute drive to work turned into a 3hr bus ride. I probably would have saved 15 minutes by walking, but these are the design differences. You probably wouldn't notice the difficulties unless you actually attempt to walk.
Anecdote time: I currently live in Texas, the closest grocery store is a hour walk. While living in Colorado it was a hour and a half, and in Florida it was 2 hours, all of these where easy 5 minute trips by a car and an excursion by foot.
If it was a 2 hour by foot, assuming an average of 3 mph walking, that's 6 miles away. For that to be a 5 minute trip by car you need to drive 72mph.
Reasonable on the interstate but as your driveway (nor the store entrance) are directly on an interstate, there has to be at least some stretch of slower driving bringing the average down, so the speed on the interstate section would have to be much higher to bring the overall average speed to 72 mph.
You're assuming a straight line and constant speeds. While this is naive for both situations the error will not average out.
Let me give a direct example. I pulled up google maps and what is a 10 minute car prediction (2.8 mi) is also a 54 minute walking estimation (2.7 mi) and a 17 minute bike estimation (2.8 mi). Also, 33-43 minutes by bus fwiw
Not to mention that all three of those states have major portions of the year where being outside that long can actually be dangerous. Either through dehydration and heat stroke (especially considering that on pavement temperature is higher) or through freezing temperatures (and potentially frozen over sidewalks).
For starters, they could stop encouraging unhealthy eating (cough food pyramid cough). We should be be eating like our grandparent's grandparents (or as I call it: 'A real food' diet) but instead they tell us to shun meat but feel free to eat all the heavily processed carbs with HFCS and canola oil foods you want. Don't eat red meat, but pizza and fries are just fine!
My two of my great-grandparents lived in the house where I was growing up as a kid and teenager. They were both born in 1905, both much thinner than their descendants and both lived to their mid 90s.
Their diet was closer to the food pyramid than mine has ever been. Breakfast every morning was either Quaker oatmeal, Creme of Wheat or a similar cereal, one piece of fruit and coffee. Their lunch and supper was impossibly boring arrangements of sandwiches, meat and potatoes with a vegetable on the side, and the occasional dessert once a week or so.
They didn't "shun" meat per se, but they did live through the depression, WWII rationing, etc, and really weren't used to large quantities of it outside of big holiday dinners.
I think you'd be hard pressed to find a nutritionist that recommends eating a lot of processed food. And red meat is a hazard, even though I agree that it tastes great. If you're not convinced, this YouTube channel does a good job of going over a lot of the science: https://m.youtube.com/watch?v=EtLNHvC4aUw
This is true. There are also, though, other environmental factors that make it harder to maintain healthy weight in postindustrial countries than it was in the past, even if you eat no processed foods, cap your calories and work out regularly. Pharmaceutical and industrial waste in the water supply, Roundup in the grain supply, pesticides, hormones in the meat. Personally I'm swayed by the argument that these are at the root of other issues too, like gluten intolerance.
I'm all for encouraging people to eat healthier but some of this is beyond what an average person can control unless you grow your own food and drink from your own well.
> unless you grow your own food and drink from your own well
there was a post a few days ago about Australia: home-farmed eggs have 40x more lead than the industrial ones, because of unchecked pollution in non-agricultural areas...
I was under the impression that that "40x" argument" largely speaks to pollution in cities and suburbs. Curious how the rural/urban breakdown relates to that number.
Michael Pollan advocates for this in his book, "In Defense of Food" [1], and to a lesser degree in "The Omnivore's Dilemma". The big take-away for me was (paraphrased) that ethnic cuisines worldwide built and supported civilizations over many generations. It's only been over the past couple generations that we've been able to deviate from traditional cooking, with the globalization and industrialization of our food supply, and that's led to poor eating habits. It's especially pronounced in the US because we have a pretty short and heterogeneous cultural history and identity. He basically advocates choosing an ethnic cuisine and sticking with it.
We can look at it from the source side, and assume that what gets produced gets eaten (not entirely accurate of course). How have food production, processing, preservation, and distribution changed?
An interpretation of the obesity epidemic and resulting health crisis is that we are now producing a toxic quantity of food.
>Healthcare systems can only do so much to compensate for a bad lifestyle.
And this right here is my problem. Healthcare doesn't only begin when you get to the doctor or the hospital. There's no reason that healthcare officials/leaders/experts/whatever can't recommend baseline levels of fitness for Americans, and provide help for getting to that standard. I don't know, maybe Healthcare plans should include subsidies for gym memberships by law.
From what I’ve observed, even with free gym and advice, most of people will still ignore it. It’s simply not convenient, especially for people who haven’t gotten into a routine.
I live in an extremely walkable neighbourhood of a fairly dense city, and honestly speaking, and just walking around to do my daily chores already helps with casual fitness. I do bike, swim and lift, but mostly for “fun” rather than for health. And before consistently working out, I weighed constant amount (+-4 pounds change depended on the season). Honestly, I want to blame the epidemic on cars and the convenience it brings to everyone.
I agree, and that was a glib suggestion of mine. It's a combination of cultural proclivities and the infrastructure. I was in the military, so I lift weights basically every day and either swim or run on the days I don't ... but that's because I've just had fitness culture inculcated in my mind since I was 18. I don't live in a city where I have to walk everywhere to get everything. But my fitness preferences do make me vote in certain ways (for candidates that encourage more public transit, bike lanes, and so on). Politics is downstream from culture, I suppose?
> From what I’ve observed, even with free gym and advice, most of people will still ignore it. It’s simply not convenient, especially for people who haven’t gotten into a routine.
Maybe we should consider stronger incentives.
Such as “exercise passports”, you can’t enter public spaces unless you did 30 minutes of exercise that day. Would solve the problem very quickly.
> I don't know, maybe Healthcare plans should include subsidies for gym memberships by law.
I can only imagine the level of added bureaucracy , certifications for gyms to qualify, and spiraling prices for gym users without healthcare plans through white collar salaried jobs. Just look at health care costs over the past 50 years as lengthier and lengthier laws have been passed in the hopes of shifting incentives and otherwise tweaking the system.
Average amount of exercise has gone up and average amount of alcohol consumed has gone down. Those two factors alone cannot explain the steady rise in obesity starting in the 1980s in the US and other developed nations. This[0] analysis points to environmental contamination, specifically three candidates: animal antibiotics, PFAs, and lithium.
For most people weight creeps up on them slowly. Losing a lot of weight quickly does require radical changes to diet, but not putting on the pounds in the first place is generally going to be a matter of burning an extra few hundred calories a day.
Also, just not being sedentary all day is associated with a ton of positive health outcomes (possibly mental even more than physical) independent of body fat percentage. So it’s worth it all on its own.
Of course! Nobody can deny the panacea that is exercise. But it's still a widely misunderstood concept. Throughout many of these comments, people are claiming that the remedy to obesity is more exercise, but I hold that indeed a much larger component of combatting obesity is diet, not exercise.
I’d say on a population level exercise (as in more active, less sedentary lifestyles) will be a large factor. Though on an individual level you are right that diet will be the big thing.
Though population level there is also a lot of food policy and incentive structures we could alter to improve diets in general as well.
it’s not a lifestyle problem. neither willpower nor lifestyles have changed much. processed carbs being addictive, however…
medication that treats it like the medical problem it is, instead of berating people for a lack of willpower that they were never missing to begin with, will fix it
It's absolutely a lifestyle problem. Americans have a shitty car-based lifestyle that causes obesity. Go to Manhattan and see how many obese people you see; there aren't many. Or go to any other country where people walk a lot. This is uniquely a western, and especially American problem.
Correlation is not causation. Manhattan has many thins because thins are more likely to make more money and get better jobs in high-standard-of-living areas due to commanding more respect. (Which they mostly do not deserve, being mainly the beneficiaries of good genes, but I digress) Also, most people move out to the ‘burbs to raise kids, so Manhattan is strongly weighted towards the under-40 set.
> any other country
OK let’s pick Germany. (I’m German.) Most Germans are thin because they don’t eat many carbs at all. Orange juice is expensive and piss-poor compared to sugary American OJ. Breakfast typically consists of unleavened-style breads, mustard, and meats. Gas is super expensive so everybody walks or bikes. But guess what? Obesity is steadily rising there too! Gosh, I wonder why, with all that walking and biking? Wait, I know… They just need MORE walking and biking, that must be it!
Lifestyles haven't changed? Come now, in just my lifetime I've seen kids go from being outside everywhere playing until dark, to being mostly inside all day. And I live in a very active community!
With regards to changes in willpower, that seems like a strong assertion, got any sources on that?
100% agree that our diet (generally) has changed drastically.
But I don't get your jump of why medication has to be the solution? Maybe undoing some of the changes that got us here?
Sure, in many cases where they're already well down the road of obesity and experiencing its negative health consequences - yes medication can be useful. But that's far from the only option at hand here.
> With regards to changes in willpower, that seems like a strong assertion, got any sources on that?
How is it a strong assertion that willpower HAS NOT changed? Isn’t that the null hypothesis? It seems to me that you’d need evidence that it HAS changed
Take a look at your average individual from 100 or so years ago: probably working a manual job, lived through a depression and world war. Life was certainly harder for most in many basic ways. Obviously not true for all, but generally speaking quality of life has improved a lot.
Our culture is light years away from that in terms of the resilience that's generally expected from people.
Yes, I think it's fair to question the assumption that willpower has not changed.
That’s because amphetamines were a piss-poor solution. Meds like Mounjaro, which directly eliminate hunger hormonally in the brain instead of simply being a side-effect of brain overstimulation, seem like a significantly better option to me
Disclaimer: Been on Mounjaro for 1 month and have lost 15 pounds absolutely effortlessly and with zero side effects
Poor health is extremely profitable in the US. From the food industry to healthcare. Drug addiction is profitable. There's little incentive to do much about it at a public level.
obesity isn't a crisis of the healthcare system, it's a cultural crisis at a macro level. You don't need 'healthcare advice' as if giving individual people recommendations has any meaningful impact, you need to tackle it a social level. Living designed around movement rather than cars, prices up on high calorie foods, nationwide exercise programs in schools, put a ban on all ads for sugary drinks like Singapore did, etc.
Nobody likes to be obese or genuinely thinks it's better, they just post-rationalize it to feel better about a situation they deem to hard to change, in the same way some deaf people rationalize it's actually better to literally not hear. Humans will tell themselves anything to cope, and the only hope we have is that other humans call that out instead of enabling it. Or we just let society crumble from a health crisis that is totally preventable.
Health care money is limited and obesity kills people with other illnesses by taking away resources.
Obese guy here, we know. We don't really need the health system to tell us to drop weight (though of course, as a doctor inform us anyway). What we need is a sufficiently strong reason. Food is great and tasty, so we need a really good reason.
Mind you, everything is also more difficult as an obese person, so convincing me to lose weight so that I can e.g run better is really kinda pointless.
Doctors and the medical system can help with the issues around it, and manage the effects, but they are really the wrong place to solve it.
And no, the answer isn't making the streets more walkable (the streets around where I live are pretty walkable), or more places to exercise, since obesity is a diet thing.
And there is the issue, I think. The modern world is outstanding at solving wants by adding things. The problem is here you have to solve a problem by removing things.
I don't think this problem is solvable in the modern world at all, unless you are willing to institute calorie ration cards.
Obese people are simply a market for healthcare system. They have totally no incentive to do anything about it - will mean leaving tons and tons of money on the table.
Preventative healthcare kills repeat business.
Anecdata of n = 1 but two weeks ago I was hospitalized due to a stroke (IA).
I'm 38 years old, exercise vigorously for 10-12 hours per week, am a healthy weight for my height, have good blood pressure and cholesterol, and have zero known risk factors other than a COVID infection a bit under a year ago. I'm not ready to blame COVID just yet (we're still searching for an underlying cause) but my doctors and nurses all described a highly concerning uptick of strokes over the past few years, including for those like me who are generally in good health.
I was lucky to have recovered with essentially no noticeable deficiencies, but many of those with similar stories I've spoken with in the weeks since weren't so lucky and have permanent impairment.
Sudden onset as far as I can tell. I woke up almost entirely unable to move anything on the right side of my body, and was only able to speak individual words with significant effort.
I had a mini stroke, with long lasting problems. Look up “dormant neurons” and hyperbaric oxygen therapy. I did a relatively extended treatment and it helped me tremendously. I really wish I would have done it sooner. I might have been able to save a bit more of my brain.
Besides significant improvements in my work life, the big win for me was eliminating some anger problems that showed up after the TIA, and getting my sense of humor back! Considering my brain is my money maker, it was completely worth it (around $4k for 30 or 40 sessions, I believe).
My TIA involved significant turbulence in my blood flow, so perhaps my capillaries were extra clogged, but you should seriously consider it, if you have any lingering changes. There are quite a few studies about it. The most promising I found involved Oxiracetam, so I included that, as part of my treatment (with my doctors approval, and proper choline supplementation).
I'm sorry to hear about your situation but extremely glad to hear you've found a path towards recovery!
As I said in my previous post, I'm extremely lucky. I recovered on my own about 30 minutes post-onset, although I do have a small remaining permanent clot (presumably from the original one breaking up) that has caused permanent injury to a small area that my neurologist says should cause no noticeable impact.
I'm terrified though that even though we haven't found any deficiencies yet, there might be long-lasting personality changes that are harder to pin down. At least so far all my friends seem to believe that I'm still pretty much the same person I was prior to the stroke, which is an enormous relief. But I'll look into that therapy just in case we do find a reason to pursue something like that, thanks!
If I may ask, the worst part of it for me so far is that I haven't had a good night of sleep since. Since it happened while I was sleeping, it's like I don't trust that my body won't try to off me in my sleep again for no reason. So I wake up halfway through the night in a panic that my body is betraying me again, and it takes awhile for me to convince myself that everything is alright to be able to go back to sleep. Have you dealt with anything that at all?
Yeah, I think I went through something similar. The realization of fragility really got to me for a while, and I think my perspective about how temporary life is has permanently shifted. I feel like I'm just more anxious, in general, because I feel like it's going to crash down at some point. It makes me feel like I'm always in a hurry. Maybe it will eventually be a positive, where I came to terms with it, and put more effort to cherish every day, rather realizing it when I'm old, and it's too late?
I would still consider the oxygen therapy, since it could bring back some of the tissue around that clot. I also did it in an attempt to reduce the chances of Alzheimers, which we are now many times more likely to get.
My quality of life decreased after my booster shot. Had severe reaction and my athletic performance dropped quite a bit afterwards never going back to the baseline pre-vaccine. Also having more heart palpitations and a decrease on VO2max.
But apparently when I talk about this, I am either labelled anti-vaxx (even though I got the damn vaccine), a conspiracy crazy or people try to justify my issues with something else that magically coincided with the date I took the booster.
My young healthy sister got myocarditis after her booster and had to be hospitalized. This is after successfully fighting off a covid infection months prior.
I'm far from antivax, and have had 3 shots myself. But it's crazy that you aren't allowed to talk about this stuff without being labeled a conspiracy theorist.
Another point of anecdata here: After my AZ booster (2 first vaccines were pfizer) I got a micro stroke (Lacunar Tia). My QoL also decreased after that. Too bad it's currently a taboo to talk about these sort of things.
Filing with the vaccine injury court and reporting this adverse event will have a far more effective impact than encouraging people to draw conclusions and take action based on selection-biased anecdata posted to Hacker News.
I did, of course, post my own anecdata. But it's much harder for people to choose whether or not to actually become infected by COVID than it is to decide whether or not to vaccinate.
You'll also note that we are now in fact having the pointless argument I predicted.
(it's literally the same publication from the CDC, just a year later)
At that time, the CDC announced a dramatic decline in life expectancy by extrapolating one-year changes in death rates over the entire expected lifetime of someone born in 2020. This makes small differences look huge. But of course, that's not realistic at all -- we had a significant short-term change in certain age groups (mostly elderly).
When you calculate the impact on life expectancy without assuming that every year after 2020 will look just like 2020, the change is only a few days.
Low carb diet helped me with this. Calories in calories out, but if you have a lot of carbs you are going to get hungry when restricting the calories, whereas on a low carb diet I sometimes have to think hard as to whether I have had breakfast or not by 10am. Having woke up at 7am. "Oh I should probably eat something..."
I think I have less than 50g of carbs a day, and probably 1500 calories but I don't track it too closely. I also do strength, but a little each day and make it incidental. I might play with the TRX or do a few pull up or dips at the park while the dogs are off leash.
Something that makes it easier is there are low carb treats and drinks. It does mean taking in more alcohol (as in chemically an alcohol, not ethanol) based sweeteners, so I worry about that a little.
For someone who doesn't go out much this is easy, but in your younger years with social pressure it might take a lot of will power, and even changing your friends and breaking up with partners and so forth to support this kind of habit, since it goes counter to the average person's culture in the west. Especially quitting alcohol too.
Quitting alcohol and going to OMAD (one meal a day) helped me lose 20 kilos in < 2 months. And I wasn’t even obese, that was straight from overweight to goal weight. Alcohol is an enormous contributor to weight for several different reasons. Plus, the weight you get as a drinker (the “hard” fat) is the worst kind of fat your body can have.
Wow, 20 kilos in less than 2 months seems like a heck of a lot. Any issues with gallstones?
I lost a nice bit of weight at the start of the pandemic when I stopped drinking (primarily a beer drinker). It is really surprising how much of an effect it can have.
The rule I have seen, and have followed is to target 1-2 lbs (about 0.5-1kg) per week. Any more than this and you start having issues where your skin doesn’t shrink at that same rate, or your body having issues baselining to the new weight[0]
Personally, while tough to keep that as an average weight, I was successful doing this, primarily by going to one meal a day, and limiting calories (especially carbohydrates). Only issue is your body does end up burning fat, which makes your feel a bit more “oily”.
As with all guidelines, this always depends on the starting point and personal data.
If you are on the heavier side and a heavy drinker and carb eater, going low carb/no alcohol you will lose easily 10 kilos in a month (mostly being water weight).
If you are a healthy weight and eating normally with a glass of wine here and there, 0.5-1kg is probably a good range (and probably around 70% of it being fat loss)
If you are lean, 0.25-0.5kg a week is a good goal (and probably 50% will be fat).
No issues with gallstones. It was 230 lb to 185 lbs also at the start of the pandemic (May-July 2020). I have managed to mostly keep it off (currently 190, but have yo-yo’d back up to 200 once), despite resuming drinking and being a semi heavy drinker. Mostly due to diligence around keeping an OMAD style diet.
Alcohol makes you crave calories in general and specifically carbs, which is in my experience a double whammy. I might never even want a pizza for weeks, but put three beers in me and I want to eat half or more of a large pizza.
I have also done one meal a day previously, works wonders. For those interested, it's difficult for the first week but it gets much easier after that. Was able to lose 20 pounds last year without changing exercise.
A lot of success in fixing your diet comes from experimenting and seeing what works for you. Low carb can help some people, while particular carb-heavy but satiating foods like oats or potatoes can help others. I don't think it's always clear-cut.
“Healthy at any size” is a reasonable stance, and one in reaction to a medical system and social norm of being mean and hateful towards overweight people. BMI is not the only measure of health, but doctors will regularly tell heavyset patients with real other diseases to lose weight.
Fat people are literally the only group where it’s just OK to make fun of them, in many circles.
Even for those who are overweight and unhealthy, berating and shaming someone is never going to be a way to help someone heal.
It’s okay to shame smokers because they are hurting more than just themselves with second hand smoke. But it’s not okay to shame fat parents who let their kids get fat even tho that’s hurting others. The logical conclusion of what you’re asking for is absolving people of accountability for their poor life choices. People rightly and understandably vehemently disagree with this.
"Healthy at any size" does not literally mean "obese people are as healthy as thin people."
I recommend reading the book, the entire point of which is about shifting one's health efforts from an exclusive focus on weight to a more holistic view.
I.e. even if you can't drop that last 20 pounds (and many people struggle to do so, especially as they age), you should still eat a healthy diet, exercise, limit alcohol intake and avoid smoking.
The "healthy at any size" kick isn't talking about an extra 20 pounds. From the pictures I've seen it is at least an extra 100lbs. The problem is by removing the stigma of being obese, we are ushering in massive health issues and disease for this upcoming generation.
Shockingly, it turns out if you tell someone with 100 lbs to lose that they are a disgusting lazy piece of shit doomed to an early grave, they tend to withdraw from health care and other social settings, seek comfort in unhealthy habits, and suffer from anxiety and depression. They may give up on their health entirely. After all, if you've struggled your entire life to lose weight and made little progress, then what's the point?
It's like not that there are fewer overweight people, they're virtually impossible to find. Today I feel like almost anywhere you look there are people with such problems it's affecting their gait.
I don't think it's constructive to blame the people that have gotten fatter. It really doesn't add up that all these hundreds of millions of people collectively at the same time lost their resolve and and willpower. Seems far more convincing if there are environmental factors at play.
The big wake up call for me was a few years earlier. I had just hit 130Kg (285+ pounds) and I had just had enough of it all! By the time I had COVID earlier this year I was down to around 90Kg (198 pounds) - I get the feeling that helped out immensely compared with how I used to be. Vaccines also did their part combined with the lessening impacts of the various variants.
The other thing that got brought to my attention was an off handed comment about various health issues that are impacting populations. Things like declining fertility and increasing health issues almost always correlate more with obesity rather than the environmental factors. Yes, correlation is not causation but it does seem at fairly plausible.
For example could things like micro plastics be doing these things? Yes. But one would expect these to be near global - yet the impacts are felt mostly in obese nations. It could potentially be a threat multiplier however.
The rise in obesity is likely environmental. It's entirely possible that microplastics or PFAS (or whatever contaminant you want to point the finger at) causes obesity, which then causes health issues.
It’s lifestyle: Americans lead the world in both obesity and car centric lifestyles, and we have a ton of reinforcing factors – suburbs designed around cars are unpleasant/unsafe to be active in, people eat unhealthy food because it’s cheap (cars and suburbs are both more expensive) and something they can eat in the car or pickup on the way home, kids are prevented from exercising because there are few safe places in their neighborhoods, etc.
Americans who live in walkable settings are healthier on average but it’s not like they aren’t exposed to the same chemicals as their suburban counterparts.
What proof do you have that it's lifestyle? My opinion is loosely based on http://achemicalhunger.com/, specifically the papers that found wild animals are getting fat, and the timing.
The things you say are all true, but they were also true to a lesser extent in the 60s, when Americans were much less obese than they are now. They're also not true for wild animals.
International comparison. Countries with just as bad chemical/microplastic/PFAS contamination, be it France or China or Japan have far fewer obese people. Coincidentally they also have less car-centric lifestyles.
> The things you say are all true, but they were also true to a lesser extent in the 60s, when Americans were much less obese than they are now.
You're talking about movements over time — it's not like everyone moved out to the suburbs in 1955, and in the 1960s you still had a lot of people living in more urban walkable environments (the riots in the 60s and crime in the 70s really ramped up suburban flight). American leaders were already talking about an obesity crisis by the 1960s (the flawed dietary guidelines in the 1970s were a “we don't have time to wait!” response to decades of that trend) but it just kept getting worse over time, which seems to track with an increasingly car-dominant lifecycle.
That site doesn't have a good reputation and I would especially be careful about drawing conclusions from a single study of one type of animal. There's an especially big confound that many “wild” animals have still had significant habitat disruption from humans and it's not clear whether those macaques have access to human food, crops, etc. which would not otherwise have been the case.
Suburbs are very walkable. You don't always have to have a destination to walk to. My wife & I walk every night for an hour and enjoy observing our neighborhood.
It's nice that the suburb you lived in is enjoyable to walk in, but that's not what the word "walkable" means in the context of a neighborhood. Walkable means you can accomplish daily tasks by using walking as a mode of transportation, not just a form of leisure.
To address your main point, many US suburbs are not safe to walk in. Many suburbs lack things like sidewalks, crosswalks, and traffic signals for pedestrians because pedestrians are a complete afterthought. Other places have a sidewalk but no shade, or are by roads with loud high-speed traffic so they're not pleasant to walk in. I've lived in all of these kinds of places and it really affects your willingness to walk anywhere.
That's too bad. In the area around where I live I have yet to encounter a suburb that doesn't have sidewalks!
I understand what you meant by "walkability". I also don't think it's fun or practical. I tend to visit a lot of different stores, not just one or two. But I only go out shopping once a week or two, not daily. That sounds exhausting.
I also hate super dense living being packed in like sardines with everyone else. It's nice having a house with a decent sized yard and 10+ trees. Plenty of space and isolation, but at the same time close enough to friendly neighbors to socialize with. More Americans should give small to mid size cities a chance. They have a lot to offer. Far cheaper too, our neighborhood definitely isn't wealthy.
> That's too bad. In the area around where I live I have yet to encounter a suburb that doesn't have sidewalks!
It’s often linked to ugly history: when we were shopping around here in the DC area, there were tons of suburban houses with no sidewalks and transit-hostile road design which were built right after the major civil rights wins, when the thinking was that most black people couldn’t afford cars.
> I understand what you meant by "walkability". I also don't think it's fun or practical.
My thinking is that it’s less about fun than barriers to activity and car-centricity. If exercise is something which requires traveling elsewhere or you have to do on will-power an awful lot of people won’t do it very much, especially over time (maybe they walk the exercise trail when they first move in but lose interest over time because there’s only one route and that gets monotonous, etc.). Having kids is eye-opening that way when you’re seeing where they can go safely and under their own power, not to mention parents realizing how long they’ll be playing chauffeur.
The car centric point I mentioned is related: cars are expensive ($11k/year on average in 2019) so when your household has purchased one per adult you typically end up treating them as your default mode of transportation, which over time degrades your body and conditions you to think of being outside of air conditioning as outliers, and cars are dangerous which further reduces your options. Kids are driven to parks 3 blocks away because their parents are worried they’ll get hit by a car; pedestrian routes are hot, noisy, and extra long; etc.
Obviously they’re useful too but I don’t think it’s coincidence that obesity has been going up as an increasingly large fraction of people live in environments designed to be used while sitting sedentary in a machine.
City living isn’t without its own problems but when you get 10k steps without even making an effort to exercise it helps.
> But I only go out shopping once a week or two, not daily. That sounds exhausting.
It's not exhausting when it's just a couple of blocks away. I live about 5 a minute walk from our local grocery store, so it can be a nice break to pop over there for a couple things multiple times a week. There's no ceremony to it at all since there's no hassle of parking and it's easy to go when the store isn't crowded. An added benefit is that I can plan less and also waste less food, because I go to the store more often and get exactly what I need.
Exhausting in the time sense. I don't have much free time and the little I do I value a lot. Even if it is a few blocks that's a 30 minute trip each day.
Sure it can be fun occasionally, but I'd hate to do it regularly.
It's fairly obvious when you travel to places with high obesity that the problem is environmental, but microplastics aren't even going to be in the top 20 reasons for that. The food culture in those places is just completely busted. You can sense it even in layovers at US airports.
Obesity can be an indicator of health, but I'd be careful about drawing the conclusion that obese people are dying at higher rates simply due to their weight.
When it comes to Covid, I'd bet on a physically active obese person having a better chance at survival over healthier looking people who aren't active, smoke, etc.
The good news is that maybe we got it backwards, in at least some of the cases[1]:
> Higher fasting insulin and higher c-reactive protein confound the association between BMI and the risk of all-cause mortality. The increase in mortality that has been attributed to higher BMI is more likely due to hyperinsulinemia and inflammation rather than obesity.
What i understood (this is quite new and i haven't had time to research this): Some nutritionists and medical practitioner think that most obesity (the >35BMI kind) are caused by hormones (some gland inflammation, like i said i didn't researched this) or prediabetes. Hence why European immigrants are not hit the same as natives in the US, as phylogenetic have quite an impact on hormones production.
This was an old theory and some recent research proved that at least it needs to be investigated more seriously.
In general hormones effect on human development, while being quite an active field, seems to be still underfunded or at least more ignored than it should be.
imo, one of the biggest causes of obesity is calories in drinks. sodas, juices, and alcohol are all incredibly easy ways to add a few thousand calories per week to your diet without filing you up at all. milk is slightly better (but only because it naturally has a much smaller serving size).
I am obese. I am a tall guy who had been athletic most of my life until moving into the corporate world and spending most of my time at work at a desk. I dont' drink or smoke. I am still quite active on the weekends and weekdays. I am in Japan currently so I walk alot.
But I've still been struggling for the past 8 years trying to lose weight and I even moved to Japan to try to put myself in an environment that generally has healthy food options.
By FAR the biggest impact I've found on my weight is coca cola and other sugary type drinks. Unfortunately I am addicted to it and have a really hard time stopping.
Right now I'm in a good spot, losing weight, and feeling pretty healthy and what helped immensely was Japan restaurants always having green tea and other healthy drink options so it could help me avoid drinking coke. I still love coke and I am always wanting that or dr. pepper or something similar. Whenever I go back to the US and go out to eat I really struggle finding drink options that are healthy and that I enjoy and its so easy to just order a soda.
I imagine that are millions of people that are like me - generally healthy but because they drink coke or other sugary drinks on a regular basis they are killing themselves. I am pretty sure that the obesity situation won't go away if people are drinking sugary drinks all the time like I was. It was super difficult for me to stop in Japan even when I was away from that type of culture.
Additionally there was another post here that I really agree with: "The good news is that maybe we got it backwards, in at least some of the cases[1]:
> Higher fasting insulin and higher c-reactive protein confound the association between BMI and the risk of all-cause mortality. The increase in mortality that has been attributed to higher BMI is more likely due to hyperinsulinemia and inflammation rather than obesity."
When COVID started I stopped going outside because of lockdowns and worry about my obesity and it really impacted my health. I started feeling much worse all the time because I wasn't' active and I became very sensitive to the food i was eating. I realized that my blood sugar was going all over the place depending on what I eat and I believe I had high levels of inflammation due to that. I then switched to a diet that balanced my blood sugar much more (Stopped eating pasta, or lots of bread, and other things that spike your blood sugar and switched to eating Kind Bars and mostly protein or green things when i felt hungry) and even before i started losing weight this made a huge difference in my standard of living and how I felt. I was still the same weight but my general health and concentration increased a lot and was one of the reasons I could start having energy to focus on losing weight.
I'm not overweight, I'm a double-vaxxed, very athletic (weight training and running habits) and I got nailed hard on the post-acute sequalae front. Dry cough, shortness of breath lasted over two months. I had to completely stop strength training as it's a known risk factor for long covid-inspired problems like mitochondrial dysfunction and dysautonomia. I had the latter and it was a deeply existentially displeasurable experience.
I got back into it not long ago and feel I've dodged a bullet, and learned a lot about how not to take health for granted.
That’s an interesting point, I wonder how much of obesity is contributing factor to consuming fast food such as cola or sodas and burgers etc. because McDonalds were around even in the 70s. Or perhaps the obesity is propagating through genetic changes passed on from people who started consuming fast food at mass scale only after a generation or two?
Obesity is to health what nuclear is to the energy debate.
A political side that:
dislikes universal medicine
dislikes decent city planning
dislikes pollution controls
dislikes regulating food advertising
dislikes government health info
dislikes taxing externalities like sugar
dislikes regulating medicines
dislikes harm reduction strategies for addiction
dislikes wearing masks
I could continue...
really doesnt want to talk about those things that they are obviously and provably on the wrong side of. So they've convinced themselves that their political enemies are all saying "being clinically obese is politically correct" and therefore they can get really upset at them for the problem.
Problem is, this is mostly not true. Their political enemies want to stop bullying, and victim blaming and people having body image issues because they don't look like a airbrushed Barbie doll or GI Joe on steroids. Which is good.
Their take on that, presenting it as a threat to health, is just deflection, and while I'm sure they sucked in a few misinformed but well meaning people at first, it feels more and more desperate, more and more deliberate misdirection as time goes on.
We have the web. We have access to academic journals. If the average software dev chooses to be misinformed on these topics then they're no better than a flat earther.
The article has figures backing up its claims. Do you have any evidence to support your statement that obesity/COVID have caused this decline in overall life expectancy?
Age is a multiple times larger risk factor for COVID risk than weight. So while weight is important, the real elephant in the room is an ageing population?
Very few people refuse to talk about aging, and it's not a problem we are equipped to solve or something unfamiliar to us as a species.
Plenty refuse to talk about rising obesity rates, and it's not only something we can address now but also a massive change (no pun intended) that has taken place in living memory.
You used the word literally four times in your post, and even twice in one sentence.
What's the fascination with this word? It seems to be used to add completely unneeded emphasis, rather than anything resembling its original definition.
Covid literally attacks obese people. And obese people also are at huge risk. I'm overweight and I was literally frightened during covid.
Now I lift weights every day and work on my diet very hard.
But we are literally ignoring the elephant (literally) in the room.