Obesity in America is an undeclared national emergency. POTUS should invoke the Defense Production Act to nationalize the production of generic tirzepatide at a cost of $50/month for bulk compounded injectables. Compensate Lilly $10 billion and let that be that because national welfare is more important than profits.
This reply is so "American" I find it hard to believe it's not satire.
The, IMO, logical solution would be to change the underlying problem. Maybe even through some "national emergency". Force the food industry to change, help people to make healthy decisions, punish/rewards etc. But no: let's put everyone on medication.
I could imagine the latter to be a legitimate option if a country's people have some genetic trait that makes obesity harder to fight. But I don't believe that's the case in the US.
Nobody wants their car infrastructure taken away or reduced. But everyone loves living in the places where car infrastructure was taken away or reduced. It's a well-known conundrum. One that takes strong political will, leaders, a crisis or all of that.
I live in the Netherlands, which in the '70s and '80s was just as car infested as any place. Part luck, part timing and part political caused it to turn away from that, invest in bikes. And not top-down, nor bottom-up, just an accidental "perfect storm". We're now a in a situation where PT, car and bike infrastructure are a complex network that co-exists and is highly efficient. Where virtually everyone has (at least) one bike, takes that to work/school on average almost daily and also travels by car, train and other PT a lot. But where, above all, this is commonly seen as something good and people do feel really happy in it.
And even here, still, removing stroads or parking lots to turn them into parks, restaurant-areas or pedestrianized areas, will always meet a lot of resistance from people who think the cars are crucial to their lives/businesses/shops/schools. Yet when it's pushed through, generally, even those opposing it, often are much happier with the space after cars were removed from it.
However, I’m struggling to imagine how centralised actions would work. e.g.:
* Food and food ingredients are probably part of the problem, yet lots of people in America also manage to not be obese. There are some low-hanging fruit (eg high fructose corn syrup and saturated fats), but how far to go and where to stop? Also, this would generate a huge fight with those industries affected.
* We could create economic incentives or disincentives, but give there’re links between obesity and lower socioeconomic status, this would hit poor people harder and potentially exacerbate inequality.
* Education also seems like a rational response, but agreeing the ‘truth’ to educate people with would be a difficult fight! As in, the ‘Standard American Diet’ pyramid taught for generations and supported by “experts” is arguably a very bad diet to teach people to follow, yet misaligned incentives and economic influences meant that it persisted for generations. If that dogma was changed, where to go: low carb, vs. plant-based, vs. calorie counting, vs. paleo/primal, vs. intermittent fasting…?
And ultimately, as we saw during the pandemic, large groups of people are able to be stubborn and make scientifically bad decisions, especially in this world of ever-more polarised politics. You really think the anti-maskers will cope well with centralised (“communist”) meddling with their freedoms around food and drink?
> However, I’m struggling to imagine how centralised actions would work.
Don't imagine, just have a look at what is happening in other countries. Overlooking the world outside of the USA is also very "American".
Chile has the same problem with obesity. Some national policies where introduced, including mandatory information on food packages and a sugar tax. Of course, it did not magically solve the problem, but the obesity pandemic is decelerating, and the sales of unhealthy food have dropped, especially for children.
Other countries have introduced similar rules for mandatory package labels. In this domain, Mexico and Canada are ahead of the USA.
Adding one can of soda to your diet, and changing nothing else, will see you gain 10lbs in a year, or 50 in five. Sugar alone explains a substantial portion of the obesity epidemic. A sugar tax, were there political will for it, would go a long way and be far and away the simplest approach. Our political system is just so dysfunctional right now, it shard to imagine it happening anytime soon at scale.
I'd say that "centralized" action should first and foremost counter the "centralized systems" that cause this. food lobby, medicine lobby, car manufacturers. All their marketing, sales and "information supply".
One can argue that e.g. Coca Cola or Mac Donalds are mere players in a vast decentralised market, but everyone knows they are at best oligopolies and at worst centralized monopolies with a clear financial incentive to sell their inherently unhealthy products. Your local farmer, selling stuff for home cooked meals isn't anything close to a true competitor to these multinationals.
Eliminate zoning to enable functional walkable communities
Tax sugar (and eliminate subsidies for corn that goes into corn syrup)
The anti-maskers are going to be crybabies about literally anything. If we invented yellow paint today they’d insist it couldn’t be put on roads because they sometimes prefer to drive on the left side. We can’t let our country be permanently held hostage by the tyranny of the minority.
This idea is the natural conclusion of interventionist medicine culture where preventative measures and working the root causes are both disliked.
It has been shown, for example, that statins prevent much of the heart disease that kills middle-aged people, but this medication needs to be taken for decades before. And yet in many countries, although it is a known fact and statins are safe, doctors don’t prescribe it until people have heart failure and it won’t help much anyways.
Our approach to pain management has also shifted a lot in the last 2-4 decades. Managing pain was about finding the root cause and treating it. Now its about hiding the symptoms with paracetamol and ibuprofen.
Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common. We in the West also know the science, but more often than appropriate make fun of Asians exercising in the parks every morning. Then we medicate for all the symptoms of diseases that obesity brings. Doctors do not even prescribe exercise to most obese people. That is a prescription which is very effective with $0 monthly costs.
The goal is not quality of life. It is not to prevent disease, or to holistically treat it. The goal is to do interventions to prevent death.
And maybe that’s more liberal in a way — people can live their lives more consequence-free, enjoy unhealthy habits, and know that some % will be bailed out of their coffins just before things get bad enough. Ozempic is such a bail-out.
Yes, Ozempic is an effective drug in reversing obesity. It is a great drug. It will give people back many years of their lives that would have been lost to obesity. Maybe it is even as effective as good exercise habits, which cost $0 and have about 0 side-effects. It is definitely not a better option than exercise for most of the population. But if it’s the only option possible in our healthcare culture, then it is still very valuable. It just won’t end the obesity epidemic. A health culture that only prevents death simply does not concern itself with improving the quality of life.
Unfortunately, we are also quite proud to have such a dysfunctional culture.
> Exercise is a known and very effective treatment for obesity. Many cultures in the East accept it and group exercises in public are common.
The second sentence. What does this mean? Are you talking about elderly Chinese people doing Tai Chi? It is neither building muscle (resistance training) nor improving cardiovascular health. Sure, it might help with mental health, like yoga, but not for muscles/heart/lungs. And the rest of "the East"? Have you seen India? There are an incredible number of obese people in that country. I would guess that Korean, Japanese, and Vietnamese have lower obesity rates because of portion control and caloric density in their traditional diets. However, in the urban populations of Korea and Japan, obesity is rapidly increasing as processed food increases in their diets.
I was not taking about specifically Tai Chi. But I remember from public health classes in medschool that it is known for increasing flexibility and mobility, as well as improving balance and reducing falls in elderly. I also remember something about backwards walking/sageru exercises in Japan, but it is difficult for me to find much online about it.
I was talking about the broader culture that values Tai Chi. Tai Chi is one of “morning exercises” in China. Others include just walking. But my point was about a culture that incorporates morning exercises as a norm. Japan has “radio taiso”, which is a similar phenomenon. I think the West had a similar culture in the 80s and 90s. I was actually growing up in the Central Europe then, and it was normal in elementary and middle school to start the day with a 30-minute exercise lead by school staff.
I don’t know how to label this culture but “culture where it is the norm to exercise daily”.
Yes, as you say, obesity also has many, many other causes. And many other cures. It’s definitely not so one-dimensional. But exercise is very effective, and a culture that promotes exercise daily for everyone, at all paces, would benefit us a lot in the West.
I think people tremendously underestimate what 30 minutes of daily body weight exercises like push-ups, squats, and sit-ups, plus a little bit of walking can do for the said weight. There are many, many technology workers that now just work from home and barely walk at all. Not the majority, but many. There are many more office workers that just commute to work with their cars and never walk more than that demands. In that context, 30 minutes of morning exercise is quite a lot.
Yes, exactly right. Because they don’t work that well in this interventionist mode when they are prescribed to already treated patients.
The study you shared talks about primary and secondary prevention in a clinical setting. So this is for people who either have heart disease or are likely going to develop it. At that point, it seems like it is already too late and I would say primordial prevention[0] is better. When I say prevention, I speak as not a medical professional, and I mean it in the common sense of the word, which aligns with primordial prevention.
There seems to be extensive research that they work well if prescribed preventatively decades in advance, and it’s covered in a few recently popular books by doctors on the topic of lifespan vs. healthspan. For example, Outlive: The Science and Art of Longevity by L. Attia.
Moreover, the study you quoted shows a 9-29% relative reductions of the outcomes. About 1% is absolute. For the entire population, 1.3% fewer will die from a myocardial infarction. But it is a 29% reduction in the sub-population that would die from it. And those are fantastic results with only primary and secondary prevention. Unless I misunderstand something.
The study you provided is relevant and valuable for critical reading of such books as the aforementioned. Thank you.
The healthier answer simply isn't feasible, unfortunately: it means bulldozing the suburbs, confiscating most cars and handing out bicycles in exchange, and building new, walkable cities and forcing Americans to live in them. Also needed would be strict regulations on food quality, and banning some ingredients.
The drug may be a band-aid solution, but if it actually works for making people lose weight, it's better than telling them to eat better and get more exercise and then being shocked when they don't.
I very strongly disagree. Fixing our food, transit, and social systems is absolutely worth it. There are very simple measures we can take like offering a subsidy for e-bikes like we do for electric cars that would get more people outside. Taking measures to make more healthy food more accessible to people who need it would absolutely be worth it.
Cities all over the country are already assessing which roads can be converted from four lane stroads to two lane streets with protected bike lanes on either side. We can provide federal funds to encourage more of this.
Weight isn’t even the only problem with our culture. Being stuck in cars and eating unhealthy food also affects rates of heart disease and depression. Making those people lose body fat might help with those factors, but I suspect it would do so less than actually making healthier food options more accessible.
For those that really feel medication is their best choice, when we have made sure other options are available, we should also offer free medical care to all people. But that should not be the primary solution to this problem for most people!
The "simple measures" you name are things that require political will, and America doesn't have it. That's why these things are infeasible: American voters have to want them, and have to elect people who will enact them. They're not going to do that, outside of a few select municipalities (where obesity probably isn't a big problem anyway, because the people there are wealthy and educated). Even worse, America is almost certainly going to elect Trump for a 2nd term; the country is swinging conservative, so these "simple measures" you name definitely aren't happening any time soon. Look at NYC for instance: the Democratic state governor just scrapped their congestion charge program, so living in blue states and electing Democrats isn't any kind of guarantee of positive change either.
Honestly most of the stuff I mentioned is pretty in line with Bidens infrastructure plan which did actually pass! But even if you say my proposal is pure political fantasy, so is giving everyone ozempic. If we’re actually going to dream of fantasy proposals, “give everyone drugs to mask one symptom of our many problems” seems to me an impoverished fantasy.
It’s not the cars and it’s not the walking. Ignore the unique cities like LA and NYC, and daily suburban life is the same in Santa Clara or Little Rock or St. Louis or Charlotte. But some cities are full of morbidly obese people, while some (e.g. Bay Area, where you drive everywhere) have basically none of it.
Also exercise really doesn't burn as many calories as people think. You usually need to work out as much as a pro athlete or olympian to burn a noticeable amount of calories from exercise. The reality is that a lot of Americans just eat too much.
Building walkable cities (at large scale) in the US is impossible. Not because of physics or resources, but because of politics and American voters' preferences.
Sure, there's a small portion of the electorate that wants this, but they're a minority and not powerful enough to get real change outside of a few localities.
100 years ago the US had ~76m inhabitants - a fifth of what we have today - plus horses and buggies were used broadly throughout the country. The streets in our older cities weren't born from nothing but aether when cars were invented.
I'd dig one deeper and look at the reasons why it's "not feasible" and the change that first. If people propose "national emergency" as a solution, clearly such options should be on the table.
It's not feasible for various reasons, but they mostly boil down to "political will". There's two main causes I see: food/nutrition, and lifestyle (i.e. not enough exercise, and using cars, which is caused by urban design). There simply isn't enough political will to make any significant change on either of these fronts. Don't forget, the US is almost certainly going to elect Trump for a 2nd term, so obviously there isn't going to be any positive change in either nutrition or urban design for quite some time.
So, basically the US electorate chooses to be obese? If so, the underlying question is: why do they choose this?
I can think of several reasons, but to me the most obvious cause is "runaway capitalism", where a few big corporations lobby and market and (mis)inform, to make people think this is what they want, just so they can sell more cars, sugar, processed (high marging) foods and so on.
Not to make this an anti-capitalist rant, to be clear. Just that I'm fairly sure we're seeing a clear limitation of "free markets", where people simply aren't the rational homo-economicus that many promised we'd be.
There's tons of healthy food options available to consumers these days, even in regular supermarkets. They all have "organic" food aisles now. Some Americans have become more conscious of this and have adjusted their diets. (Of course, there's also some companies trying to profit off this unfairly, like advertising "gluten free" on foods that would never contain gluten anyway, and also pushing gluten-free foods as "healthier" when there's really no evidence for that, they're healthier of course for people with a gluten allergy or sensitivity but that doesn't extend to everyone.)
In a democratic society, it's the people's responsibility to be educated about issues, so they can vote accordingly. Most Americans are making conscious choices to eat bad foods, not exercise, live in suburbs with car-dependent lifestyles, etc. They could move to inner cities and/or push locally for more density and anti-car measures, but they don't, outside of a few select places.
Instead, a large chunk of American society "educates" itself about conspiracy theories and the "importance" of guns and religion, and votes accordingly, and what you get is the society you see now.
Why? It works and is (so far as we can tell, except for a few exceptions like thyroid cancer) completely safe. It would have immediate results. Sure, it would be better to fix the root causes. But we are so far from being in a position where that is feasible.
The general consensus seems to be that obesity is not lifestyle related, those affected can't do anything about it, and the only option is taking a drug (that has other severe side effects imo).
Caloric restriction and exercise of course do not work because thermodynamics are subjective.
Describe as you see it the process and ideal timeline that sees every 500lb and under American lose weight and regain the health benefit that comes from it.
Do you support the use of statins and diabetes medications in this population for this process or do you consider that cheating as well?
Obese people generally have lower lifetime healthcare spending. The third knee replacement and a year in assisted living is expensive, and in the US that senior-care cost is primarily borne by the government as opposed to the health insurance paid by the working. Which is why ozempic blows up the federal budget - obese people dying young is a very cheap solution to the problem, and it’s not a cost that’s borne by the government.
I don't think this is obviously true, if it is true. You're the one equating money with obesity. You shouldn't do that and then instantly deride the previous person for doing it. They didn't.
So, socioeconomic status vs personality traits it is?
How does personality develop?
Is it somehow inherent to sub-humans or a product of ones environment?
Of course its a socioeconomic factor. If you try to argue against this one, you have essentially only the other option left and derserve to be ripped apart in the comments.
Others have asked for the root cause before, here is my grand take: better education <- fair taxation <- social mobility <- wealth distribution <- matured laicists and a healthy democracy. I tried to put capitalism in there but it just lingers all over it. That socialist take is also my broad explanaition why other developed countries habe better health metrics. Guess what happens when you argue against this one :)
> Guess what happens when you argue against this one :)
I'll assume you'll either accidentally or deliberately find a way to box what I'm saying into a much narrower confine, which you will then threaten to beat the straw out of. Given it's happened twice now.
> Of course its a socioeconomic factor. If you try to argue against this one, you have essentially only the other option left and derserve to be ripped apart in the comments.
Everyone seems very keen to accept that obesity is linked to maternal mortality without actually looking at any of the details, how the deaths occur, how they could have been prevented, etc.
Wow Tonga is running away with it. Based on their population apparently just under 30,000 more people got wicked fat in 8 years? What have they been eating on that island
- Their original food culture was wiped by colonialism
- Now they rely on imported foods without regard for its composition
Phrased differently:
It is easier for imported foods to beat existing options, because the island culture does not preserve attractive options so well. And it is easy for imported foods to be unhealthy.
> ... Pacific islanders are more prone to obesity than people in other nations. Now a new study led by the University of Oxford has examined why islanders on Nauru and in the Cook Islands in the Pacific have the highest levels and fastest rates of obesity increase in the world. On both the islands, between 1980 and 2008 the increase in the average body mass index was four times higher than the global average. The paper, published in the journal Public Health Nutrition, provides a novel theory for why obesity levels are so high there. It suggests that social changes, introduced when the islands were under colonial rule, have significantly contributed to unhealthy dietary habits.
They don't - not to the same degree. Most imports to the southern pacfic islands come from NZ and Australia. Both countries have their own obesity issues, but not to the same rate as in the islands.
Orthogonally, the USA has a fentanyl epidemic, and neither China or India (who export fentanyl) nor Mexico (where it flows into the USA) have a fentanyl problem.
That's true, but that's not saying that Mexican culture is going to the US and making people die from drugs. If it were Mexican culture to take fentanyl and Mexicans weren't dying from it, we'd probably look outside of fentanyl to explain the US deaths from that hypothetical culture.
Anecdotally and from my own experience living in a couple of small towns in Mexico. Cartels don’t allow the sale of fentanyl in their hometowns because they know what it does to a population.
Not only that increases the death rates exponentially, but it also diverts money away from other healthcare areas.
https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...