Obesity Catch-All

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Basically converting this post into a catch-all about obesity to continue a discussion in the loathe thread.

Original post:
This may be old news for some of you, but it's only recently come to my attention, and I really wanted to discuss it.

At the beginning of April, University of Michigan published a study in the Annals of Internal Medicine. The study took 105 obese employees at a children's hospital and divided them up into two groups and tested two different financial incentive designs. They were followed for 24 weeks with monthly weigh ins, but in one group, participants would individually receive 100$ when they met or exceed the weight loss goals, while in the second group, participants were promised 500$ to be split amongst a group of 5 people.

[size=9]Extra link for those interested: U of Michigan's own page on the study[/size]

Reading this got me thinking. We know the US has a huge obesity problem, the numbers have positively exploded in the last 25 years, and the CDC estimates that 35% of the adult population is obese. This is a huge public health problem as obesity can lead to diabetes, obstructed arteries, sleep apnea, high blood pressure, some forms of cancer, asthma and arthritis.
However, from an ethical point of view, is this truly the best solution we can come up with? Financial incentive? I mean changing your eating habits is hard (sugary drinks, processed foods, the disappearance of formal meal time are prime suspects), but is this the best that we can come up with? I'm having a hard believing that this would actually be effective, but the numbers are there.
And as I was reading up on this matter, I remember that NY state is talking about outlawing large soda drinks. Is a ban really the only solution?
This may be incredibly naive of me, but I've always believed in informing patients of the risks and benefits of a behavior, and letting them take it from there.

So I guess my question is the following: what are your opinions on financial incentive as a weight loss method?

[size=9]And for the record, we're not talking about obesity as result of genetic diseases or other thyroid related syndromes, I'm talking about the obesity caused by our diets and sedentary lifestyles.[/size]

Edit: I've decided to go ahead and rename this thread to Obesity Catch All. The original concept was to discuss it from a public health, population-based point of view, but it's since encompassed the individual level as well. Carry on.

My main concern is it gives an incentive to fatten up to then get paid to lose the weight, repeatedly even. I think there would have to be some pretty strict rules on how it was implemented, maximum collected per unit time, and so on.

As for banning large soda drinks - the thing is people (well, most adults anyway, I would imagine) know the risk, but human psychology is such that we are prone to presuming the bad stuff will never happen to us. Even among those who accept that it's bad for them some will still shrug 'I don't give a f*ck, I want my big gulp (or whatever). The thing is these actions often harm more than just the person involved, will forcing people to buy multiple small sodas at a higher cost force result in them consuming less? I think it will, just as smaller dinner plates tend to result in eating less. Is this the government's buisiness? Well if not them who? Is not their purpose to assist the well-being of their citizens?

ETA: I would rather see healthy fruits and vegetables lowered in cost but that only helps making them more available, it doesn't help making them more desirable to a populace addicted to fat,salt, and sugar. Additionally it can result in other problems if taken to extremes (see: corn and soy and their resulting presence in _everything_).

My employer incentivizes healthy living. There are various options such as logging exercise regularly for 8 out of 12 consecutive weeks, going in for a physical and having good numbers (and/or improving them), and individual/family participation in a free nutrition program. You pick two, and get $150 each upon successful completion.

I disagree on emphasizing weight loss. By itself it is not an indicator of healthy life choices. I'd totally be up for something similar to what my employer offers in terms of a tax credit from the government, though. It makes sense from many points of view such as keeping a healthy work force and reducing long term impacts to our health care infrastructure.

It seems like a uniquely American - and therefore fairly unsurprising - solution to the problem of obesity.

Weight loss may not be the only indicator of healthy lifestyle, but obesity is a pretty big indicator of an unhealthy lifestyle, and weight loss is not only easy to track, but it's tied to so many other healthy indicators (as eliema noted) that it's a workable stand-in.

From what I can read about this study, it's more or less verifying that The Biggest Loser exists. That show has been using financial incentives to encourage healthy living for almost a decade now, with mixed results. Fact is, we live in a weirdly dichotomous culture that lionizes both fitness and indulgence.

I think employers incentivizing healthy living is a start, as is Michelle Obama's crusade against childhood obesity. We also need to change the culture such that sugar- a known, addictive toxin - can be more easily avoided. Pie in the sky thinking would include a wholesale dismantling of the meat production industry and its subsidies such that plants became more price attractive vs Taco Bell.

Of course there's zero chance of that. A more likely reality will have McDonald's and its ilk pushing healthy options while millenial and younger generations adjust their relationship with food.

@Krev: Huh, hadn't really seen it that way. I really didn't think it would encourage gaining weight only to lose it again. It's hard enough losing and keeping the weight off. But barring that, is "you'll get a hundred bucks" really the only solution we can come up with? Aren't there other alternative, like lowering the price of fruits and vegetables, increasing that of processed foods? Or compelling the manufacturers to reduce the amount of sugar and fat they put in processed foods?
As for the sodas, well... I understand your point, and that's exactly why people keep smoking or taking cocaine. Even when you know it's bad for you, sometimes you're just going to do it, but it makes you feel good, or whatever. But I definitely think it's the government's once it impacts the country on such a large scale, and has such dramatic consequences. That's exactly what I mean by a "public health problem".

@LouZiffer: It's not just weight loss that was addressed in this particular study but weight loss in obese patients. I wholeheartedly agree, however, that it's not just dropping pounds that matters, but promoting healthy living. Eat right, exercising, and all that jazz. I had no idea that it was already in effect, after a certain fashion, and it's interesting that your employer has that kind of program. Have you already seen its impact in your workplace? Or do people still stick to their habits?

@Seth: I agree that Michelle Obama's "Let's Move" program is a step in the right direction. We could take a few pointers from the cigarette industry and go with the "get 'em while they're young" approach. What I'm curious to know is the impact of the program (which would be excruciatingly hard to measure). But yes, there's definitely something to be done on the level of the processed foods industry. When it's easier and so much cheaper to pop in a TV dinner in the microwave, that's just not helping.

Also, I'd like to take this opportunity that this isn't an indictment of the US per se, as obesity is also a rampant problem in most Western countries. It's just gotten particularly bad in the States.

We all know that the United States has a serious obesity problem.
This is a public health issue that costs everyone money before we even count the fact that we should move to universal health coverage.

However, I am not convinced the issue is best addressed by providing incentives for healthy living. Certainly that could be one way to get things started but IMO it is really dodging the actual problem.

As a society the US does not do as much as many other societies to encourage every day healthy activity. For example I live in the Boston area, and we have only very recently seen bike lanes on a hand full of streets. Forget about bike & pedestrian underpasses. This is in a city with a subway system and a high college population.
In the suburbs sidewalks are often in horrible shape, public parks are and open spaces are a low priority (varies by town), and public transit is poor. We are constantly seeing increases in public transit costs and decreases in schedules because somebody somewhere thinks it should pay for itself (the roads of course do not need to).

Net result is fewer people walking, biking, etc. during the normal course of their day.

Huge numbers of people without basic health care doesn't help.
We MASSIVELY subsidize high fructose corn syrup but can't get even 1% of that same subsidy for healthy foods.

Sorry but this has to be posted even though everyone has seen it.
IMAGE(http://1.bp.blogspot.com/-8icKZ3WDodE/Tc-gtLngv-I/AAAAAAAAAKo/GQzPp428spc/s1600/health-club.jpg)

Eleima wrote:

@LouZiffer: It's not just weight loss that was addressed in this particular study but weight loss in obese patients. I wholeheartedly agree, however, that it's not just dropping pounds that matters, but promoting healthy living. Eat right, exercising, and all that jazz. I had no idea that it was already in effect, after a certain fashion, and it's interesting that your employer has that kind of program. Have you already seen its impact in your workplace? Or do people still stick to their habits?

The program is presented as a health care rebate, and probably does end up giving my employer (with ~400,000 employees) a significant rebate of their own from insurance companies. I don't remember how long ago it started. It's been at least several years - maybe even a decade. Participating in it year after year helps to keep a continual focus on health, and it definitely works for a lot of people. Employees even form fitness "teams" which work together on accomplishing their goals.

To give you an anecdote from the opposite side of the coin, my employer runs an annual initiative encouraging it's employees to be more active. It runs for a couple of months in late spring/early summer, and they'll give you a hundred bucks if you meet the exercise goals you set for yourself.

I'm the guy whose training plan exists in spreadsheet form, and it's taped to my kitchen cabinets. In my case, this is my employer wasting a hundred bucks, because I'm sure as hell going to take their money for doing what I was going to do anyway. There is no incentive for me from that hundred bucks, it's just free money.

Moral of the story - it can be wasteful and inefficient.

Jonman wrote:

To give you an anecdote from the opposite side of the coin, my employer runs an annual initiative encouraging it's employees to be more active. It runs for a couple of months in late spring/early summer, and they'll give you a hundred bucks if you meet the exercise goals you set for yourself.

I'm the guy whose training plan exists in spreadsheet form, and it's taped to my kitchen cabinets. In my case, this is my employer wasting a hundred bucks, because I'm sure as hell going to take their money for doing what I was going to do anyway. There is no incentive for me from that hundred bucks, it's just free money.

Moral of the story - it can be wasteful and inefficient.

If they end up paying less for your health benefits or even get a calculated overall benefit from helping to guarantee a healthier workforce, I wouldn't consider it to be wasteful. You're saving them money over the long haul. They're giving some of it back.

It would be far more efficient to devote all possible dual-use resources to fixing our obesity stigma problem before channeling them into fixing out obesity problem. Stress kills, stress makes you sick, especially the stress of social rejection to creatures as hard-wired to be social as humans. And the negative feedback loop that making people feel bad about their obesity lowers their self-esteem. And what do people with low self-esteem do? Engage in self-destructive behavior.

Gee, wonder which behavior the obese will choose, especially the obese who are the caretakers for other people who can't choose vices that leave them unable to pick the kids up from soccer practice. It's a lot cooler to drive around doing blow off a stripper, but it's a lot easier to fit a snackcake into most peoples' lives.

However, from an ethical point of view, is this truly the best solution we can come up with? Financial incentive? I mean changing your eating habits is hard (sugary drinks, processed foods, the disappearance of formal meal time are prime suspects), but is this the best that we can come up with? I'm having a hard believing that this would actually be effective, but the numbers are there.

Money is the GamerScore of life. I wonder if it even has much to do with the raw economic incentive as opposed to the gamification of weight loss.

I said this over in the 'Republican world' thread, but I'll say it again here as it is worth repeating:

Alot of people DON'T have access to information about health and nutrition. It's no coincidence that there are higher rates/percentages of obesity in poor neighborhoods. Neighborhoods where healthy food option are little to non-existent. Hell, even the grocery stores in poor neighborhoods are stocked with sh*ttier food and produce that - if it isn't already expired - is close to its expiration date.

Not to mention that the cost of living for many people is such that they have to work multiple jobs and thus don't have the time - or at least feel like they don't have the time - to have sit down meals that are prepared properly. Gone are the days when a family of four could live off of one parent's income of $40-60,000 per year. I saw a news expose where the reporter went with a single mother and showed her how to make a simple and healthy meal for her kids, instead of getting take out from McDonalds. We're talking fairly simple chicken and rice with vegetables type of preparation here, and the mother's response was along the lines of "Wow! I didn't know how easy it is to eat healthier. I always went with fast food because I thought it was more convenient."

nel e nel wrote:

Alot of people DON'T have access to information about health and nutrition. It's no coincidence that there are higher rates/percentages of obesity in poor neighborhoods....
Not to mention that the cost of living for many people is such that they have to work multiple jobs and thus don't have the time - or at least feel like they don't have the time...

I think those are two very important factors that contribute to the issue as a societal problem. Many countries have far fewer people living in poverty and make information on health much more available.

LouZiffer wrote:
Jonman wrote:

To give you an anecdote from the opposite side of the coin, my employer runs an annual initiative encouraging it's employees to be more active. It runs for a couple of months in late spring/early summer, and they'll give you a hundred bucks if you meet the exercise goals you set for yourself.

I'm the guy whose training plan exists in spreadsheet form, and it's taped to my kitchen cabinets. In my case, this is my employer wasting a hundred bucks, because I'm sure as hell going to take their money for doing what I was going to do anyway. There is no incentive for me from that hundred bucks, it's just free money.

Moral of the story - it can be wasteful and inefficient.

If they end up paying less for your health benefits or even get a calculated overall benefit from helping to guarantee a healthier workforce, I wouldn't consider it to be wasteful. You're saving them money over the long haul. They're giving some of it back.

Yes, but the point is that they give me a hundred bucks, and it doesn't change my behavior one iota. They're incentivizing me to do something that I'm already doing. My point is that the incentivization needs to be targeted to where it will be effective. All it does for me is cost them a hundred bucks for no gains.

Jonman wrote:
LouZiffer wrote:
Jonman wrote:

To give you an anecdote from the opposite side of the coin, my employer runs an annual initiative encouraging it's employees to be more active. It runs for a couple of months in late spring/early summer, and they'll give you a hundred bucks if you meet the exercise goals you set for yourself.

I'm the guy whose training plan exists in spreadsheet form, and it's taped to my kitchen cabinets. In my case, this is my employer wasting a hundred bucks, because I'm sure as hell going to take their money for doing what I was going to do anyway. There is no incentive for me from that hundred bucks, it's just free money.

Moral of the story - it can be wasteful and inefficient.

If they end up paying less for your health benefits or even get a calculated overall benefit from helping to guarantee a healthier workforce, I wouldn't consider it to be wasteful. You're saving them money over the long haul. They're giving some of it back.

Yes, but the point is that they give me a hundred bucks, and it doesn't change my behavior one iota. They're incentivizing me to do something that I'm already doing. My point is that the incentivization needs to be targeted to where it will be effective. All it does for me is cost them a hundred bucks for no gains.

You were clear. I got that from your original post. My point is, it doesn't matter why you're doing it. You're saving your employer additional costs by being healthier anyway. Giving you an additional incentive to continue isn't wasteful in my opinion. It's just fine with me if it's wasteful in your opinion. We can disagree there.

CheezePavilion wrote:

It would be far more efficient to devote all possible dual-use resources to fixing our obesity stigma problem before channeling them into fixing out obesity problem. Stress kills, stress makes you sick, especially the stress of social rejection to creatures as hard-wired to be social as humans. And the negative feedback loop that making people feel bad about their obesity lowers their self-esteem. And what do people with low self-esteem do? Engage in self-destructive behavior.

Is that really what we want to do? De stigmatize an activity that is arguably more dangerous than doing blow off someone's back or smoking? We've spent half a century turning the image ofa smoker from Don Draper to a lazy, ill educated sleaze; I'm not sure we want to encourage a different dangerous activity, especially considering how much we already do. I mean seriously, we get wind of Twinkies going away and people flip out because they might lose one of literally millions of unhealthy options.

If anything we should be reinforcing that obesity is a choice, one that can be reversed with hard work and education.

Efficient, haha.

Seth wrote:
CheezePavilion wrote:

It would be far more efficient to devote all possible dual-use resources to fixing our obesity stigma problem before channeling them into fixing out obesity problem. Stress kills, stress makes you sick, especially the stress of social rejection to creatures as hard-wired to be social as humans. And the negative feedback loop that making people feel bad about their obesity lowers their self-esteem. And what do people with low self-esteem do? Engage in self-destructive behavior.

Is that really what we want to do? De stigmatize an activity that is arguably more dangerous than doing blow off someone's back or smoking?

Being obese isn't an activity, though. Notice the difference here:

We've spent half a century turning the image of a smoker from Don Draper to a lazy, ill educated sleaze; I'm not sure we want to encourage a different dangerous activity, especially considering how much we already do. I mean seriously, we get wind of Twinkies going away and people flip out because they might lose one of literally millions of unhealthy options.

Yeah, but we didn't stigmatize Don Draper's lungs. The second Don Draper puts down that cigarette (and maybe takes a shower/airs out his clothing) he's indistinguishable from a non-smoker. The second you put down the Twinkie, you're still every bit as fat as you were a second ago. You'll continue to be fat for many seconds after that.

If anything we should be reinforcing that obesity is a choice, one that can be reversed with hard work and education.

The problem is how you do that without also reinforcing the negative perceptions we have of the obese. Pun not intended, but it's a 'can you have your cake and eat it to' situation. Along the lines of abstinence-only vs. condom use. In theory abstinence is better at STI prevention, but in practice it's clear that condom use is superior. In theory, stigmatizing obesity sounds good, but looking at how that has worked out, and questioning how much of the health issues associated with obesity are the result of the stress of being stigmatized, in practice, I think stigmatization doesn't work.

CheezePavilion wrote:

In theory, stigmatizing obesity sounds good, but looking at how that has worked out, and questioning how much of the health issues associated with obesity are the result of the stress of being stigmatized, in practice, I think stigmatization doesn't work.

anecdotally i thought this was being done but stopped for being insensitive. When i grew up there were rarely any obese kids and the few that were they were picked on relentlessly. Parents (not just mine) would tease all kids about needing 'husky' clothes if they didnt watch what they eat. Radio DJs back then would constantly talk about 'porkers' (anyone over 200lbs) and make fun of them.

Flash forward to today and i went with a friend to pick up their grandson from school and it was easier to count the skinny kids than the fat ones.

ranalin wrote:
CheezePavilion wrote:

In theory, stigmatizing obesity sounds good, but looking at how that has worked out, and questioning how much of the health issues associated with obesity are the result of the stress of being stigmatized, in practice, I think stigmatization doesn't work.

anecdotally i thought this was being done but stopped for being insensitive. When i grew up there were rarely any obese kids and the few that were they were picked on relentlessly. Parents (not just mine) would tease all kids about needing 'husky' clothes if they didnt watch what they eat. Radio DJs back then would constantly talk about 'porkers' (anyone over 200lbs) and make fun of them.

Flash forward to today and i went with a friend to pick up their grandson from school and it was easier to count the skinny kids than the fat ones.

Right, that's why I'm saying it hasn't worked out. The other adults picking up those kids: I'm guessing the fat/skinny ratio is different from that of the adults when you were growing up too.

CheezePavilion wrote:
ranalin wrote:
CheezePavilion wrote:

In theory, stigmatizing obesity sounds good, but looking at how that has worked out, and questioning how much of the health issues associated with obesity are the result of the stress of being stigmatized, in practice, I think stigmatization doesn't work.

anecdotally i thought this was being done but stopped for being insensitive. When i grew up there were rarely any obese kids and the few that were they were picked on relentlessly. Parents (not just mine) would tease all kids about needing 'husky' clothes if they didnt watch what they eat. Radio DJs back then would constantly talk about 'porkers' (anyone over 200lbs) and make fun of them.

Flash forward to today and i went with a friend to pick up their grandson from school and it was easier to count the skinny kids than the fat ones.

Right, that's why I'm saying it hasn't worked out. The other adults picking up those kids: I'm guessing the fat/skinny ratio is different from that of the adults when you were growing up too.

Personally i think it did work up to a point.

It wasnt as drastic as it was with kids but there were more skinny than fat folks back then. It just seems to me that there's been a whole cultural shift that helped with the the financial shift that made it easier or more acceptible to be obese. Now we're seeing that while harsh, and mean at times it was truly in our best interest they treated us that way.

ranalin wrote:
CheezePavilion wrote:
ranalin wrote:
CheezePavilion wrote:

In theory, stigmatizing obesity sounds good, but looking at how that has worked out, and questioning how much of the health issues associated with obesity are the result of the stress of being stigmatized, in practice, I think stigmatization doesn't work.

anecdotally i thought this was being done but stopped for being insensitive. When i grew up there were rarely any obese kids and the few that were they were picked on relentlessly. Parents (not just mine) would tease all kids about needing 'husky' clothes if they didnt watch what they eat. Radio DJs back then would constantly talk about 'porkers' (anyone over 200lbs) and make fun of them.

Flash forward to today and i went with a friend to pick up their grandson from school and it was easier to count the skinny kids than the fat ones.

Right, that's why I'm saying it hasn't worked out. The other adults picking up those kids: I'm guessing the fat/skinny ratio is different from that of the adults when you were growing up too.

Personally i think it did work up to a point.

It wasnt as drastic as it was with kids but there were more skinny than fat folks back then. It just seems to me that there's been a whole cultural shift that helped with the the financial shift that made it easier or more acceptible to be obese. Now we're seeing that while harsh, and mean at times it was truly in our best interest they treated us that way.

I don't disagree that it worked up to a point, I just don't think that point is acceptable given the trade-offs, and therefore it wasn't in our best interests. First thing off the top of my head: maybe there were fewer fat kids, but think of the increased suffering those fat kids experienced. I don't think it was worth the benefits derived from the kids that were kept skinny by that kind of, well, bullying.

The issue here isn't fat vs. skinny. The issue here is healthy vs. unhealthy, and I'd include mental health in that, as ultimately any solution has to take into account that there's a point where collateral damage to the subjects of this treatment becomes unacceptably high.

CheezePavilion wrote:
ranalin wrote:
CheezePavilion wrote:
ranalin wrote:
CheezePavilion wrote:

In theory, stigmatizing obesity sounds good, but looking at how that has worked out, and questioning how much of the health issues associated with obesity are the result of the stress of being stigmatized, in practice, I think stigmatization doesn't work.

anecdotally i thought this was being done but stopped for being insensitive. When i grew up there were rarely any obese kids and the few that were they were picked on relentlessly. Parents (not just mine) would tease all kids about needing 'husky' clothes if they didnt watch what they eat. Radio DJs back then would constantly talk about 'porkers' (anyone over 200lbs) and make fun of them.

Flash forward to today and i went with a friend to pick up their grandson from school and it was easier to count the skinny kids than the fat ones.

Right, that's why I'm saying it hasn't worked out. The other adults picking up those kids: I'm guessing the fat/skinny ratio is different from that of the adults when you were growing up too.

Personally i think it did work up to a point.

It wasnt as drastic as it was with kids but there were more skinny than fat folks back then. It just seems to me that there's been a whole cultural shift that helped with the the financial shift that made it easier or more acceptible to be obese. Now we're seeing that while harsh, and mean at times it was truly in our best interest they treated us that way.

I don't disagree that it worked up to a point, I just don't think that point is acceptable given the trade-offs, and therefore it wasn't in our best interests. First thing off the top of my head: maybe there were fewer fat kids, but think of the increased suffering those fat kids experienced. I don't think it was worth the benefits derived from the kids that were kept skinny by that kind of, well, bullying.

The issue here isn't fat vs. skinny. The issue here is healthy vs. unhealthy, and I'd include mental health in that, as ultimately any solution has to take into account that there's a point where collateral damage to the subjects of this treatment becomes unacceptably high.

If i had time i'd look to see if there were studies along this line. I feel that a lot of the 'beneficial' changes that have happened over the past 30 years are showing that they werent that beneficial over all. Especially when it comes to healthy vs unhealthy. I'm not talking changes or advancements in medicine or science but lot of the social changes that have happened. Nor do i promote going back to knuckle dragging, bullying ways either. Just seems culturally we over corrected and by doing so we made it to hard to adjust back some.

Right, so you guys all went to bed, and my day's just getting started. Looks like I have some catching up to do.

@RealityHack: Heh, thanks for posting that photo, it's a classic. Definitely won't argue with you on the universal health coverage, but that would be another question in and of itself. You're absolutely right that our society needs to create more opportunities for healthy activities, by encouraging biking lanes (seriously, it's hazardous to your health to be biking to work in some cities!!) and public parkings in the outskirts of the city with a subway or tram system. It's going to come to that anyway because of the pollution all those cars are creating. From what I've been told, "London smog" is no figure of speech. Of course, my failing on that point is that I do see the issue from a medical perspective, identifying the problems that doctors can have an impact on. What we're talking about here is more a city planner's responsibility. Which, of course, does not take anything away from your very valid point.
Great point also about high fructose corn syrup. It's something that Krev had already mentioned, along with soy (and I forgot to mention that soy has also been identified as an endocrine disruptor, so caution is advised with that one, particularly where children are concerned).

@LouZiffer: That actually sounds really great. Not only do the employees get healthier, the company gets a rebate on health insurance, and the program promotes teamwork with different people banding together to accomplish their goals. I'm trying, but I can't see any cracks.

@Jonman: I think your opinion that it is wasteful and inefficient is unfair, because you're not looking at the larger picture. Sure, if we calculate the cost of paying you to do something that you were going to do anyway, it's a loss. But if the program has an impact on the people it's truly aiming for, then you've got a win, and a big one. A win in matters of mortality, of morbidity, and of course, a win on the purely economic level. What's cheaper, paying 100$ per objective met or tens of thousands of dollars on inevitable surgery and drugs (like I said, diabetes, arthritis, cardiovascular disease - and I even think I'm being conservative here, hundreds of thousands would probably be more accurate). The point isn't to change your behavior but other people's.

@CheezePavilion: I'm glad you brought this up, because this is definitely a point of concern. How do we deal with the stigma society inflicts upon obese people? It's definitely a problem to be tackled, because we need to help obese people, not belittle them. Stigmatization exists, it's out there. But I disagree about smokers not suffering from it, I think you can ask any smoker nowadays, and they'll probably answer that they do feel stigmatized now. But to reprise your STI example, we can't go around saying that unhealthy behavior is a good thing. Sleeping around without protection is bad for you. Smoking is bad for you. Eating unhealthily and lack of exercise is bad for you. That's it, plain and simple. Now that may seem harsh, but it's the truth. And while I understand the need to open night clubs for the obese, I worry that it's a double edged sword that will comfort people in the opinion that it's okay to be extremely overweight. But if we're going to talk about bullies and the relentless teasing, that's probably what should be worked on. As I myself was bullied, I can understand how incredibly difficult life can be for an obese child at recess. Bullying, teasing and taunting is unacceptable, whatever the context, and that's something we should be teaching to our kids.
So does stress really kill more than obesity? Well, it would be difficult to give a definitive answer as it's incredibly hard to measure stress' death toll (too many confusing factors). But obesity itself is a big, big killer, of that you can be sure. I understand that stress can lock you in a vicious circle, but that's the point, really. How do we break free of the circle, how do start moving things in the right direction?
And for the record, the accepted theory in the medical profession regarding sexual practices is the ABC: Abstinence, Be faithful, use a Condom. Abstinence alone never works.
As for money being the GamerScore of life. I guess you're right, but I was thinking along the lines of "a good action is its own reward" kind of thing, if you know what I mean.

@Seth: Not to get into the politics of Twinkies, but I kinda miss the Twinkie...

@Nel e nel: You basically hit the nail on the head there. Sometimes people just don't know that there are healthier options. It's increasingly true, but people were brought up eating TV dinners, and fast food, and they genuinely don't know that it's bad for them. It's become the norm, in a sense. Getting the message out there is absolutely a huge part of the solution, no question about it. What's to be said about the grocery stores that pander less then healthy options though... *sigh* This kind of preying on the poor makes me genuinely angry. Especially when healthy doesn't necessarily have to equate with pricey. Local produce usually is (and if/when it isn't, it should be) cheaper than food that was processed in a plant on the other side of the country.

@Ranalin: I'm not exactly sure what studies you're talking about? Studies on the impact of teasing the obese on their weight? Probably not. That's not something you'd do, because it really wouldn't be ethical (having a group relentlessly teased versus a control group - in which teasing would probably occur anyhow). Not to mention that the follow up would probably have to be excruciatingly long. Studies on social elements are notoriously hard to conduct, and it's extremely difficult to get hard proof.
What I think you're trying to say is that more and more we're seeing the "it's okay to be obese" message. Which it is, it happens, but it's still bad for you. Like I was saying earlier, it's truly a fine line we're walking here, a very delicate balance has to be achieved.

Thanks for your contributions, guys, I'm really enjoying this discussion! Sorry for the wall of text, I did spell check it, but didn't proofread.

Eleima wrote:

@CheezePavilion: I'm glad you brought this up, because this is definitely a point of concern. How do we deal with the stigma society inflicts upon obese people? It's definitely a problem to be tackled, because we need to help obese people, not belittle them. Stigmatization exists, it's out there. But I disagree about smokers not suffering from it, I think you can ask any smoker nowadays, and they'll probably answer that they do feel stigmatized now.

I didn't say smokers don't suffer from stigmatization. I said that it's a lot easier to become a non-smoker than to become a non-obese person, and therefore the stigmatization is a lot easier to avoid. You can become an ex-smoker much faster than you can become an ex-obese person. Therefore it's not a good comparison.

But to reprise your STI example, we can't go around saying that unhealthy behavior is a good thing. Sleeping around without protection is bad for you. Smoking is bad for you. Eating unhealthily and lack of exercise is bad for you. That's it, plain and simple. Now that may seem harsh, but it's the truth. And while I understand the need to open night clubs for the obese, I worry that it's a double edged sword that will comfort people in the opinion that it's okay to be extremely overweight. But if we're going to talk about bullies and the relentless teasing, that's probably what should be worked on. As I myself was bullied, I can understand how incredibly difficult life can be for an obese child at recess. Bullying, teasing and taunting is unacceptable, whatever the context, and that's something we should be teaching to our kids.

I don't think there's a question it's a double-edged sword, just that one edge is much more dangerous than the other.

So does stress really kill more than obesity? Well, it would be difficult to give a definitive answer as it's incredibly hard to measure stress' death toll (too many confusing factors). But obesity itself is a big, big killer, of that you can be sure.

It's the kind of answer we need though in order to answer questions about stigmatization.

And for the record, the accepted theory in the medical profession regarding sexual practices is the ABC: Abstinence, Be faithful, use a Condom. Abstinence alone never works.
As for money being the GamerScore of life. I guess you're right, but I was thinking along the lines of "a good action is its own reward" kind of thing, if you know what I mean.

I'm not sure I do know what you mean.

If you 'gamify' weight loss and/or other measures for healthy living by creating extrinsic motivators around them, you risk stripping them of their intrinsic value; that is, people can become incapable of valuing those activities in themselves and unwilling to perform them without outside incentive.

Dan Carlin has done many a podcast about the idea of the 'fat police', a term he uses to describe the prospective practice of essentially taxing healthy people less than unhealthy ones (which, let us remember, is exactly the same thing as any other scheme that incentivizes good health financially using government funds). His central claim is that it isn't especially clear whether some forms of risky living (say, participation in extreme sports) should be exempt from taxation while others (say, overeating) are not, and so agreeing to what might seem to be a sensible measure to improve people's lives may actually end up restricting people's freedoms in ways we cannot at the moment predict (ie: Wealthy people can 'afford' to do dangerous things like eat a lot or ski while lower income people get forced into crummier lifestyles either by not doing these things or bearing a disproportionate financial burden for doing them).

I don't know whether I agree, but in any case I don't think this kind of program is the place to start. The first thing we should do is stop allowing the lobbyists of companies who essentially manufacture addictive poisons to gain government subsidies in order to help their parent companies push addictive, poisonous food products on the under-educated and the impoverished at prices lower than anything achievable by the 'good guys'. There is no reason to subsidize beef or corn except to make money for the beef and corn industries.

These subsidies and other such corruption make it so that presently we actually live under 'skinny police' legislation that punishes you for eating good food and rewards you for eating crap, which is crazy.

I'm not sure I agree about it being easier to become a non-smoker. I've never smoked, but I've worked with a lot of them, and it can take months, years even to quit smoking. There's nothing "easy" about getting rid of a physical and/or psychological dependence on nicotine. It would be unfair to both obese people and smokers to compare them. In both groups, some have an easier time, some have a harder time.

Ok, so we agree that it's a double-edged sword, but I don't think comparing how lethal both sides are is productive. However, since you've prompted me, I'd venture to say that staying obese is more dangerous, and generates a lot more fallout, on both medical and economical levels. I've said it before, but feel the need to repeat it, obesity leads to diabetes, cardiovascular diseases, arthritis, sleep apnea amongst others, diseases which bring their own hosts of problems. The damage may not be immediately apparent, but in the long run, it's as destructive, if not more.
I do want to stress that I'm not neglecting the psychological impact of society's stares and finger-pointing, on the contrary, I think it's detrimental to proper health care. What I'm saying is that accepting obesity as the norm and giving up on turning the tide would be a grave mistake.

Going back on the last two sentences you quoted, they're actually two different things, I was reacting to sentences you posted last night, let me put it back in context.

CheezePavilion wrote:

Pun not intended, but it's a 'can you have your cake and eat it to' situation. Along the lines of abstinence-only vs. condom use. In theory abstinence is better at STI prevention, but in practice it's clear that condom use is superior

What I meant is that you can't use this as an example, because the guildlines are abstinence+faithfulness+condom. All three are advised to patients in order to limits STI in case the first or second fall through. So it's never abstinence versus condom, that shouldn't even be a discussion. From a medical perspective, people are going to have sex anyway, so while abstinence is advised, and also counsel faithfulness and using a condom. My failing is perhaps being utterly unable to see how staying obese will keep you healthier. And we're circling back here, but I genuinely think that the benefits of shaping up, of changing your lifestyle, outweigh anything else.

CheezePavilion wrote:

Money is the GamerScore of life. I wonder if it even has much to do with the raw economic incentive as opposed to the gamification of weight loss.

I agree that money is basically what are lives are largely built upon. Without cash, we can't live, we can't eat, we can't clothe ourselves. However, I'm not sure I would call it gamification in and of itself. I'm calling it the power of a support group. What is that? You'd have to take a closer look at the study. The study had two groups: the first group, every one was trying to lose weight individually, and if they accomplished their goals, they got 100$; the second group they divided up in smaller groups of five people, and if the five people succeeded, they got 500$ to split amongst themselves. What's the difference, you get 100$ if you succeed, no matter the group, right? Wrong. When you're part of a group, there's a momentum that snowballs the whole thing. Oh, if I fail at this month's goal, Billy, Bob, John and Joe won't get their 100$/will be disappointed/etc. I truly think that the essence of this study lies there.

Not sure if I made things much clearer, but at least they're back in context, right?

Addendum: Ninja'd by 4xis While replying to Cheeze!
That's exactly what I'm afraid of, that the message will be lost in translation. Shaping up is important because of your health, not because there's money waiting for you at the end of the program. If you don't instill why it's important, people won't have the will to maintain a change in lifestyle in the long run.
I had no idea extreme sports were being taxed (goes with not participating, I guess). But I have to say it would make sense to stay consistent and either tax everything or nothing. You can't tax alcohol and cigarettes but not sugary sodas.
If anything, I'd argue that if wealthy people can afford to do dangerous stuff like being dropped off by a helicopter to do some off track skiing, then maybe they should be paying for their own health care and med evac.

Can't argue with you in the subsidizing, though. Having healthy foods more expensive than the unhealthy options is just mindboggling. Especially when a meal made from scratch ends up being more expensive than its processed, traveled counterpart.

Extreme sports are not, at present, taxed in any way (unless you count the risk of increased personal health care costs). But the idea is that if the government does get into the business of penalizing lifestyles that ultimately lead to increased healthcare costs it isn't clear that they should target food specifically over every other lifespan-reducing thing we do (and therefore, Dan Carlin would argue, it is better not to attempt to levy taxes on lifestyle choices).

Another example: Driving is perhaps the single most dangerous thing anybody ever does, and on top of the associated medical expenses (which I imagine are non-trivial) the costs of the infrastructure surrounding it are immense. Does that mean it's a good idea to tax drivers (or provide tax breaks for people who walk, cycle, or use transit)? I'm not sure.

Eleima wrote:

@Ranalin: I'm not exactly sure what studies you're talking about? Studies on the impact of teasing the obese on their weight? Probably not. That's not something you'd do, because it really wouldn't be ethical (having a group relentlessly teased versus a control group - in which teasing would probably occur anyhow). Not to mention that the follow up would probably have to be excruciatingly long. Studies on social elements are notoriously hard to conduct, and it's extremely difficult to get hard proof.
What I think you're trying to say is that more and more we're seeing the "it's okay to be obese" message. Which it is, it happens, but it's still bad for you. Like I was saying earlier, it's truly a fine line we're walking here, a very delicate balance has to be achieved.

Thanks for your contributions, guys, I'm really enjoying this discussion! Sorry for the wall of text, I did spell check it, but didn't proofread. :)

lol why in the hell would you make a study like that? I was curious in studies comparing results of cultural movements (if that truly was the motivator) and their end results or if it was all monetary and political that ended up with the accpetance or relaxing of social mores about people being obese. We had the cut in funding for Education so PE classes were being cut across almost all school districts and the food companies making non healthy in roads into the schools and family homes. Like i mentioned before if it is cultural it seems to have been an over correction and now we're seeing things like what you put in the OP attempting to correct it.

Eleima wrote:

I'm not sure I agree about it being easier to become a non-smoker. I've never smoked, but I've worked with a lot of them, and it can take months, years even to quit smoking. There's nothing "easy" about getting rid of a physical and/or psychological dependence on nicotine. It would be unfair to both obese people and smokers to compare them. In both groups, some have an easier time, some have a harder time.

All that is true, but we're not talking about physical or psychological dependence, we're talking about stigmatization here. For smokers, the stigmatization basically stops the second you quit--people can't see your lungs inside your body the way people can see the exterior shape of an obese person's body.

Ok, so we agree that it's a double-edged sword, but I don't think comparing how lethal both sides are is productive. However, since you've prompted me, I'd venture to say that staying obese is more dangerous, and generates a lot more fallout, on both medical and economical levels. I've said it before, but feel the need to repeat it, obesity leads to diabetes, cardiovascular diseases, arthritis, sleep apnea amongst others, diseases which bring their own hosts of problems. The damage may not be immediately apparent, but in the long run, it's as destructive, if not more.

I do want to stress that I'm not neglecting the psychological impact of society's stares and finger-pointing, on the contrary, I think it's detrimental to proper health care. What I'm saying is that accepting obesity as the norm and giving up on turning the tide would be a grave mistake.

I disagree that it's not productive. The comparison is the additional people who will lose their obesity because they are motivated by stigmatization vs. the increase in health issues stigmatization will produce in those who don't.

Going back on the last two sentences you quoted, they're actually two different things, I was reacting to sentences you posted last night, let me put it back in context.
Pun not intended, but it's a 'can you have your cake and eat it to' situation. Along the lines of abstinence-only vs. condom use. In theory abstinence is better at STI prevention, but in practice it's clear that condom use is superior

What I meant is that you can't use this as an example, because the guidelines are abstinence+faithfulness+condom. All three are advised to patients in order to limits STI in case the first or second fall through. So it's never abstinence versus condom, that shouldn't even be a discussion. From a medical perspective, people are going to have sex anyway, so while abstinence is advised, and also counsel faithfulness and using a condom. My failing is perhaps being utterly unable to see how staying obese will keep you healthier. And we're circling back here, but I genuinely think that the benefits of shaping up, of changing your lifestyle, outweigh anything else.

I'm not saying staying obese will keep you healthier, I'm saying stigmatization is an ineffective tactic. My point was that what sounds like it will work in theory doesn't always work in practice, especially when it comes to social health initiatives.

Money is the GamerScore of life. I wonder if it even has much to do with the raw economic incentive as opposed to the gamification of weight loss.

I agree that money is basically what are lives are largely built upon. Without cash, we can't live, we can't eat, we can't clothe ourselves. However, I'm not sure I would call it gamification in and of itself. I'm calling it the power of a support group. What is that? You'd have to take a closer look at the study. The study had two groups: the first group, every one was trying to lose weight individually, and if they accomplished their goals, they got 100$; the second group they divided up in smaller groups of five people, and if the five people succeeded, they got 500$ to split amongst themselves. What's the difference, you get 100$ if you succeed, no matter the group, right? Wrong. When you're part of a group, there's a momentum that snowballs the whole thing. Oh, if I fail at this month's goal, Billy, Bob, John and Joe won't get their 100$/will be disappointed/etc. I truly think that the essence of this study lies there.

Not sure if I made things much clearer, but at least they're back in context, right? :)

So it's the MMO-ification of weight loss ; D

Addendum: Ninja'd by 4xis While replying to Cheeze!
That's exactly what I'm afraid of, that the message will be lost in translation. Shaping up is important because of your health, not because there's money waiting for you at the end of the program. If you don't instill why it's important, people won't have the will to maintain a change in lifestyle in the long run.
I had no idea extreme sports were being taxed (goes with not participating, I guess). But I have to say it would make sense to stay consistent and either tax everything or nothing. You can't tax alcohol and cigarettes but not sugary sodas.
If anything, I'd argue that if wealthy people can afford to do dangerous stuff like being dropped off by a helicopter to do some off track skiing, then maybe they should be paying for their own health care and med evac.

Can't argue with you in the subsidizing, though. Having healthy foods more expensive than the unhealthy options is just mindboggling. Especially when a meal made from scratch ends up being more expensive than its processed, traveled counterpart.

Nah, I'm not afraid the message will be lost in translation at all. I also think one of the biggest obstacles is getting non-obese in the first place. It's a lot easier to maintain a healthy lifestyle when society is treating you like a healthy person. When you know your doctor won't be a dick to you for being obese, you're more likely to be diligent about preventative health care. When you look like you belong in a gym or out running, you're more likely to expose your body to the judgement of strangers.

ranalin wrote:

lol why in the hell would you make a study like that?

You wouldn't, hence my confusion. The type of study you suggest would be extremely hard to do because of all the different intervening factors. How do you separate the chaff from the wheat? How do you know which obese cases are a consequence of the budget cuts, and which are due to poor eating habits? That's near impossible to determine.

4xis, you speak of driving, but I'm not sure that's a good example. When you compare the raw numbers of people who take their cars every day to the number of people who actually get injured or killed, it's really (and I know how this sounds), not that bad. At least from a statistics point of view. In contrast, there's a lot more obesity and its long-term consequences are extremely sever, on several levels.

CheezePavilion wrote:
Addendum: Ninja'd by 4xis While replying to Cheeze!
That's exactly what I'm afraid of, that the message will be lost in translation. Shaping up is important because of your health, not because there's money waiting for you at the end of the program. If you don't instill why it's important, people won't have the will to maintain a change in lifestyle in the long run.
I had no idea extreme sports were being taxed (goes with not participating, I guess). But I have to say it would make sense to stay consistent and either tax everything or nothing. You can't tax alcohol and cigarettes but not sugary sodas.
If anything, I'd argue that if wealthy people can afford to do dangerous stuff like being dropped off by a helicopter to do some off track skiing, then maybe they should be paying for their own health care and med evac.

Can't argue with you in the subsidizing, though. Having healthy foods more expensive than the unhealthy options is just mindboggling. Especially when a meal made from scratch ends up being more expensive than its processed, traveled counterpart.

Nah, I'm not afraid the message will be lost in translation at all. I also think one of the biggest obstacles is getting non-obese in the first place. It's a lot easier to maintain a healthy lifestyle when society is treating you like a healthy person. When you know your doctor won't be a dick to you for being obese, you're more likely to be diligent about preventative health care. When you look like you belong in a gym or out running, you're more likely to expose your body to the judgement of strangers.

That's where I am on it, too. I don't think the 'gamification' of getting healthier will make people ignore the real benefits. The benefits become more obvious and become a motivator in and of themselves when you are healthier. There are numerous motivators which folks can use to get to the point where health itself becomes one. Having more isn't a bad thing, IMO.

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