Obesity Catch-All

We have a whole thread in EE where fellow goodgers have gamified their fitness routine; maybe they could weigh in?

Btw Cheeze once again, your thoughtful responses have changed my mind. Thanks for your posts!

Edit: it's the fitocracy thread to which I am referring: http://www.gamerswithjobs.com/node/1...

realityhack wrote:
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.

I agree with this. Two places where our general education system absolutely craps out are in healthy lifestyle education and personal finance.

bandit0013 wrote:

I agree with this. Two places where our general education system absolutely craps out are in healthy lifestyle education and personal finance.

Bandit, do you think it is lack of financial education that is one of the primarily factors responsible for people living in poverty?

Eleima wrote:

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).

Viewing the issue as a public health issue we are faced with all kinds of different approaches to the problem. It is almost certain that the best solution is a combination of different approaches.
From the public health perspective I think the best long term improvement can be achieved only through cultural shift. I see the best allocation of resources for this being in:

  • universal health care
  • improved infrastructure (food islands tossed by better transit come to mind) aimed at encouraging walking, biking, etc.
  • eliminating perverse incentives like subsidization of high sugar foods
  • subsidizing healthier foods instead to maintain a healthy farming base

Paying people to loose weight is very low on my list because I think it is much more temporary than getting a person a doctor who can explain the factual risks on an individual level and put them in a room with a nutritionist.
Rethinking urban planning could lead generations toward a different lifestyle.
Yes they are more expensive but I guess my point is that IMO paying people to excessive or loose weight is very much a bandaid.

Oh, I agree that it's a big part of public health, it's just something I hadn't included in my previous post. I wholeheartedly agree that durable progress will be made with a global approach, by tackling the problem in all its different aspects. Hence my original question: I don't see how giving people money would work in the long-term.
I suppose a better question would be how do we implement this cultural change? What do we do on the individual level to nudge the ball in the right direction? Not so simple...

Realityhack: rethinking urban planning is easier said than done. I'm part of a group lobbying our local DDA to make our city more pedestrian and bicycle friendly at the intentional expense of vehicular traffic, and the amount of pushback - venemous, supercilious pushback- we get from suburbanites addicted to their Yukon denalis and acres of parking space is staggering.

Seth wrote:

Realityhack: rethinking urban planning is easier said than done. I'm part of a group lobbying our local DDA to make our city more pedestrian and bicycle friendly at the intentional expense of vehicular traffic, and the amount of pushback - venemous, supercilious pushback- we get from suburbanites addicted to their Yukon denalis and acres of parking space is staggering.

Oh I didn't intend to say it would be easy. All of those bullet points are near impossible. But assuming we actually had leaders who wanted to address problems, even at the expense of upsetting some constituents and becoming a single term whatever... those would be the ways to do it.
Alternatively you could move to Sweden

I honestly don't know the first thing about achieving any of those goals, just that that is what I think we need to address the problem (and a number of other issues).

Time, realityhack, the father must die so that the son might live, and all of that. The problem is that the oldsters get such damn good healthcare, that it might be 50-60 years.

KingGorilla wrote:

Time, realityhack, the father must die so that the son might live, and all of that. The problem is that the oldsters get such damn good healthcare, that it might be 50-60 years.

Cut off voting rights upon your eligibility for full social security. See how that changes the landscape?
Please no flamethrowers... I am kidding... seriously that stuff burns man.

Honestly though I don't know if time will fix that problem. It is working along on some of our societal issues but others remain. I am not convinced that better urban planning wither better public transit, or better biking will come with time. The MBTA keeps cutting it's schedule. Sure there are some new lines... one after a lawsuit, but no more all night on the weekends to keep the drunks off the street. Too expensive, it comes from a different budget than scraping drunk driving victims off the sidewalk.

realityhack wrote:
KingGorilla wrote:

Time, realityhack, the father must die so that the son might live, and all of that. The problem is that the oldsters get such damn good healthcare, that it might be 50-60 years.

Cut off voting rights upon your eligibility for full social security. See how that changes the landscape?
Please no flamethrowers... I am kidding... seriously that stuff burns man.

I almost fell out my chair laughing at that.

So this happened:

sometimesdee wrote:

Infrastructure is another part of the bigger picture. We need more walkable communities. If all the places you need to go are outside of reasonable walking distance, of COURSE you're going to drive more and walk less. I totally hate the fact that I have to drive 4 miles to the gym; it seems counter-intuitive and/or counter-productive. Cycling is extremely dangerous, since there are no bike paths, and drivers don't expect cyclists. Or pedestrians. Or other cars, for that matter.
Where's Grenn? I swear, Spanish Inquisitors would be expected before cyclists around here!

While that's true, it's unfortunately not that simple (sorry, seem to be repeating myself). Yes, we need to make cities more bike-friendly, and yes, it's preposterous to put 5 step escalator in front of a gym (see above), but the thing about the US is that it's a big country. Cities are large and sprawling, and sometimes, you just can't get around using a car. If anything, we need better public transportation systems.

In short, I believe obesity to be both disease and symptom, it all depends what the context is. At least that's what I've been taught and told for the better part of the last ten years.

Eleima wrote:

While that's true, it's unfortunately not that simple (sorry, seem to be repeating myself). Yes, we need to make cities more bike-friendly, and yes, it's preposterous to put 5 step escalator in front of a gym (see above), but the thing about the US is that it's a big country. Cities are large and sprawling, and sometimes, you just can't get around using a car. If anything, we need better public transportation systems.

I never said it was simple; I was just mentioning one single facet of a very complex problem. I agree 1000% that we need better public transportation systems, but do you know what would be even more ideal? A community where you would seldom need public transportation, because everything you need is within walking distance.

Eleima wrote:

In short, I believe obesity to be both disease and symptom, it all depends what the context is. At least that's what I've been taught and told for the better part of the last ten years.

I agree. One of my fears in regards to the pathologization (is that evem a word?) of obesity is that actual causes of obesity may be overlooked. For example, obesity is one cause of sleep apnea. However, do you know what's a risk factor for obesity? Sleep problems! Fix the sleep apnea, and a person can end up with more energy. More energy in the day can lead to less reliance on high-energy (read: calorie) foods. It also means having the energy to exercise. So which do you treat first, if they're both diseases?

NB: speaking of sleep disturbances, it's 5:30am and I'm typing this with one hand while feeding a newborn with the other. Forgive me if I'm not as coherent as usual.

Oh of course, I never meant to imply that you said so! Unfortunately, like you said, it's a very complex and multifaceted issue.
As for the disease/symptom... Well, doctors are supposed to be trained to look for causes. It's my hope and belief that doctors will keep trying to figure out the wherefores and why of health problems. It's well known that it's pointless emptying water out of a boat when said boat has a big hole at the bottom, right?

As for the relation between sleep apnea and obesity, it's a well known, very much documented relationship. One that actually creates a vicious circle, not to go into the physiopathology of it. When that happens, we usual try to tackle the problem from both angles and work with what we can. Sleep apnea is most commonly treated with CPAP machines, so there's that in conjunction with the "traditional" angle on obesity. That's what's so difficult in medicine though, because you try to hammer out guidelines and generalizations when most of the time you're just using the knowledge to support a case-by-case approach.

And no worries, I've been there. Hope the two of you went back to sleep.
Also, hope I didn't overstep my bounds by redirecting the conversation here, I just know that I can go on at length when it comes to public health issues.

We can only do so much to educate people.

As someone who was considered morbidly obese for many years and recently lost about 80lbs through diet, exercise and sheer force of will, I'm still conflicted on this. I've met and known people who are severely overweight for medically related reasons. There are disorders you can get that make you basically uncontrollably fat. And that sucks. But the thing is, the diseases that cause that obesity are already recognised as diseases.

But in my experience (and that's all I have to go on), I've known and seen a great number of very overweight people who are that way by choice. They eat too much, they eat stuff that's bad for them and they don't exercise. My grandmother died of diabetes and my Father has it. Why? Because my grandmother ate nothing but sweets and my Dad ate nothing but fried foods. They were told to stop, they didn't. I was one of those people for a decade. Obesity is an epidemic in the western world right now because of the near ubiquity of bad food and so many entertainment choices that we always have reasons not to exercise. But so many people still make poor choices and a boon of options doesn't remove your responsibility to choose the healthier ones. Again, I was one of these people, I know it's damn hard to decide to eat a stir fry instead of pizza and go spend an hour on the treadmill when you'd rather be playing a game. But that's what your body requires to be healthy and if you don't want to or won't do it, that's your fault and not a symptom of a disease, at least as I regard them. I was fat because of my choices and I always knew that and knew it was on me to change it.

I know that the way medical associations define disease doesn't necessarily mean "it's not your fault, it's something you catch" but that's how many interpret it and I know there are a lot of overweight people who are now going to say "Oh, it's a disease, that means this clearly isn't the fault of anything I did." and I think that's the wrong message to send. There are some medical reasons for obesity but the vast majority of the problem is due to poor life choices right now and giving people yet another way to deflect responsibility from themselves isn't how you fix it in my opinion.

I hold a similar viewpoint when it comes to things like drug and alcohol addiction. If you are addicted, that's a major mental and physical dependency that you can't just will away or shake off. It needs treatment and options should be provided for that. I'm all for my tax dollars funding addiction treatment programs. But you can't contract drug and alcohol addiction (yes, babies born to addicted parents can inherit the addiction and that's an exception), you get it because you chose to start drinking or doing drugs. I've known people with addictions who knew before they ever touched alcohol or drugs that there was a history of addiction in their family and that they had a much greater chance of becoming addicted themselves. Yet they tempted fate anyway, by choice. I'm all for giving those people the help they need but again, where does medical responsibility end and things become about personal responsibility?

Again, when it comes to the obesity problem, I have first hand knowledge of this phenomena. There are medical causes of obesity and those are known and considered as such. But if you're someone who is overweight because of poor life choices you made, that's not a disease, that's a lifestyle. I think it needs to be clearly established which is which and I think it should be very clearly stated that "though we recognise this as a disease, for many people, it's still their job to fix it."

I know there's more to this debate than what I've stated here, it's just what I think from where I sit.

sometimesdee wrote:

I'm typing this with one hand while feeding a newborn with the other. Forgive me if I'm not as coherent as usual.

DO NOT FEED HANDS TO INFANTS.

Honestly, this is where obesity starts.

Parallax Abstraction wrote:

I know that the way medical associations define disease doesn't necessarily mean "it's not your fault, it's something you catch" but that's how many interpret it and I know there are a lot of overweight people who are now going to say "Oh, it's a disease, that means this clearly isn't the fault of anything I did." and I think that's the wrong message to send. There are some medical reasons for obesity but the vast majority of the problem is due to poor life choices right now and giving people yet another way to deflect responsibility from themselves isn't how you fix it in my opinion.

I think it's much more likely to make overweight people say "Oh, it's a medical issue not a moral issue" and I think that's the right message to send. For every one person who uses this to deflect responsibility and not take their health seriously, there are probably at least two who will use it to deflect the mental baggage that keeps them from doing anything as long as it is framed as a moral issue. I can't help but think it's a net plus.

IMAGE(http://img.gawkerassets.com/img/18qpi6x38fi8gjpg/ku-xlarge.jpg)

One of the big problems that is probably unconsciously missed due to the composition of the site, financially, is that obesity is an epidemic that preys on the poor. Between cheap, high-calorie foods, lack of available resources for fresh produce, and active attempts by government to further weaken access to education and resources that could help stem obesity, the poor are f*cked. It may be a question of choice for the middle class and beyond, but it really isn't that easy for most Americans.

It's clear to me that, generally speaking, the path of personal responsibility has not worked to stem the tide of obesity in the western world.

I don't say that to diminish the fantastic efforts and results of people like you, parallax (seriously congratulations, that is a huge success); rather I think it's to showcase just how difficult it is to rely on willpower in the face of the double team that is 1) near-universal societal scorn, and 2) near-universal commercial encouragement of obesity promoting activity.

As a guy who struggles with smoking 2 years after quitting - i am a results oriented person and if this shift in cultural thought brings results, i can support it.

(Taken with the caveat that I don't trust a lifelong reliance on pills as an acceptable result)

Tanglebones wrote:

One of the big problems that is probably unconsciously missed due to the composition of the site, financially, is that obesity is an epidemic that preys on the poor. Between cheap, high-calorie foods, lack of available resources for fresh produce, and active attempts by government to further weaken access to education and resources that could help stem obesity, the poor are f*cked. It may be a question of choice for the middle class and beyond, but it really isn't that easy for most Americans.

Blame Earl Butz. Who was he? He was the head of the USDA under Nixon who pushed for the massive expansion and subsidizing of corn and other commodities back in the early 70s. He wanted food to be cheap and plentiful and that's exactly what we got:

IMAGE(http://www.venturacountytrails.org/WP/wp-content/uploads/2012/01/ObesityChart1.jpg)

The first step in tackling obesity would be to eliminate all the farm subsidies Butz championed. But to do that we'd have to go up against every business who relies on cheap commodities: soft drink manufacturers, fast food companies, snack food companies, the entire processed foods industry, the entire livestock industry, etc. All of them have built their fortunes on the back of cheap corn.

Well, I think you can keep the Nixon era farm subsidies, but subsidize what is needed. Yes, coca-cola is cheap, but so are eggs and eggs are a healthy food. Shift the subsidies off of corn and soy and put them on green vegetables, tomatoes, carrots, spinach, etc.

It is similar to the fuel conundrum. Shift the existing incentives off of the bad stuff and onto the good stuff.

Thanks for sharing, KG. That game actually doesn't look half bad (although I do take issue with the pretzels/cheese advice as a snack).
Don't speak German, so not sure I got the point the guy wanted to make. He was actually making fun of it, right?

Parallax, congratulations and loads of respect for going from morbidly obese to where you are today. That's one heck of a hard road to tread. I understand your point of view, truly I do. But you raise a very important question, one with no easy answer. Where *does* medical responsibility end and personal responsibility begin? Like I said, no easy answer. As a medical profesionnal, the only answer I can give is that the minute a patient enters your office, you owe them to give them your help, your advice, every tool at your disposal to help them, cure them, assist them. What they do with those tools is ultimately up to them. You can prescribe medication, but you can't force them to take it. Sometimes, people know they need their medication, and yet they won't take it. Why? They fear side effects, it's too much of a constraint, who knows (a lot of studies are trying to delve into this, human motivations are a curious thing). I see obesity and lifestyle guidelines similarly.

Tanglebones, that's just... Seriously, describing sodas like they're a fine vintage? Mind blowing. This there is definitely part of the problem.
Obesity definitely plagues the poor above others, I could not agree more. And it's truly part of the injustice in this, that a lot of people not only don't know that there are healthier options, but also don't have access to them.

Interesting, Seth, it's really fascinating that you would take Parallax's experience and come away with something completely different. I want to believe that people can have the willpower, and that they just need to be helped, accompanied, supported, I really do. However, I've also seen the failure of personal responsibility. If anything, I have mixed feelings on the matter, I guess.
Congratulations and best of luck on staying cig-free, that too is a difficult road.

It is just such a 90's thing to do-the golden era of crappy PSAs. What is really insidious is that McKids was actually a pretty good game.

I also have a hard time demonizing Ronald McDonald, over chairs and desks. Sure, healthy diet is important, but no matter what you do with vegetables, if you sit on your rump all day and night you will never have a healthy heart.

We drive to work, to sit at a desk for 9 hours, to drive back home, to eat dinner, to sit in front of the TV. Both parents if the household has 2 will be working full time. Both spouses working full time means you do not have a lot of time to shop and cook and clean. My wife and I have no kids, but at least an entire day of the weekend is spent getting our produce and other groceries. Show of hands, who has the energy to for an entire year not get a take out pizza for dinner because you and your spouse worked a 60 hour week, your kid was sick, and you are too damned exhausted to put together some stuffed peppers?

How about tax credits for every mile you bike or walk to work in a given year? How about grants to cities, counties, and states to beef up the walking and biking infrastructure. There is a big hubub about the Citibike. How about you get those bikes in St. Louis and surrounding suburbs? What about reworking education to make each class incorporate a physical component? Teach Trigonometry and calculus using the football field.

Something I think has real merit is looking into the correlation between national weight/health and national happiness. People come home exhausted and unwilling to cook or exercise also because they just spent 8-9 hours doing incredibly repetitive and unfulfilling work. Does the 35 hour work week make America healthier?

KingGorilla wrote:

It is just such a 90's thing to do-the golden era of crappy PSAs. What is really insidious is that McKids was actually a pretty good game.

I also have a hard time demonizing Ronald McDonald, over chairs and desks. Sure, healthy diet is important, but no matter what you do with vegetables, if you sit on your rump all day and night you will never have a healthy heart.

We drive to work, to sit at a desk for 9 hours, to drive back home, to eat dinner, to sit in front of the TV. Both parents if the household has 2 will be working full time. Both spouses working full time means you do not have a lot of time to shop and cook and clean. My wife and I have no kids, but at least an entire day of the weekend is spent getting our produce and other groceries. Show of hands, who has the energy to for an entire year not get a take out pizza for dinner because you and your spouse worked a 60 hour week, your kid was sick, and you are too damned exhausted to put together some stuffed peppers?

How about tax credits for every mile you bike or walk to work in a given year? How about grants to cities, counties, and states to beef up the walking and biking infrastructure. There is a big hubub about the Citibike. How about you get those bikes in St. Louis and surrounding suburbs? What about reworking education to make each class incorporate a physical component? Teach Trigonometry and calculus using the football field.

Something I think has real merit is looking into the correlation between national weight/health and national happiness. People come home exhausted and unwilling to cook or exercise also because they just spent 8-9 hours doing incredibly repetitive and unfulfilling work. Does the 35 hour work week make America healthier?

How about we stop wasting billions in crapholes like Iraq and Afghanistan and using a fraction of the savings to build actual infrastructure here.

Paleocon wrote:

How about we stop wasting billions in crapholes like Iraq and Afghanistan and using a fraction of the savings to build actual infrastructure here.

I read that story the other day. The House is trying to cut food stamps by $2 billion a year and we're leaving $7 billion of military equipment in Afghanistan. Check that. We're paying contractors to destroy the $7 billion of military equipment we're leaving in Afghanistan. How's that for national priorities?

KingGorilla wrote:

I also have a hard time demonizing Ronald McDonald, over chairs and desks. Sure, healthy diet is important, but no matter what you do with vegetables, if you sit on your rump all day and night you will never have a healthy heart.

We drive to work, to sit at a desk for 9 hours, to drive back home, to eat dinner, to sit in front of the TV.

Don't forget that our kids are bussed to school to sit at a desk for 8 hours, with PE and recess being cut.

Tanglebones wrote:

Between cheap, high-calorie foods, lack of available resources for fresh produce, and active attempts by government to further weaken access to education and resources that could help stem obesity, the poor are f*cked.

The poor are f*cked for a lot of reasons, but the idea that they are too ignorant to link excessive food intake or certain types of food to higher obesity rates is like suggesting that poor people smoke only because they don't understand that smoking is dangerous to their health.

Most obese people, poor or rich, know why they get fat. What they lack is the mental state necessary to stay thin. It's not a fault issue so much as a cause and effect. If people feel the need to eat excessively or to eat certain foods, they will eat those foods whether or not they are educated in food science or have access to fresh vegetables. You can eat 5 servings of fresh vegetables a day and eat only lean meats, but if you are also eating 3 cakes a day you are still going to end up obese absent vigorous physical labor or exercise.

The question to ask is, why do people feel the need to eat so many cakes? Or whether it's possible to redirect those mental needs into an activity that's less glucose-oriented.

Funkenpants wrote:

The question to ask is, why do people feel the need to eat so many cakes? Or whether it's possible to redirect those mental needs into an activity that's less glucose-oriented.

"It feels good" is a simplistic answer, but I think a powerful one.

I always try and compare it to another public health issue like, say, sex: imagine what STI/D rates would be if we didn't have the condom. Yeah, we've got sugar-free this and that, but nothing that's even close to the condom for food. All of a sudden, those obesity rates don't look so shocking.

Funkenpants wrote:
Tanglebones wrote:

Between cheap, high-calorie foods, lack of available resources for fresh produce, and active attempts by government to further weaken access to education and resources that could help stem obesity, the poor are f*cked.

The poor are f*cked for a lot of reasons, but the idea that they are too ignorant to link excessive food intake or certain types of food to higher obesity rates is like suggesting that poor people smoke only because they don't understand that smoking is dangerous to their health.

Not sure that's entirely what he's saying.

Funkenpants wrote:

The poor are f*cked for a lot of reasons, but the idea that they are too ignorant to link excessive food intake or certain types of food to higher obesity rates is like suggesting that poor people smoke only because they don't understand that smoking is dangerous to their health.

They aren't ignorant at all. They unfortunately often live in food deserts and apply simple, cold logic to their purchasing decisions, which tells them that a fast food value meal provides more calories per dollar than a comparable healthy meal (if those ingredients were even available).

The policy issue is that billions and billions of dollars of federal subsidies make that sh*tty meal a lot cheaper than more healthy alternatives. And when there's a lot of money on the table, there's going to be a lot of lobbying against common sense and science. Which is why soda, snack, and fast food companies have lobbied hard to make sure that their products can be bought with food stamps.