Obesity: A Global Economic Issue

Yves here. This article may seem to be a bit wide of the usual Naked Capitalism terrain, but as the world has shifted from subsistence farming to significantly agri-business controlled food production and distribution, it is not unreasonable to see health outcomes like widespread obesity as a direct result of how the food industry has evolved. Let us not put too fine a point on it: the risk of getting Type II diabetes is highly correlated with body mass, and the high and rising incidence of Type II diabetes is a public health crisis in the making.

And as someone over 50, I can attest that chunky people, and in particular, chunky Americans, really were not the norm once upon a time. I recall when I was assigned to a project in London in 1984. When I went to the gym, the age distribution in the classes I took (and these were tough classes, at least as hard as the ones as I took in NYC, so the target was a serious fitness crowd) was similar to that of the classes I took in New York, but the participants were visibly heavier on average. The next time I spent a decent clip of time in London, in 1997, when I went back to the same gym, the clientele was a bit thinner than their New York City counterparts. And remember, the UK scored then as now close to a par with the US on obesity indices.

There of course is also the secondary but not at all trivial related effect of industrialization and specialization of labor, that the physical activity of hunter-gather and minimally mechanized farming lifestyles are vastly healthier than sedentary advanced economy lifestyles. One of my big reasons for never wanting to own a car is that running my life on foot keeps me out of the sedentary category, which is the most important step to make exercise-wise, in terms of health (more exercise up to the point of not messing up your joints is better, but the most important thing you can do for yourself is get out of the sedentary category). And that also has an impact on body weight.

The article basically says that you can only rely so much on individual initiative as far as getting most people to lose weight is concerned. You actually need broader cultural changes. The one that comes out top of the study list is portion sizes. It isn’t widely enough discussed that the move to bigger portions in the US started in the restaurant trade as a way to justify higher prices. A oft-mentioned contrast is France, where not only are portion sizes much smaller than American norms, but it is not considered impolite not to finish all of your food, and women, who can’t consume as many calories as men, are also typically trained at home not to finish desserts (when they have them, desserts aren’t a staple as they are in many American households).

Many readers will note that the article omits other issues: that some heavy people are healthy, and that some populations like Hispanics and Chinese, are susceptible to diabetes at much lower body mass indices than Caucasians. Another striking oversight is the fact that highly processed foods, particularly high fructose corn syrup, refined sugar, and white flour, are big culprits in glucose intolerance and may contribute to overeating (as in the hunger satiation they give lasts less time than comes from foods with more fat and protein). Finally, it does not mention the other ways that my favorite culprit, overly large portion sizes, contribute to eating disorders. Bulimia is widespread among populations that have to stay thin, like ballet dancers and models. Not only is it not uncommon among young women, but it is apparently increasing among increasingly body-conscious young men. And among lower-income groups, the pressure of juggling multiple jobs and managing tight budgets and erratic schedules means eating calorie-dense, inexpensive, convenient and often obesity promoting foods is not just economically rational but pretty much the only manageable option, no matter what the long-term cost.

By Richard Dobbs, Director, McKinsey Global Institute, and Corrine Sawyers, Engagement Manager, McKinsey. Originally published at VoxEU

Obesity has a similar impact on global GDP as smoking, and around 60% of obese people are in developing countries. This column discusses the seriousness of the problem, and argues that more policy action is warranted – particularly in the form of low-risk, low-cost behavioural interventions.

Obesity is now a critical global issue. More than 2.1 billion people – nearly 30% of the global population – are overweight or obese today (Ng et al. 2014). That’s nearly two and a half times the number of adults and children who are undernourished. Obesity is responsible for about 5% of deaths worldwide. Simon Stevens, chief executive of the National Health Service England, warned in September that “we are sleepwalking into the worst public health emergency for at least three decades.”1

This crisis is not just a pressing social and health issue, but an economic one, too. The global economic impact from obesity is roughly $2.0 trillion, or 2.8% of global GDP – roughly equivalent to the global impact from smoking or armed violence, war, and terrorism, according to new research by the McKinsey Global Institute (MGI 2014) (see Figure 1).

Figure 1. Obesity is one of the top three social burdens generated by human beings

dobbs fig1 12 dec

Source: MGI (2014).

Today, the toll of obesity on health systems alone is between 2% and 7% of all healthcare spending in developed economies. That does not include the large cost of treating associated diseases such a type 2 diabetes and heart disease, which takes the healthcare cost up to 20% by some estimates.

Obesity is a Global Problem

And the problem is escalating rapidly. Worldwide, if the prevalence of obesity continues on its current upward trajectory, almost half of the world’s adult population will be overweight or obese by 2030.

No country managed to reduce its obesity prevalence between 2000 and 2013. During this period, prevalence grew by 0.5 percentage points or more a year in 130 of the 196 countries for which the OECD documents obesity prevalence data (OECD 2014). This was once a problem of relatively prosperous developed economies but, as incomes rise in the emerging world, the problem is spreading. Today, around 60% of the world’s obese people are in developing countries.

There is growing evidence that, on top of the costs to healthcare systems, the productivity of employees is being undermined by obesity, compromising the competitiveness of companies. MGI assessed the productivity lost to obesity using the standard measurement of disability-adjusted life years, or DALYs, which measure the number of years that are lost or rendered economically unproductive due to disease. The number of DALYs lost to obesity today is three times as high in developed economies as it is in emerging markets. However, that gap is narrowing. The rise in the number of DALYs per 100,000 people lost because of obesity slowed in developed economies between 1990 and 2010 but soared by 90% in emerging economies.

Policies to Tackle Obesity

So what needs to be done? By reviewing around 500 obesity-reduction research trials around the world, MGI has identified 74 interventions to address obesity in 18 areas. These include subsidised school meals for all, calorie and nutrition labelling, restrictions on advertising of high-calorie food and drinks, and public health campaigns. There were sufficient data on 44 of these to be able to measure potential impact if scaled up to a national level. The systemic nature of the obesity challenge and the highly variable quality of the data that are available mean that this analysis is directional rather than perfect. Indeed, we see our analysis as analogous to a 16th century map that has islands missing and misshapen continents, rather than a perfect 21st century map of the full range of solutions.

If the UK, the country where MGI chose to pilot its initial assessment, were to deploy all 44 interventions that we were able to analyse, it could reverse rising obesity and bring roughly 20% of overweight and obese individuals back into the normal weight category within five to ten years. This would reduce the number of obese and overweight people by roughly the population of Austria.

Cost-Effectiveness and the Need for Coordinated Action

A comprehensive set of interventions needs to employ the full set of mechanisms for changing physical activity and nutritional behaviour. Education about the risks of obesity is important; so is taking personal responsibility for one’s health, fitness, and weight. But all the evidence shows that these are not sufficient on their own to offset the body’s desire to eat that has been honed over millennia of evolution. People need help and that means a change in the environment in which they are making choices – change such as reduced standard portion sizes, changing marketing practices, and restructuring cities and educational establishments to make it easier for people to exercise.

Our analysis for the UK suggests that almost all the interventions identified are cost-effective for society – savings on healthcare costs and higher productivity could outweigh the direct investment required to deliver the intervention when assessed over the full lifetime of the target population. An integrated program to reverse rising obesity could save the National Health Service about $1.2 billion a year. It is important to note that not all of the interventions are cost-effective for the specific stakeholder delivering them. Sometimes the return on investment lands elsewhere in the economy, the benefits going to households or to healthcare systems, for instance. This misalignment of economic incentives is one of the major challenges inhibiting concerted coordinated action on obesity.

Figure 2. Cost-effective interventions to reduce obesity in the United Kingdom include controlling portion sizes and reducing the availability of high-calorie foods.

dobbs fig2 obesity

1Impact and costs are estimated and measured in disability-adjusted life years (DALYs) across full 2014 population in the United Kingdom. For full methodology, download the McKinsey Global Institute (MGI) discussion paper Overcoming obesity: An initial economic analysis, on mckinsey.com.

2Based on the evidence rating system of the Oxford Centre for Evidence-Based Medicine.

Source: Literature review; expert interviews; McKinsey Global Institute analysis

Only a systemic, sustained portfolio of anti-obesity initiatives, implemented on a large scale will be sufficient to overcome rising obesity. No single group in society – government, retailers, consumer goods companies, restaurants, employers, media organisations, educators, healthcare providers, or individuals – can offset rising obesity on their own. Yet efforts to address obesity have been piecemeal thus far. To date, there have been pockets of excellent interventions delivered around the world, but there’s been insufficient attempt to take an integrated view on what it will really take to reduce the public health burden across the board. Moreover, the global debate on how to respond has become polarised, and in some cases deeply antagonistic – partly because the response required is so complex, and spread across such a range of actors in society. This is proving a barrier to progress.

More Research is Needed, but Action Should Start Now

The MGI analysis is far from offering a complete picture as research into obesity has many gaps and data is of variable quality. There clearly needs to be more investment in obesity research. Globally, such investment is estimated at about $4 billion a year – but this is only 0.2% of the social cost of obesity.

Given the increasing severity of the obesity crisis, we cannot afford to wait for perfect evidence on which interventions work and which don’t – especially given many of them are behavioural interventions for which it is difficult to conduct randomised controlled trials, and which are, in any case, low-risk. On many of the interventions, there is enough evidence to know that they work for at least some segments of the population and are low-risk and low-cost. We should therefore learn as we go and make a start. The knowledge we already have justifies much more action against obesity than is currently typically taking place.

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  1. Mogden

    I realize that this suggestion is probably too radical for Naked Capitalism and its array of well intentioned technocrats, but how about we just leave people alone and let them be fat if they want to be?

    1. upstater

      @Mogden: That would be fine if BMI was made a component of higher health insurance premiums. If fatties had to pay 200-300% higher premiums (or mine cut by 2/3), that would be fair. One of the only such penalties under Obamacare is for smokers, but not fatties. I am not sure how this could be applied for single payer.

      1. Propertius

        BMI is a really unreliable indicator of obesity (ask any bodybuilder who has an “obese” BMI at <10% bodyfat).

        How about basing it on bodyfat percentage instead?

        1. rusti

          I think the “bodybuilder” criticism of BMI is overstated. The relatively small percentage of people with a lean body mass high enough to throw it off are probably more health conscious than the average anyway. It’s advantageous over Bodyfat in that it doesn’t require any special tools to measure even if it’s less conclusive. And I say this as someone who fits your criteria :P

          1. Yves Smith Post author

            Bodybuilders with high BMI are still exposed to greater heart attack risk. They are still overloading their hearts carrying all that mass around.

            Bodyfat measures are unreliable. The government of Quebec did a $2 million study something like 15 years ago because it was refusing to hire people it deemed to be too fat to be cops and was sued for discrimination, so it needed to a scientific basis for determining who was fat.

            Electrical impedence is no good because it is affected by how much salt you had before the test. It turns out the supposed gold standard of water displacement (developed using only about 8 cadavers of thin men) is also no good. Black men who are trim will come up with negative body fat using the formula.

            The best method is a ten-site caliper test, but the person administering the test needs to have done the caliper test 4000 times to be good enough to be highly accurate. Not making that finding up.

            And no new methods have been developed since then.

            1. rusti

              Interesting. I wasn’t aware of the limitations of BF% measurement procedures. I suspect that over a broad swath of the population either BMI or BF% are fairly representative, but when high precision measurements are necessary for determining thresholds like in the case you mention maybe they aren’t sufficiently rigorous. Anecdotally I’ve seen about a 2% swing having had a number of measurements using electrical impedance.

              For the vast majority of people visiting a doctor, having a height-weight lookup table and/or a cheap impedance measure is going to be a reasonable indication. So long as the measurement precision is taken in context I don’t see any reason to throw them out.

            2. Francois T

              The Québec study merely proved what specialists already knew; BF% isn’t about accuracy, but about getting a baseline and measuring a trend over time. As imprecise as it can be, it is still a useful tool to confirm what the mirror or the clothes can tell.

              Why did they do the study, then? Because this was a legalese problem, not a scientific one; a typical case of “we need numbers, what they could mean is secondary!”

      2. Athena1

        Why stop with fatties? We should charge more for people who engage is any and all risks, including but not limited to riding in cars (depending on traffic density), driving motorcycles, participating in sports, caffeine consumption, alcohol consumption, being underweight (more risky than obesity!), over consumption of meat , etc and so on.

        Or we could just move to single payer and let people live their lives.

        1. readerOfTeaLeaves

          Actually, I live in the Puget Sound region and know people who know a ton about metabolism and are very active in research and public education. It’s a fascinating topic.

          What I think you don’t realize is that there are increasing numbers of chemicals in the environment – your shampoos, dish soaps, household cleaners, personal care products, that impact your hormones and can create disruptions in the way that your body’s internal communications systems function — in other words, the chemical messages between cells get disrupted, and that creates the beginning of out-of-control health issues.

          Hormone disruption almost certainly lies at the core of diabesity (diabetes + obesity). Anything that disrupts hormone function — from lack of sleep, to infrequent eating, to exhaustion, to pollutants — can trigger the processes that lead to diabetes and obesity.

          A few pointers:
          Eat meat if you like, but make sure it is grass fed and not from a feed lot (where it would be fed hormones).

          Replace your household cleaners with products made by Seventh Generation, ECOS, or similar products that do not contain harmful chemicals — you don’t want them in your house.
          Ecos may be Pacific Northwest only; if they are available in your area, they have a whole line of products and personally I wouldn’t use anything else.

          For personal products, Aveda is expensive, but safe. There are other product lines (also tend to be more expensive) that also avoid harmful chemicals.

          Eat in moderation.
          Move at least 30 minutes per day.

          You may want to check out:
          Their ‘Media’ link has some excellent online videos.
          The local Seattle NBC affiliate’s morning show has done some incredible public education on the general topics of fitness, obesity, diabetes, nutrition, and health. If you are interested, this is a great resource.

        2. Spring Texan

          Amen! I’m for single payer and letting people live their lives.

          Although I’m amenable to interventions to change the environment some (I actually didn’t think Bloomberg’s idea of not allowing sale of giant soft drinks was as bad as represented), punishing individuals is mean, unwarranted, and divisive. Let’s not only have people set against each other by class and race, let’s divide them by size and smoking habits too. Just what those in power and making the money want.

    2. Clive

      Before I became a well intentioned technocrat and started commenting at Naked Capitalism, I was blissfully ignorant of what the first class (prize-winning, if I recall correctly) expert debaters such as Yves and Lambert had to teach about logical fallacies.

      Not wishing to live stoopid-ville if I can help it, through their examples I learned up on the subject.

      Now, I’m certainly no expert and would without hesitation welcome corrections on this one, but I believe what you just did there was known as an ad hominem or, to quote, “means responding to arguments by attacking a person’s character, rather than to the content of their arguments”.

      While I feel that other web sites might better cater to your way of thinking, I will be polite and ask why you don’t think that there’s anything — nothing, nada — interesting to consider in discussing if certain economic factors, class-warfare factors, economically-influenced social changes and possibly big-business-preying-on-their consumers wrongdoing might be making the population as a whole less healthy through a poor diet.

      It is without doubt interesting to me, so please forgive me if I take a seat and watch what might well be an interesting discussion takes place below.

      1. fresno dan

        I really don’t see the comment by Mogden as ad hominem (maybe I just have a thick skin, but being called a “well intentioned technocrat” is practically praise at many of the sites of frequent).

        I would refute the proposition by noting that almost nothing humans do or believe is the result of “being left alone.” How many times we eat a day, how much we eat, and what we eat is not something most of us have spent much time truly considering. But that doesn’t mean there aren’t lots of people who make a good deal of money by trying to do just that.
        Being a microbiologist, and having some serious health problems exacerbated by diet, and having believed the general government/medical establishment on a “well balanced diet” – and than finding out how much of this information, if not completely wrong, was seriously incomplete, well, it causes a reassessment of beliefs. Some of it was wrong because people don’t know as much as they think, and some of it was wrong because people could stand to lose a lot of money if people were advised not to eat or drink certain things (soft drinks are harmful – there is nothing to justify them).
        As I have commented before, reassessing one’s own ideology, beliefs, religion – whatever, is something that is extraordinarily difficult for people. Just as “a calorie is a calorie” is pretty common sense ridiculous (1,000 calories of Coca cola does the same to your body as 1,000 calories of broccoli???), the same can be said for “just being left alone.”
        Just being left alone….I can remember when gasoline stations sold ….gas, oil, windshield washer fluid…but no food. Sometimes there was a horizontal refrigerator that had the old 6 oz cokes in them. Now, what place can you get gasoline that isn’t FULL of candy, chips, cookies, ice cream, soda…..
        MAYBE a few bananas. Why no apples???
        Is that being left alone? No one makes anybody buy that stuff – but the fact remains that the choices we actually have influence the choices we choose.
        The problem with leaving people alone, is that the people who make money by influencing people to make bad choices (from a very, very early age) have no competition or countervailing voice. Unfortunately, there is no BIG broccoli, BIG cauliflower, BIG apple (the fruit, not the city).
        And the people influencing our eating, and therefore our health, have a vested interest that is contrary to our interest.
        In general, I do want to be left alone – as long as the phrase and ramifications are understood….

    3. Katniss Everdeen

      Do you REALLY think that, when legitimately given the choice, ANYBODY would CHOOSE to be fat?

      This illusion of “choice,” when most of the options are scientifically formulated to promote addiction and over-consumption, contorts the concept beyond all recognition. Most of what passes for “food” these days is nothing but a chemical concoction engineered to keep the “consumer” coming back for more.

      And then there is the pervasive, self-righteously judgmental blame-the-victim mentality that excuses every societal failing to which it is applied on the basis of “choice.” They’re weak. They “chose” wrong. I am so much more worthwhile for having chosen “correctly.” Where are their parents?

      Give me a break.

      1. jrs

        Why wouldn’t they? The psychologists usually give the example of someone who was sexually abused choosing to be fat to not be considered sexually desirable. That’s probably not most people, and I agree that much more of it is due to unhealthy food, but yes one can choose to be fat.

        1. TheraP

          OK, I’m a psychologist. So I think I should respond to this. Yes, it may be true that a tiny minority of sexually abused persons make a choice, at some point, to get fat – IF they have reason to believe the abuser dislikes fat people. However, this is not a knee-jerk reaction to sexual abuse. Nor can we conclude it is a conscious decision with that reason as the precipitating factor. Indeed some people eat to self-soothe, for whatever reason.

          Nevertheless, even if a small child thinks being fat might protect them from abuse… Well, we adults know it ain’t so. That’s on the one hand. On the other hand, fat kids grow up. And guess what? Most would realy, really rather not be fat. In fact, the plenitude of diets out there is proof of how many people want, and try, to lose weight. Even victims of sexual abuse.

          Obesity is a huge, huge social, economic and medical problem. Fat people are downwardly mobile. Fat people have trouble finding jobs. They have low self-esteem by and large. And a population of overweight individuals is a strain on the healthcare system of any nation. If you simply consider thar many obese people are unable to work and likely to become medically disabled, then you and I will be paying for their social security and their medical care.

          Given a choice, we’d all love to eat rich foods with no consequences. Few of us, however, very few would prefer the consequence of obesity.

          1. jrs

            Yes I knew the sexual abuse thing was a bit of a cliché, I wasn’t proposing a global psychological or other cause of obesity. But it’s a commonly used example that maybe has some truth. I don’t think people are ALWAYS unequivocal even on wanting to have whatever the media tells us is the ideal body type. One may as well just be motivated to rebel from trying to meet that stupid image all one’s life.

            Also I figure in many cases the rich foods may simply be more important to the person than the consequences.

            I do actually think a lot of processed foods are highly palatable and cause one to overeat, and that certain foods like omega 6 fats may contribute to obesity by raising hunger setpoints etc.. Just doubt there is a universal explanation that applies to every fat person.

    4. Larry

      I fully agree with you here. Life is difficult enough without being shamed for being overweight. Now, there are likely some solutions to this global “problem”

      1. Provide access to healthcare, not health insurance.
      2. Subsidize healthy nutrition
      3. Provide adequate leisure time. How about 4 day weeks and 6 weeks minimum vacation?

      Without those three, I don’t see this “problem” abating anytime soon.

      1. Propertius

        How about a living wage, so poor people don’t have to hold down multiple jobs just to get by? As Yves has pointed out, cheap, processed, calorie-dense meals requiring little or no prep are often the only rational alternative for people working multiple, minimum-wage level jobs.

    5. jrs

      I agree we should just leave individuals alone (are you them? do you fight with their demons? do you know why they may emotionally eat? if they aren’t hurting others, leave them alone).

      But social change is another matter. Are we going to change farm subsidies? Ban GMOs, chlorine chickens, transfats, omega 6 fats in food? (industrial food wouldn’t survive all this btw) Make society less economically stressful, give people more leisure time to cook and exercise, create a society better at meeting human needs?

      No? Then just leave people the heck alone please.

    6. NoFreeWill

      Or we could recognize the social dysfunction that our unhealth symbolizes and take steps to correct it. Give every man 3 glasses of Soylent a day!

    7. Francois T

      We ARE leaving people to their own devices now and…how’s that working out for us so far?
      As for letting people getting fat if they wish, that’d be (barely) possible in a dystopian, Ayn Rand world where no one has to interact with, nor care about any one else.

      In the reality-based community, inquiring minds with some knowledge of health care are aware that obesity carries an ever-expanding list of chronic diseases that will forcibly and severely impact health care budgets everywhere on the planet. From the rise in diabetes type 2, sudden cardiac deaths in middle aged non-smokers, early cognitive decline, (the precursor of dementia) and several types of cancer, as well as worsening of auto-immune diseases, the table is being set right now for a future of hurt, pain and scarcity of services due in no small part to the inferiors who govern us now.

      The people at McKinsey are essentially correct in their assessment; this is a global problem, it is much more complex than what conventional thought (calling the attitudes on obesity “wisdom” would be…unwise!) and it requires solutions that go far beyond the “personal responsibility” stupid meme.

    8. Bunk McNulty

      First they came for obesity, then they came for alcoholism. They’ll pry my bottle of Minervois from my cold dead hands.

      1. jrs

        Well what’s left to make life bearable? Oh that’s right legal pot.

        We are the people and we demand our rightful opium!

  2. Nik

    If there’s a focus on foods that require any kind of labeling or use substantial advertising campaigns, you’re having the wrong conversation. Processed foods can be pretty cheap, but processed “healthy” foods are almost always at a premium that a lot of lower/lower middle class households can’t afford. You can absolutely have a healthy diet on a small budget, but it’s not going to be made up of high margin products that big food processors and grocery chains will get behind. My feeling is that an effective diet that could actually work for large numbers of people has to move away from “products” prepared outside the home and towards a diet of mostly bulk grains, raw fruit/veg, lean meats, etc.

  3. rusti

    I realize it’s the norm for economics discourse, but I find it a bit bizarre to frame obesity in terms of “Impact on GDP” as the authors do. Figure 1 where “Armed Violence, war and terrorism” can neatly be compared with obesity (about 5%, it seems!) is something that belongs in an Onion Infographic. Should we make a hard choice whether we want to hang on to imperial wars or obesity when passing next year’s budget?

    That aside, obesity seems to be something of another symptom of capital’s squeeze on labor.. Workers with more free time, pocket change and health education will make better decisions about how they eat and the level of exercise they get. Here in Sweden, having a health benefit from your employer that covers the better part a gym membership or other physical activity is the norm. People generally work fewer hours and there’s a higher minimum wage, so people are more conscious about where the calories they get are getting come from.

    My life is a lot more rich when I can bicycle to work, take a few hours off in the afternoon and go to the climbing gym or take a yoga class and I wish that everyone had access to similar opportunities. Tough to do when you’re struggling to cover the rent or pay down health care debts.

    1. jgordon

      I believe the author included “armed violence, wars, terrorism”–with a caption of someone holding a handgun–because the author wanted to create the maliciously false illusion that hand gun violence had anywhere near the same impact on society as fat people and smokers do. Just goes to show that those who are zealots against firearms are not only irrationally emotional but also willing to engage in deception, however subtle, to make their illogical points.

  4. grayslady

    There are so many causes for obesity, and the cost versus quality of food available in the U.S. is certainly one of them. Anyone who has traveled to France knows that a French strawberry is exquisite, while an American strawberry tastes like cardboard. Sadly, with the exception of figs, just about every fruit and vegetable sold here has lost all its taste because of growers preferring hybrids that ship well, and that means a loss of succulence and natural sweetness. Consequently, why spend money for something that can’t be consumed without disguising the taste with fats, sauces or lots of salt and pepper?

    But cost of food versus quality is just one of the issues. Anyone who wants to lose weight needs to restrict calories to 1200 per day–either through a food regimen, or a food plus exercise regimen. At 1200 calories per day, no one is going to receive the right amount of vitamins and minerals. Therefore, supplements will be required. Some supplements can be obtained inexpensively, such as Vitamin D. Other supplements, such as B Complex (and B needs to be taken as a complex) are incredibly expensive for the correct balance and dosage and to ensure that the type of B (such as B12) is obtained from sources that are used most effectively by the body, such as methylcobalamin for B12 instead of cyanocobalamin.

    Doctors in the U.S. are particularly poorly trained in nutrition–not just in understanding proper diet, but in understanding the role that vitamins and minerals perform in overall health. Just eating less or exercising more is not enough to maintain a healthy weight while also maintaining a healthy body.

    1. rusti

      Anyone who wants to lose weight needs to restrict calories to 1200 per day

      What in the world led you to this conclusion?

      1. grayslady

        What led me to that conclusion is a lot of published information, including by Sandoz Pharmaceuticals, among others, and my own successful attempt–using that guideline–to lose 30 lbs.in six months some 20 years ago. The consensus among weight loss professionals is that 2 lbs per week is a safe and achievable goal. For a woman, that means calories–and or calories plus exercise–should be 1200 per day in order to lose 2 lbs per week. Men may have a somewhat higher number for daily caloric intake on a diet.

        1. rusti

          It doesn’t seem odd to you to suggest the same caloric intake of an incredibly meager 1200 calories to someone who is 6’4″ with a lean body mass of 180 lbs, versus someone who is 5’4″ with a lean body mass of 100 lbs?

          Or to suggest the same caloric intake to someone looking to go from 300 lbs to 180 versus 140 to 120?

          1. grayslady

            I said this was the recommendation for women. Personally, I have never known a woman who was 6’4″. I also said this was the medical advice I researched and that the information was correct in my personal experience. Clearly, a small woman v. a large man is going to result in different maintenance calories, but for most women, if they truly want to lose 2 lbs per week, 1200 calories per day will work.

    2. savedbyirony

      Not so. A 1,200-1,500 calories/day (and i think that is recommended for women; for men the daily caloric recommendation is slightly higher) diet can supply the needed vitamins and minerals. It’s a matter of a reasonable but not extravagent diversity of healthy food choices over days eaten in moderate proportions. I’ve been doing it for decades, at low cost as well (but am lucky to have nearby locally grown and produced food sources). Nearly never get sick, weigh the same as when i graduated from H.S. and have plenty of energy for work, exercise and leisure activities. Can’t say enough for the habit of eating moderately and healthy, and how fortunate i am to be able to do so. As it applies to the above article and Yves intro, i eat nearly exactly as did while growing-up in the seventies, so i also can’t say enough about how beneficial it is for kids to have the opportunity to form healthy eating habits early on.

      1. grayslady

        Your situation may not be achievable by everyone else. For example, twenty years ago, I, too, was able to easily maintain a healthy weight (although I still needed vitamin supplements). For many women, once they go through menopause, the hormonal changes make it much more difficult to control weight and still eat a healthy, balanced diet. Also, for individuals who have high blood pressure caused by hypoaldosteronism (a tumor on the adrenal gland causing the high blood pressure), it’s almost a given that the individual will need to consume supplemental potassium since potassium levels are decimated by the necessary blood pressure medication.

        I bring up these examples only to point out that diet alone isn’t everything when it comes to health. A lot depends on your age, your overall physical condition, and your genes. You have been fortunate so far, not least that you can obtain nutritious, tasty food at a reasonable cost. Others may not be so fortunate–for any number of reasons.

        1. savedbyirony

          I can’t stand the usual spin out and about concerning “going thru the change” and its after affects. But i’ve been there, done that, not really a big deal, perfectly natural, actually quite freeing. Also, as for eating a healthy, balanced diet at that point in one’s life and after (and continuing to moderately exercise) THAT is precisely the best way to control ones weight. That doesn’t mean parts won’t shift (which is healthy and natural) or that there probably won’t be some weight gain in the middle (which is also healthy and natural), but that that behavior will keep it within healthy limits, and good mental and physical health is what is the point, not thinness.

      2. Yves Smith Post author

        The USDA wrote in 1938 recommended that the public start taking vitamins and minerals because the soil was too depleted to provide enough nutrients. I can’t imagine the situation is better now. But I agree re calorie levels. Americans have been conditioned to eating more food than they need to.

        1. readerOfTeaLeaves

          Part of the benefit of small scale agriculture is amending the soil so that it is pretty healthy and full of nutrients. That’s the benefit of truly organically grown food – the soils are amended and the plants carry more nutrients. The move to smaller scale, sustainable agriculture is toward healthier, more nutritious foods.

          1. savedbyirony

            Maybe that’s why i’ve never had a nutrient problem but never taken any supplements (not even iron,and that is fairly uncommon for women). We have a large Mennonite and small Amish community supplying plenty of produce.

        2. different clue

          Soil scientist William Albrecht coined the term “hidden hunger” to describe the deprivation of key minerals and other nutrients experienced by animals ( including people) when fed food from mineral defficient/ unbalanced soil. Such animals will keep ingesting ever-greater quantities of nutrient-free virtual food in an effort to obtain nutrients. Of course non-human animals will chew on cement, minerals, etc. to get nutrients. Most humans feel culturally inhibited from doing such things. My younger brother once told me about a short film his range-management class was shown in college. It involved some cows kept on very-mineral-depleted scrubby range-land to see what they would do. One such cow was filmed sidling over to a jackrabbit ( the range could support some jackrabbits), acting all casual-like to avoid attracting the jackrabbit’s attention, and then reaching over and grabbing the jackrabbit in its mouth, crunching the jackrabbit all up, and then swallowing it. To get some minerals, you see.
          (The jackrabbit really wasn’t expecting it from a cow).

          Here is an article by one-time soil scientist Firman Bear about different mineral contents of crops depending on different mineral levels and balances in the soil they were grown in.
          And here’s another. http://soilminerals.com/Bear_cations-anions-plants-crop%20quality%201950.pdf

          Here’s a place where a bunch of such articles reside.

    3. jrs

      Quite honestly I think a lot of the depression in women is due to dieting. Inadequate nourishment … will do that, and yes it’s harder to get adequate nourishment on an unhealthy diet at any calorie range.

  5. susan the other

    Obesity is a subject the entire world can come together on. It goes beyond nutrition and fitness. Consider that air pollution makes you tired, gives you a headache, makes your thinking fuzzy – symptoms of chronic poisoning that are self evident and human fat storage processes cart away the toxins and deposit them in fat cells because vital organs will be overwhelmed otherwise. So much of what is eaten cannot be fully utilized because it’s just too toxic – both the food itself which is infused with chemicals and the air we breath which infuses our blood with more poisons. My point? Stop using chemicals in food production. And stop using gasoline and diesel. Stop driving cars. And stop making them. And stop trying to self medicate your poisoned body with refined carbs. That’s just an insidious way to commit suicide. We need some victory gardens.

    1. susan the other

      And speaking of gardens, did anybody else see the little report on NHK about the Japanese farmer (maybe a group of farmers) who have turned their backs on high tech ag methods and are raising veggies based on quality. On the vitality of the plant. I kinda like that trend.

      1. Clive

        Yep. I liked it too. Which is why I’m encouraged by the, well, courage, of the usually reliably dreadful Japanese government to stand up for small regional agriculture in the face of the would-be TPP steamroller. While the motives may not be entirely pure (there may well be both pork barrel politics and gerrymandering at work), any sort of support for farmers who value quality over quantity is fine by me. And what is so wrong if there are subsidies provided for farmers eschewing GMOs, Monsanto “patented seeds” and land-degrading chemicals ? Subsidy is not necessarily a dirty word.

  6. flora

    I note with interest Figure 2 and the obesity interventions list that includes “Pharaceuticals”.
    I hope they mean not only pharma for people, but antibiotics in animal feeds for beef,pork, and poultry production. Antibiotics in animal feeds are used to promote faster than normal weight gain as well as to fight disease. Antibiotic run off into the surface water supply, used for drinking water in many places, results in trace amounts of antibiotics in drinking water even after treatment. The rise of resistant bacteria is a well known effect. Less appreciated, I think, is the possibility that constant low exposure to antibiotics may contribute to weight gain in people. This is just a guess.

    1. ambrit

      There’s also the early weight gain for women due to early sexual “maturity” due to ingesting sex hormones via chicken and beef. These were implicated fairly early in the crisis of premature sexual maturation of girls in our society. As I’ve observed from my own family, childbirth and breast feeding often leads to a permanent slowing of the womans’ metabolism. I’m not sure if a similar effect occurs in men, but I wouldn’t be a bit surprised.

      1. MyLessThanPrimeBeef

        It’s a problem when not accompanied by early emotional maturity and early intellectual maturity. With those, at least we can look at lowering the legal age.

        Unfortunately, we seem to be without them, and so kids today get the adult body chemistry, but still feeling and thinking like a kid.

  7. Graffiti Grammarian

    There is a lot going on in our industrial food supply that you don’t cover.

    Humans evolved over millions of years along with our food sources, just like every other animal on the planet. This co-evolution means our bodies produce the right enzymes to break down the molecular structure of certain plants and animals.

    But Industrial Agriculture has been fooling with the molecular structure of our basic foods for decades now. Long before GMOs, they began to use aggressive plant breeding methods, including radiation and other induced mutations, to create what are essentially whole new strains of wheat, corn and soy that produce bigger yields and therefore bigger profits.

    Those new breeds of wheat corn and soy make up the vast bulk of our food supply.

    But many people cannot digest them. You never used to hear about “gluten-intolerance” 20 years ago, did you? Or soy allergies? But today everybody knows somebody who says they have problems when they try to eat these foods.

    These foods are basically wrecking our insides, and causing all kinds of dysfunction. Obesity is one side effect because our nutrient-starved bodies push us to eat, eat, eat when we cannot derive the nutrients our bodies need from the stuff we are feeding ourselves.

    This is going to come to a bad end.

  8. ptup

    I don’t know. Let’s look at the other side of this coin. We have arrived at a time in human history, even though the population of the Earth is at it’s highest and climbing, when hunger has essentially been eradicated from the developed world, at least. That is a major accomplishment in human history. Think of how a citizen of America from, oh, the early nineteenth century would react when led into an average supermarket on a cold January day. I’m sure you would have to help them pick their jaw up from the floor and fix it’s placement, especially after they see the produce section. Fresh blueberries at a reasonable price, sir? Hell, Royals from the eighteenth century would be stunned. Then drive them up to a window on Main Street and order them a meal that contains all plus more of their caloric needs for the day for, again, a very modest sum. I’ll bet they’ll think it’s delicious, too. Most people today do, except for those like us who are so jaded we can afford to look down on it.
    Of course, we’re overshooting. That can be expected, considering this is a new phenomenon in history, a severe change from, well, almost all of human history. But, at the same time, is it all really so bad? As America gets fatter, life expectancy just keeps on extending, too. I know, medical science gets most of the credit for that, but, still, if it was such a scourge (like smoking) where’s the problem, really?

    btw, I’m pretty fit, exercise, watch my diet and don’t eat out of drive up windows. That stuff will kill you, I’m told.

    1. MyLessThanPrimeBeef

      I think it depends, for both people of the 19th century and today.

      If he/she (from any period in history) is really hungry, yeah.

      But they say, for example, today’s tomatoes don’t smell nor taste the same. And so, a typical shopper from the 19th Century might not even recognize them.

      The same goes with apples. Apparently, before the 20th century, apples were used mainly to make ciders and not for eating. So, someone from that time might not be so impressed at those stacks of apples.

      And when he/she sips on tap water from today’s bottle water, if it’s fluoridate, he/she might think it not potable.

      So, it’s far from certain we can impress them.

      1. ptup

        “But they say, for example, today’s tomatoes don’t smell nor taste the same. And so, a typical shopper from the 19th Century might not even recognize them.”

        The “typical shopper” of the 19th century was a farmer, probably growing most of his own food and bartering for the rest. If one had a bad crop year and a harsh winter afterwards, the quality of apples was superseded by a survival diet.
        Water? Hey, that fluoride may be a little strange, but, at least most of our water doesn’t carry toxic contamination that could wipe out most of a family in weeks. Like most water before the 20th century, and most fresh water supplies in the third world today. Mortality rates were high. There’s a reason even the rich made a lot of babies.

    2. Spring Texan

      Yes, this is a good problem to have compared to a lot of others. If you go somewhere and see a lot of skinny kids, you realize that, and Americans even 100 years ago were often stunted as adults from malnutrition.

  9. AQ

    I see wellness plan and insurance premiums tied to weight. Potential job loss or job screening: not only background checks, credit reports but now also health reports pre-existing conditions be damned because these are LIFESTYLE choices ha ha!!!

    Control reins. We’ll give you the food pyramids, subsidize processed foods, gmo crops, fertilizers, etc. Kill local farming and now any labeling/handling requirements through global trade agreements. We’d also like total control over the seed stock. Then turn around and penalize you on the backside to pay for said subsidies and giving us that control.

    In other words, the herd is pushed toward our “conventional wisdom” because it serves someone else’s interest (cereal and orange juice for breakfast, eggs bad for heart health, butter v. margarine, sugar v. corn syrup, etc., etc., etc.)

    Now to segue back:
    How in the world do they measure these so called costs anyway? e.g., I’m often struck by all of the state tobacco settlements. Billions of dollar supposedly and yet there’s still talk about how much smokers cost society. Sorry, I may not be a smoker but that seems more like a shaming proganda technique than actual analysis, especially when there’s no mention of pollution and it’s affects on people. Cars? Nope. Air pollution from China? The Bakkens? water pollution? prescription drugs in the water? Nope. Nope. Nope. Nope. Food allergies on the rise. That’s on the individual not our agricultural system.

    Back to smoking: why people smoke and under what circumstances? Isn’t it a cheap drug of choice compared to prescription drugs plus how should we analyze the state’s tax/use revenue stream. Speaking of taxes, how much revenue will be generated by proposed soda taxes to fight obesity?


    Sure, I see a potential problem but I also know that it’s a media darling these days, so it’s someone’s agenda. Which leads to me what’s the end game here?

    1. Keenan

      I see wellness plan and insurance premiums tied to weight.

      Perhaps in large employer group plans and perhaps places other than my part of Pennsylvania. The wretched ACA offerings here are based only on age and tobacco use. And tobacco free for the past 6 months is all that’s required on that criteria. Doc says my physiological age is at least 10 years younger than my calendar. That doesn’t get one a better rate either.

    2. readerOfTeaLeaves

      Having talked to a couple of healthco admins about what the predicted numbers of diabetics in the US will mean for the health care system, the numbers they are looking at are downright scary. The McKinsey information is pointing to a huge, huge problem.

      The amounts of money tied up in insulin, syringes, needles, and insulin-monitoring equipment are staggering.
      In addition, diabetes over time impedes blood flow, first in capillaries in the extremities, which means people end up requiring surgeries to remove ‘dying limbs’, generally feet first.

      In addition, diabetes is basically a process in which the cell is not able to correctly break down nutrients; this means the body as an energy system gradually becomes less functional; people tire more easily and are more apt to constant low-level illnesses. So the MKI information about the impact on employee performance is pretty significant.

  10. DakotabornKansan

    J. Eric Oliver, Fat Politics: The Real Story behind America’s Obesity Epidemic, set out to write his book believing that “obesity” is a real problem in America. However, “What I thought was an epidemic began to look like a politically orchestrated campaign to capitalize on America’s growing weight.” The “heath-industrial” complex profits once you can label fat people as “sick”.

    Obesity is not a disease according to Oliver. It is a symptom, not a cause, of the nation’s health problems. Oliver writes that proclamations of an “obesity epidemic” are built upon shoddy science and marketing campaigns developed and promoted by those who either sell purported “solutions” to the “problem,” or whose funding depends on belief that they’re researching or fighting a terrible disease:

    “Consider, for example, what an obesity epidemic means for the following groups. For scientists researching issues of weight, an obesity epidemic inflates their stature and allows them to get more research grants. For government health agencies, it is a powerful rationale for increasing their programs and budget allocations. For weight-loss companies and surgeons, it is a way to get their services covered by Medicare and health insurance providers. And, for pharmaceutical companies it can justify the release of new drugs, and help inflate their stock prices. The very same people who have proclaimed that obesity is a major health problem also stand the most to gain from it being classified as a disease. For America’s public health establishment, an obesity epidemic is worth billions.”

    Oliver says that despite the claims attributing increased incidence of diabetes to weight gain and insulin resistance, “No one has demonstrated that obesity causes insulin resistance. All we really know is that insulin resistance is simply more prevalent among people who are heavier. In fact, we just may have the whole causal relationship backward – rather than obesity causing insulin resistance, it might be that insulin resistance is causing obesity.”

    “And it is these other metabolic changes that are behind many of the diseases that are typically associated with being too fat. The reason that diabetes and some types of cancer are on the rise is not because Americans weight too much, it is because their metabolisms are out of whack. Fatness may result from metabolic processes that are behind these ailments, but it is the underlying metabolic processes, and not the weight, that cause us so much trouble.”

    Fatness is not a disease. According to Oliver, “It is a protective mechanism that evolved to survive fluctuations in our food supply. Judging someone’s health by how much they weigh is like judging a camel by how much water it has in its hump — in conditions of privation, our extra weight, just like the water, may be exactly what we need to survive. Our weight is merely an expression of this adaptive mechanism at work.”

    “The only way we are going to “solve” the problem of obesity is to stop making fatness a scapegoat for all our ills. This means that public health officials and doctors need to stop making weight a barometer of health and issuing so many alarmist claims about the obesity epidemic. This also means that the rest of us need to stop judging others and ourselves by our size.”

    “Although most Americans value bodily fitness as a marker of social prestige, they value thinness more. And for good reason–in a culture in which obesity is so demonized, being fit yet heavy does little to remove the stigma of a large body size, particularly for women. For instance, if a woman is incredibly fit but still bulky or heavy, she is still likely to face size discrimination. The emphasis on female fitness is primarily concerned with being thin not necessarily being healthy. Because of our cultural obsession with thinness, any discussion of exercise inevitably becomes connected to issues of weight while concerns of health fly out the window.”

    “Instead of convening task forces to figure out ways to combat obesity, state and federal government should simply be telling health agencies to find better measures of health than weight. They should make rules on the conflicts of interest between obesity researchers, weight-loss doctors, and the diet and pharmaceutical industries. And they should develop programs to combat the stigma and prejudice that fat people must face and institute laws, such as those in San Francisco and Michigan, that protect people against size discrimination. In short, they should work on changing all the harmful perceptions we have about weight. This would do far more to improve the health and well-being of the American population than making us so worried about our weight.”

      1. Athena1

        Agreed. I’m not a fan of the author’s politics, but the lady who wrote the jubkfoodscience blog explains all this really well, too. (google junkfood science obesity paradox.)

    1. readerOfTeaLeaves

      Yes, there is now a growing body of evidence that ‘fat’ or excess weight, is actually the symptom of underlying metabolic disfunction.

  11. theinhibitor

    Changing someone’s diet is incredibly hard to do when multiplied by a populations scale. I recently read some research papers on the growing trend of sustainable agriculture and it’s positive impacts on diet and obesity, etc.

    However, the one vein everybody agreed upon is that, for agriculture to become sustainable there has to be a paradigm shift in a populations diet, which in America’s case, would be to cut down meat/dairy consumption by 40-50%. This is because, to make a farm sustainable, the proportions of cattle have to be much smaller than what we have today.

    In my mind, the only way to combat obesity would be to start taxing:
    1). foods with little nutrition
    2). unsustainable agriculture
    3). GMO’s
    and conversely, promote sustainable agriculture through tax benefits. Only when we have a level playing field, where the working class has the time and money to eat well, can we even begin to talk about curbing obesity.

    Until then, the argument merely degrades into a ‘the majority cant eat well because they have no time/money’ vs ‘they dont eat well because they have been indoctrinated to eat poorly/dont want to eat well’. And it’s probably a bit of both.

    1. MyLessThanPrimeBeef

      My idea is to make organic food the default choice and if someone want to pay more and go out of his/her way to get food that is not organic, they are free to do so.

  12. Fair Economist

    I’m surprised you didn’t bring up the economics of food companies. It’s in the financial interest of food companies to get everybody to buy as much as possible, which basically means eating as much as possible. They spend billions per year on figuring out how to make food appealing and tasty – but unsatisfying, leaving you wanting more. (On a side note – it’s shocking they can advertise this to consumers as a *good* thing – “Once you pop, you can’t stop!” That should make you run away!)

    I suspect this is the primary reason processed food is associated with obesity – not so much that processed food per se makes you fat, but that corporate processors are forced by market incentives to process in ways that make you fat. Home cooking can often be heavily processed, but seems to be associated with less obesity. The difference is that the processor in home cooking wants the eater to be healthy, as a rule, while the corporate processor just wants to trick them into spending more money.

  13. JohnnyGL

    In my view, not enough people looking at car-dependence as it relates to this issue.

    1) Decades ago, auto/oil industry pushed hard on public policy to build highways, destroy light rail, and market the suburban lifestyle as ideal.

    2) And, more recently, it’s become a class issue, too. Wealthy people move to cosmopolitan urban centers with good transport links and poorer people are pushed out by gentrification to longer-distance options where they ride multiple buses and/or sit in traffic.

    Personally, I’ve put on 20lbs since I moved 6 miles away from decent public transport access (pushed by steep real estate prices).

    In the US these days, if you’re going to yell at people for being fat, you may as well yell at them for being poor. It’s become a pretty tight correlation.

    1. Yves Smith Post author

      I was going to mention that one of the reasons I intend never to own a car is that running your life on foot keeps you out of the sedentary category, which is the most important step to make regarding physical activity. While more exercise is generally better (the caveat being injury and joint wear), the biggest benefit is from getting out of being sedentary.

    2. ptup

      I don’t know about that. I live in a very wealthy burb of NYC that is about as far from Manhattan as you can get and still work there. Probably a two hour combined commute each way (yeah, I know, but, not me), and most of these people are heading to a chair in a cube, I’ll bet. Yet, as in most upper middle class communities, I see little obesity here. There’s something else going on there.

      1. Yves Smith Post author

        Fat is a class marker, so upper income people avoid it and have the means to do so (better food, enough income and control over their lives to exercise regularly).

        1. Art Eclectic

          Class and income aren’t always tied exclusively. Being seriously overweight, smoking, shopping at Walmart, and a diet that includes regular fast food excursions are absolutely class markers. But there are upper income people who do all these things and they are still considered “lower class” by virtue of failing to take care of themselves. If I see someone with a McDonald’s bag in their hand, I may not guess at their income level but I can sure make an accurate call on their social class that’s fairly accurate.

  14. optimader


    “..We don’t doubt that McDonald’s faces technology challenges as it works to reverse sales declines, pushes to simplify its menu and works the kinks out of a new “build your own burger” concept. But let us humbly suggest that what the burger giant needs more than tech talent is cooking talent. Here’s what customers young and old want: tasty food made with reasonably real ingredients, served fast in a clean restaurant at an affordable price…”

    Maybe to reverse sales declines they should focus on serving food that smells doesn’t smell like soiled diapers even before its been digested?

  15. impermanence

    This subject aptly demonstrates why it is absurd to socialize a topic which is clearly an individual matter. This is why all people should be responsible for their own health care. If a person chooses a particularly destructive behavior, that person should suffer the consequences, if for no other reason that it will be instructive to others.

    1. Athena1

      If a person chooses a particularly destructive behavior, that person should suffer the consequences,

      This is why we must immediately repeal laws forcing ERs to treat people regardless of ability to pay. When the masses start seeing the bloody and diseased corpses piled up outside of the ER doors, they’ll learn to think twice about driving without seatbelts and eating too many Cheetos!

      1. Ben Johannson

        Not to mention wealth is by definition a socially produced good, therefore anything affecting that production (like ill health) is a social problem. It’s impossible to get away from.

      2. impermanence

        Sooner or later, mankind will realize that living a good life is not about anticipating all the bad things that can happen to you [and taking precautions], but instead, its about living freely, taking those chances you feel are prudent and accepting the consequences, be they positive/negative.

        If people knew they were responsible for their own health [care], think about how this might affect their behavior. Being bailed out personally works about the same as TBTF.

        1. Athena1

          So, there’s evidence that people in the single payer countries live far less healthier lives than we do, then?

    2. readerOfTeaLeaves

      Part of diabetes risk is genetic. Whether the genes that make diabetes more likely will be expressed are all affected by diet (quality of nutrients in the food), pollutants (which can affect both DNA, as well as hormones), stress, and sleep patterns.

      People who work night shifts may save your life some time, but their work makes them more vulnerable to weight gain. Are you going to blame them for being overweight? Is it their ‘choice’?

      The chemicals in the food supply and foods available in cities all over the US are beyond the control of any individual. People try to purchase as best they can, but their food supply is not a factor over which they have complete control.

      Difficult job situations, ill family members, moving repeatedly, and other factors that produce stress are not generally ‘personal choices’.

      I don’t know a single person, anywhere, who picked their own DNA. We just kind of get born with it, and if we have certain genetic predispositions, we are more vulnerable to obesity and/or diabetes. Blaming people for inheriting problematic genes seems a bit obtuse, at the very least.

      1. Sam Kanu

        “…People try to purchase as best they can, but their food supply is not a factor over which they have complete control.
        Difficult job situations, ill family members, moving repeatedly, and other factors that produce stress are not generally ‘personal choices’.
        I don’t know a single person, anywhere, who picked their own DNA. We just kind of get born with it, and if we have certain genetic predispositions, we are more vulnerable to obesity and/or diabetes. Blaming people for inheriting problematic genes seems a bit obtuse, at the very least….”

        You completely miss the point.
        Indeed many of these factors are beyond people’s sole control. They have some control but not all.
        However when progressive people in society try to set in place the necessary controls so that people can be protected on a macro level, then corporate forces who make money on these evils (“externalities”) then astroturf counter movements. And people fall for it every time.
        Red herrings about blaming the victims only serve to compound the misdirection!
        In our world we need strong regulation more than ever, in order to give the average person a chance at a decent life, as opposed to being steamrollered by the selfish interests of the greedy few. That’s the overarching implication of this blog and has always been, really.

        1. readerOfTeaLeaves

          I didn’t think that I was blaming the victim, and I’m not sure what point I missed,
          There are business models, and I expect more in the future, that are better aligned with healthier outcomes – whether it is Seventh Generation cleaning products, or safer personal care products, or local ag movements. With that said, there is a role for regulation, but it has to be simple enough and clear enough to work well.

          1. Sam Kanu

            But the problem with business today is they completely reject the concept of regulation at all. Science that says sugary drinks should not be marketed as every day drinks for kids? Or science that says presenting smaller portion sizes induces eating/drinking of healthier proportions? Well you cant turn that into regulation because they undermine it? The story goes on an on.

            We need responsible people in charge of businesses today. They are destroying our societies for the benefit of a tiny handful. I dont know if they think their kids are going to be able to decamp to Mars or Pluto or something with all the money they have grubbed up for themselves, but really they had better wake up quickly before it is too late of for all of our descendants.

  16. Jeff N

    ^—– 5’10”, 245 lbs.. honestly, I feel like I’m going to cry… I’m so physically drained/tired at all times of the day (Zoloft probably contributes to this); exercise or anything active seems impossible… My doctor tells me to just start exercising (literally) one minute per day, then try to build up from there.

    1. not_me

      I was 5’10” and weighed 240lb. Here’s what I did to lose 30 lbs (so far) in less than 2 months:

      1) I fasted (water only) for 8 days. This took off about 20 lbs. A shorter fast might easily work since the idea is to make the body enjoy what it formerly considered bland.
      2) I switched to a mostly steamed vegetable diet. After the fast, those formerly frozen veggies were delicious, especially salted. I like California blend (cauliflower, broccoli, carrots) frozen veggies.
      3) I also try to walk/jog a few miles a day but i reckon the diet does most of the reduction since exercise alone will not reduce my weight or volume. I do this when it is coldest so as to encourage brown fat cell creation.
      4) I occasionally eat some protein in the form of peanut butter and have a cup of cooked oatmeal a day.

      I now am confident that I can lose another 30 or so pounds after Christmas and keep them off since I’ve had it with being fat.

    2. Yves Smith Post author

      I’m really sorry. Can you walk more? Park your car way out in parking lots whereever you go as a start.

      Weight training actually does the most to elevate your metabolism, but you probably need to do more walking before you are ready to try that.

  17. TheraP

    A lot of what sets someone up for a lifetime of obesity starts in childhood. In fact, it starts in utero. What a pregnant woman eats affects her unborn child’s later food preferences. And what parents feed a child affects what the expect and want to eat. France goes to a lot of trouble to influence how families eat and that seems to be sowing up in less obesity in France.

    Changing the dietary habits of Americans will be an uphill battle. Socially, even politically, and certainly economically – given the big stakes so many corporations have in influencing consumers. To consume their chips and dips and sugary drinks and beers and hamburgers and pizzas and donuts, etc. You name it! But just look at how much space is devoted to junk food in every supermarket. And how many fast food high calorie, mouth-watering commercials on TV urging you to go out and buy or visit your nearest high calorie, fast food palace.

    1. readerOfTeaLeaves

      At the risk of commenting far too many times on this post, my resources in the health care field tell me that there are multiple, well-done research projects that show how BPA affects hormones (particularly in women). IIRC, the blood samples of American mothers now almost always show BPA.

      I drank bottled water ‘back in the day’, as well as orange juice, out of bottles made from BPA. I had no idea whatsoever that I was ingesting dangerous chemicals — if I’d realized it, I would never in a hundred years have drunk that stuff. Cheap plastic food storage containers are also likely to ‘leak’ chemicals into food – particularly oils, olives, peanut butter. Drinking from a water bottle that has been sitting in a car in the sun is really risky — UNLESS you are using non-BPA containers. (Smart Water plastic bottles are made of non-BPA plastics.)

      IOW, people may eat quite well, yet the containers their foods are stored in are leaking chemicals that later end up wreaking havoc in their bodies.

  18. nihil obstet

    Hunger is one of the strongest biological drives we have. Resisting eating enough to satisfy hunger takes enormous amounts of energy. You can stay thin with will power, but it comes at an enormous cost. The model of will-power-enabled thinness is mechanical, as though hunger measures how much is in your stomach just as your car’s fuel gauge measures how much gasoline is in your tank. In fact, hunger is a chemical, hormonal signal, and has to do with the content of the food and any changes that have been wrought in your stomach and intestines by your environment. There is probably some effect from less physical exercise and more calory-heavy food for much of the population, but the same changes have been accumulating over the last 150 years or so, and it’s only the last 30 or so that have seen the skyrocketing of obesity.

    It seems to me that at least these two factors have to be largely responsible:

    – the decreased nutritional value of foods. Plants and animals have been developed to grow faster and bigger now. While scientists assume that portions of foods containing the same number of calories have the same effect on hunger, it’s probably evolutionarily more sensible to think that foods lacking nutritional denseness will not diminish hunger as effectively.
    – the chemicals around and in us. This includes the herbicides, pesticides, antibiotics, and strange genes from the GMOs that may affect the hunger signals to the brain and the fat storage process. It also includes the plastics in which foods are stored and cooked. It also includes the medicines we take. Our food is digested by gut bacteria; a course of antibiotics to knock out an illness may well also knock out bacteria we need for healthy, satisfying digestion. To the best of my knowledge, the effect of chemicals on hunger are not part of their safety checks.

    If, as the situation of an obesity plague suggests to me, the problem is a screwed up digestion/hunger metabolism, then expecting people to control weight through lifestyle changes is like expecting people with sleep apnea to control fatigue through an exercise regimen.

    1. Yves Smith Post author

      I think I am going to make readers hate me but I am never hungry. That may have contributed to my being a fat kid. I had no body signals as to when to eat. Literally, once maybe every 18 months to two years I have a gnawing feeling in my stomach and I go, “Oh that’s what hunger is like!” That means for me eating is arbitrary, like when the clock says I should eat or when I feel I need a reward. When I am insanely busy, I can go all day not eating and I have to recognize the symptoms of a blood sugar crash (crankiness, trouble concentrating) as a sign I need to eat. So it is hard for me to relate to hunger as a driver of eating.

      1. TheraP

        This lack of sensory awareness may be more common than many realize. Since how would one even know to be aware of “absence” of sensation? Or misunderstood bodily signals? I have a spouse, who misinterprets tiredness as a signal to eat, for example.

        It’s very helpful, I think, for us to comprehend the complexity of eating. To have compassion.

      2. jrs

        Try fasting and you will learn what hunger is. I think it’s pretty normal not to be hungry on the day to day if one has adequate nutrition status, at a fatter or thinner weight.

      3. susan the other

        I know what you are talking about. It has been a long time – at least a decade – since I was actually hungry. And I don’t eat much. Make up for it with wine maybe.

  19. Curtis

    Somewhere on the web, is an article that indicates that even wild animals are fatter than they used to be. If that is the case there is some factor out there that is making fat an epidemic. My vote goes for things like atrazine, bisphenol A, and other chemicals produced to make our life better. Sort of a better things through chemistry blowback. Epigenetics is the area for research about fat. There must be a clever statement about fate and fat that we can all rally round.

  20. Blackjack

    Well, as a late 60s male, (Canadian I might add…) who is somewhat overweight (6 foot, 200 or so pounds…) and with a determined wish to lose, say, 15 pounds, I can say that, to do this permanently, is no small feat. It is easy to drop a few lbs. It is also very easy to quickly get them back. And so on. On, off, on, ad naseum. What I have discovered (way too late) is that weight loss is NOT about losing weight. How’s that for a revelation? Sure did my head in. Your whole life has to be amended, or as i say ‘dietized’. ( May have to think of a better word…) Every daily action has to be scrutinized, and changed, if need be, to fit a new, more modest perspective. This is HARD. Just eating less, better, etc. will NOT do the trick, as you always go back to old habits. (In my case it’s a ravenous, almost uncontrollable appetite. Fortunately, I am not particularly attracted to ‘junk’ food (thank god), but other than that, well…..) So, I have started this journey of reducing my lifestyle. If my waistline follows, great. If not, it doesn’t matter, particularly. ( But I think it will, ultimately.) Funny to think that using less gas in my car means I will shed a few pounds, but that is how I see it, now. Weight loss is just one byproduct of change, and cannot successfully be singled out for change by itself.

    1. Tim

      See my comment below under “Tim.” Got my pops to adopt “my” diet at 69 when he weighed 240 at 6′ 1″. He’s 72 and now hovers at 190 with minimal effort. Remove insulin from the equation and maintaining a healthy weight is a piece of cake. Heh.

    2. Yves Smith Post author

      Yes, I can relate. It’s now habit, but I spent 8 years off and on dieting (lose weight over 3-4 months, gain 2/3 of it back over the next 2-3 years, rinse and repeat) so that by the end of that period I was thin. But then it took years of insane vigilance to stay thin. That’s finally become habituated but it takes time to reprogram yourself.

      In the meantime. low calorie snacks like having cut raw or blanched veggies are a big help. And if you don’t have a blood pressure problem, drinking broths (veggie or chicken) with some herbs or mushroom in it to make it a little less naked is another way to eat when you have the munchies without taking many calories in.

  21. Brooklin Bridge

    The rise of obesity so closely parallels the rise of McDonalds specifically and fast food in general that it is hard to look beyond that phenomenon.

  22. I.G.I.

    Yes, by all accounts they are closely related. Germans -past and present- are under heavy cultural influence from the US, and fast food outlets are abundant there. And guess what? In two hours walk around Cologne I saw more obese people there (all of them young!) than I see in a week in Brussels where I live, and where cheap fast food is not (yet) so overwhelmingly dominant. Ditto for London… during lunch hour in Central London practically everybody eats industrially processed food; and it shows…

    Somebody in a previous comment expressed doubt whether industrially processing food do much harm. It does! Multiple stages processing, high temperatures, and additives significantly lower the nutritional content of the food. On paper substance X might be found in almost equal quantities in processed and unprocessed foods, but that doesn’t mean that processed and unprocessed food are metabolized the same way by the body. On the contrary, the body is very selective, and many artificially synthesized substances (like vitamins for instance) are discarded as junk; or artificially synthesized substances could fool the body, displace the proper/natural ones, and induce harm.

    A case of point is processed fats. Fats are very delicate (they gradually degrade even at room temperature and natural light), but, contrary to the orchestrated campaigns of demonization, literally indispensable for human metabolism. Overheating fats, especially plant oils, change them irreversibly, and result in a range of toxic substances with little to no nutritional value bar high caloric content.

    I strongly suspect that industrially processed fats are, if not the principal, then one of the main causes for the metabolic derailment resulting in obesity, diabetes II, and the cascade of processes leading to cardiovascular disease.

    By the way, in the OP Yves mention that,

    “……some populations like Hispanics and Chinese, are susceptible to diabetes at much lower body mass indices than Caucasians.”.

    I found that bit very interesting as I never came across before that epidemiological data. Coincidence or not, both Spanish and Chinese cuisine as practiced today involve a lot of frying in plants oils (Spanish food often tastes great, but practically everything is fried!). Frying is, without doubt, the most toxic way of food preparation.

  23. Luke The Debtor

    Fat people have garnered a lot of attention. Maybe we should talk about their increased carbon footprint. LOL. Seriously, adults are fat by choice. The shameful part is they pass their fat ideas along to their kids, giving them the belief that being fat is okay.

  24. EmilianoZ

    And don’t forget brain exercises. The brain is supposed to consume a lotta energy (maybe even most of it). I suggest doing long divisions in the head, like 4852594364/37.

  25. buffalo cyclist

    I really have to agree with Yves comment about walking. A great part of the problem in the US is that so many communities (especially many suburban and rural areas) refuse to build sidewalks and also pass sprawl inducing zoning laws, which essentially force people to drive everywhere. Of course, part of this is classism. By making car ownership a de facto requirement to live in a given area, a community can make the area unaffordable to poor people.

  26. Tim

    Recommend reading Gary Taubes’ “Good Calories, Bad Calories,” Nina Teicholz’s “Big Fat Surprise,” and “Nutrition and Physical Degeneration” by Weston A. Price. Essentially…more fat, less (better yet, ZERO) refined grains and sugar (in all forms). Since latter are heavily subsidized and the former continues to be improperly maligned, we’ll continue to see rising obesity rates. Fat does not make one fat. For the past 4 years I’ve cooked nearly exclusively with lard and coconut oil. I don’t eat grains and really avoid sugar. I exercise 4 times a month instead of 6 times a week when I ate a “conventionally” balanced diet. Then my weight oscillated between 205-210lbs depending on how long I could maintain a calorie deficit. Now I eat to satiety and weigh 188 with no effort but eating real food. Until governments recognize their longstanding error against fats in favor of grains (and by default sugar), no government policy will work in stemming this tide of corpulence and metabolic derangement.

    1. I.G.I.

      There is too much profit in the “war on Cholesterol” so I am not holding my breath for policy reversal any time soon.

  27. Ignacio

    There is growing evidence that, on top of the costs to healthcare systems, the productivity of employees is being undermined by obesity, compromising the competitiveness of companies.

    Fat robots are less efficient than slim ones?. Fu&K the competitiveness!

    1. jrs

      Goof off at work now, rather than raiding the vending machine for your stress! Try to become unproductive before you become obese.

  28. Paulo A Franke

    Yves: you started in good shape, stating that the article on Obesity is a bit wide of NC terrain. And you went wide off the mark.

    Reader Tim summarized it well: the only thing that matters on Obesity is the debate on fat vs cereals and sugars. Just that, nothing else.

    Reader Tim suggested that you read Gary Taubes, Nina Teicholz and Weston Price. I would add two names to his list: the sugar-nemesis Robert Lustig (Fat Chance) and wheat-nemesis William Davis (Wheat Belly). After reading this stuff, you may want to go back to the subject, with a fresh mind…. And fresh indignation.

    1. Yves Smith Post author

      I have to tell you, I’ve been around the diet block since I was 17. I’ve seen more fads and theories come and go than you can possibly count. I agree that refined sugars and flour is a bad idea, but this idealization of fats is yet another fad. I’ve seen tons of cutting edge nutrition ideas have their day in the sun and die over this period.

      Your need a remarkably small amount of essential fatty acids from a health standpoint. And I got thin in my teens based on simple, good old fashioned calorie restriction. That will have you cut down on sugars anyhow because they are calorically dense, as are fats. There is simply not enough history to prove the food enthusiasts’ theory that grass fed meats are good for you. I am CERTAIN they are “less bad” by virtue of not (derivatively) having GMOs in them through eating GMO fed corn and having all those growth hormones. But colon cancer incidence is highly correlated with lifetime red meat consumption, and the jury is out as to whether “less bad” red meat buys you all that much in a general health sense. There is a long track record of vegetarians like Seventh Day Adventists having much better general health than animal fat consumers.

      On top of THAT, a lot of the new wave of diet fads (variants of the Paleo diet) go back and invoke how people ate a long time ago. Guess what? Average lifespans were way lower due to accidents and disease. So even the supposedly healthier people they talked about then lived to be maybe 40 or 50. Way too many environmental risks for them to live longer. So no direct analogy to the risks (like cancer) of eating certain foods for 60 years. And the environment was clean.

      All sorts of nasties, like chemicals and heavy metals like mercury, are fat soluble. That means when you ingest them, they get into your fatty tissues. Ugh. And the higher up the food chain you eat, the higher the concentration of those fat-borne nasties. That is why tuna has high mercury levels, it’s a top predator.

      You’ve now got mercury in the air (particularly if you are downwind coal fired electrical plants) and all sorts of drugs and chemicals in minute quantities in the water. You get less of that if you eat further down the food chain. You’ll get more via the fats you eat if you eat more animal fats. Period.

      So please, don’t preach the new religion here. Nutrition is a complete and total backwater in medicine, and medicine has very very little in the way of science underpinning it to begin with. It’s a medieval art.

      1. optimader

        “But colon cancer incidence is highly correlated with lifetime red meat consumption, and the jury is out as to whether “less bad” red meat buys you all that much in a general health sense”

        I’ll bet a dollar to a donut.. er make that a granola bar… that 2 out of 3 people on this blog are chronically below the daily recommended soluble/insoluble fiber dietary recommendation and 1 out of 3 is hugely below the recommendation…

  29. LAS

    We have a culture that is unhealthy because too much of it is based on market rather than social justice. All commodities and modes of living are stratified to target classes with variable wealth to spend. Wealthy people can afford to buy their way into better neighborhoods, to better dining tables, to leisure time for exercise, to doctors, to servants and other conveniences that denote accomplishment, ease, freedom from anxiety and threats. The wealthy have resources to deliberately pick, choose, position and navigate for healthier conditions.

    Many others have limited or no resources. And please don’t say people get what they deserve. They don’t. There’s a big advantage a boss has when he buys labor from 50 persons that a person who sells his labor does not have, the ability to multiply return on investment. Labor can only be sold once, but labor can be purchased in multiples. So when the cost of labor is driven down, our culture is very deliberately crushing people so that a few might be empowered. We have no right to moralize to the poor about what they’re doing wrong. It is a much larger cultural phenomenon.

    Having spent time with both wealthy and poor people, I have to say the wealthy more often exhibit de-humanization, only they don’t know it. They are often frantic to establish their social position, and can disrespect the efforts and achievements of others because it might not be the “trendy” thing in Chelsea. The poor treat one another with more personal respect, and seem to understand what true achievement really is all about. I know of a grandmother, living in NYCHA housing, struggling with diabetes, raising a grand-daughter with disabilities and also a grandson. What she does in a day is heroic and it all goes unremarked by our culture.

  30. richmond

    This is an extremely complex issue. The simplistic approach to target/blame the victim for economic cost reasons is both grotesque and consistent with our cultures’ devolution to reducing everything to dollars. Targeting people to “motivate” them to lose weight is counterproductive and destructive.

    Ninety percent of what is sold in stores and restaurants is not human “food”. It is highly processed, polluted, contaminated and in the case of frozen items, large amounts of fats are added. Meat animals are injected with hormones and antibiotics which are then consumed. Sausage casings need to be imported, because domestic pork intestines are weak and riddled with holes from feeding gmo corn. Non-organic and gmo vegetables have nutrition profiles that are wildly different from and nutrient deficient compared to their organic counterparts. Most rice has dangerous levels of non-organic arsenic from contaminated fields if consumed over 3/4 c per week. The human diet should consist of fresh and dried fruits, vegetables, grains, peas and beans….if you always cook at home and can resist the constant barrage of advertising, cultural pressure and have access to clean reliable food sources.

    I agree, grooming and household products are loaded with hormone disrupting chemicals, as are food can linings, soft plastic bottles and frozen food packaging. There is also recent research that shows gut bacteria can determine whether rats are thin or fat, and transferring that bacteria will change a rats body type. The gut bacteria seems dependent on the contamination of the environment they are raised in.

    So by all means, lets target the victims, not the food and chemical industries that have caused the problem. Maybe the “targeted intervention” can extract some more profit by convincing people to punish themselves for trying to survive in this massive human experiment. People do not need to be fixed because we’ve suddenly changed, it’s the physical and cultural environment we are living in, which has caused the change.

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