Obesity and Ozempic and more (1 Viewer)

[Terminalxylem]

I counsel patients regarding diet and exercise, and reassure them when they become frustrated at the difficulty losing weight. I emphasize they shouldn't let perfect be enemy of the good, and any dietary improvement/activity increase/weight loss is better than none.

Interesting. That's quite a bit different from "unfortunately, diet and exercise seldom succeed in real world conditions."

Since it appears I’m not communicating well, let me restate:

1. Diet (most important) and exercise are the cornerstones of weight loss. Anyone who is overweight or obese should earnestly try to improve both. Any incremental improvement is better than no change in obesity-promoting behaviors.

2. Population data show us only a small percentage of people can maintain long term weight loss using behavioral modification alone, probably in the neighborhood of 10%, or less. The reasons for this level of failure aren’t entirely clear, but may partially due to adaptations that occur in obese people’s bodies in response to weight loss. This article offers some explanations.

3. Drugs like Wegovy (semaglutide) and Zepbound (tirzepatide) are far and away the most potent pharmacologic interventions available as adjuncts for weight loss. The latter is comparable in efficacy to bariatric surgery.

4. If someone fails at behavioral modification, the risks of unmitigated obesity are high.

5. Based on known pre-clinical and post-marketing data, semaglutide and tirzepatide appear to be safe. Drugs like semaglutide (exenatide) have been used in diabetics for almost two decades, so even long term use hasn’t proven a problem.

6. Every drug has potential for adverse effects, but there’s no good reason to believe weight loss drugs will prove more harmful than other chronic medications. More importantly, it’s highly improbable the likelihood of serious AEs exceeds the risk of uncontrolled obesity.

7. Most arguments against weight loss drugs don’t rationally consider points 2-6, instead viewing failed behavioral modification as laziness/lack of willpower, or placing undue emphasis on fears of the unknown, and unsubstantiated anecdotes of possible AEs.

8. While legal + cultural changes are certainly needed to stem the tide of obesity, any such change requires political will, and years-decades to take effect. In the meantime, we should use all available tools to treat obesity, including medications.

Sustained weight loss is really hard for Americans but not for other cultures??

Yeah, not buying it.

Better diet, more exercise. Americans are lazy and fat.

With few exceptions, obesity is a problem in much of the developed world.

Yeah, the idea of lazy American's as it pertains to obesity is really lazy humans. We are basically the top major world power but just about everybody on the planet is overweight (by BMI) save several African nations and the far East.

Most Obese Countries 2024

worldpopulationreview.com

Thanks. Why do most people think US is 36% and Japan, a very developed country, is 4%?

this is not something "everyone can do." In fact, barely anyone can do it

Do you have thoughts on:

1. Why it seems that 50 years ago, lots of people were able to not be obese?
2. Why today in countries like Japan, 96% of the population is able not to be obese?

This goes back to my water is wet comment. The way food is made/sold/marketed is different. We’re old enough that we remember the microwave being introduced. Remember the hungry man ads? We went from cooking with fresh ingredients, for the most part, to cooking prepacked crap laden with preservatives, sugar, salt, all the wrong oils and HFCS.

Take popcorn. Extra buttery microwave popcorn. Really not good for you. Loaded with trans fats and other chemicals. If you Cook the popcorn your self you control what goes in it. That’s an easy 3-4 hundred calorie difference and no chemicals/transfats. Hell, you could cook it in bacon fat and it will be healthier for you.

Occam’s razor.

Maybe you missed this.

Thanks. I saw your post. Was wondering if @AAABatteries had thoughts. And others of course too.

I find the "hardly anyone can do it" fascinating when somehow someway 96% of Japanese people do it.

The easiest way to fight overweight/obesity is never gaining weight in the first place. It helps to have a culture that isn't centered about massive amounts of unhealthy food and beverage.

Once you gain it, the body fights attempts at weight loss, as starvation is generally undesirable for short-term survival.

All that said, it would be interesting to see how frequently obese Japanese people are able to maintain weight loss via behavioral modification, vs. Americans.

 

[Terminalxylem]

Bottom line, I still got up at 5:30AM and ran my 5 miles in 90+% humidity. Was it fun, no but it is part of my normal now and that is the "lifesyle" change that must occur for most to see the benefits of diet and exercise. I know I may be in the minority, but the felling I have when done is incredible and makes it worth the work put in.

I think you're hitting on some of the real issue. Doing this is not fun. Restricting what one eats is not fun.

Exercise can indeed be fun. And eating healthy food also becomes pleasurable, if you stick with it.

Unfortunately, we know most people never realize how rewarding a healthy lifestyle can be.

 

[Terminalxylem]

And to be clear, I don't have any real point of view on this.

I'm mostly trying to understand the why on this. In particular, why countries like Japan have been able to do something we have not been able to do,.

Just culture, Joe. The standard fare in Japan is pretty lean protein.

And it helps they didn't have an FDA **** up nutrition guidelines for 50 years.

This is an old link, but super interesting how dietary composition has changed over time. It shows the even Japan's diet is getting worse, mostly through increase in consumption of meat, sugar and fat, at the expense of grains. The US is a little different, but the same general trends still apply.

Perhaps more importantly, our daily caloric intake increased ~1800 calories over 50 years, ending in 2011. Japan only went up 200 calories in that time.

 

[Terminalxylem]

I don’t have time to reply at length, but briefly - as I had written about upthread - it’s sociology-cultural conditions. Yes, I know that’s broad — but it’s not a one-factor magic-bullet kind of thing. The socio-cultural conditions that promote health BMI are legion and all-pervasive in Japan.

What doesn't add up for me is reading things like that makes it sound like people "in a culture" have no choice. LIke they are predestined to obesity.

It seems some think they are locked into unchangeable behaviours and they have no ability to break free of the chains of the culture.

When what we're talking about is eating healthier. It's not like people are in prison and being force fed a diet they despise.

It seems like some people think Americans are unable to break out of our culture and eat more healthy and exercise better. Like we're destined to accept the fate of our culture with no ability to do anything about it.

That's what I'm struggling with.

Ignoring the financial factors at play, kids who get fed junk food only know junk food as adults. Especially f everyone around you grows up under similar circumstances.

And once you slide down obesity's slippery slope, it's hard to escape.

 

[Joe Bryant]

Cultural: the types of foods people eat, portion size (e.g., all you can eat buffets - I see all you can eat sushi in the U.S., but not in Tokyo when I was there), how much people walk or exercise (the average person, not fitness focused people), societal discrimination against people who are overweight (including employment). Just off the top of my head.

Sure. But people are allowed to not gorge themselves on the all you can eat buffet, right?

And people know gorging themselves on the all you can eat buffet is a bad idea, right?

Joe: You asked me to explain what I meant when I referenced cultural and genetic difference in response to your question about why Japan has only a 4% obesity rate. I did so earnestly. Your response here is not only dismissive, it is borderline rude. Just saying. [Edit: In rereading, I think what may have happened here is that you conflated our exchange here to the debate about choice you were having with others. If that was the case, not borderline rude. For the record, I don’t dismiss your assertions about choice.]

As for your question, it is a good one (and one I tried to answer). Why do you think Japan has a 4% obesity rate and America a 36% rate?

Thanks for the feedback. Super disappointing to hear you felt that was borderline rude. I apologize as that's something I strive hard to avoid. I too thought it was a good question and one I'm interested in. Which is why I asked.

 

[bigbottom]

Cultural: the types of foods people eat, portion size (e.g., all you can eat buffets - I see all you can eat sushi in the U.S., but not in Tokyo when I was there), how much people walk or exercise (the average person, not fitness focused people), societal discrimination against people who are overweight (including employment). Just off the top of my head.

Sure. But people are allowed to not gorge themselves on the all you can eat buffet, right?

And people know gorging themselves on the all you can eat buffet is a bad idea, right?

Joe: You asked me to explain what I meant when I referenced cultural and genetic difference in response to your question about why Japan has only a 4% obesity rate. I did so earnestly. Your response here is not only dismissive, it is borderline rude. Just saying. [Edit: In rereading, I think what may have happened here is that you conflated our exchange here to the debate about choice you were having with others. If that was the case, not borderline rude. For the record, I don’t dismiss your assertions about choice.]

As for your question, it is a good one (and one I tried to answer). Why do you think Japan has a 4% obesity rate and America a 36% rate?

Wow. Disappointing to hear you felt that was borderline rude. I apologize as that's something I strive hard to avoid. I too thought it was a good question and one I'm interested in. Which is why I asked.

No worries. I (mistakenly it seems) interpreted your response as curt, dismissive, and not really responsive to anything I said (which had nothing to do with choice), which was disappointing to me because I had spent a good deal of time thinking about and responding to your question.

But I’m interested in your answer to the question. Why do you think Japan has a 4% obesity rate while the U.S. is at 36%?

 

[bigbottom]

I don’t have time to reply at length, but briefly - as I had written about upthread - it’s sociology-cultural conditions. Yes, I know that’s broad — but it’s not a one-factor magic-bullet kind of thing. The socio-cultural conditions that promote health BMI are legion and all-pervasive in Japan.

What doesn't add up for me is reading things like that makes it sound like people "in a culture" have no choice. LIke they are predestined to obesity.

It seems some think they are locked into unchangeable behaviours and they have no ability to break free of the chains of the culture.

When what we're talking about is eating healthier. It's not like people are in prison and being force fed a diet they despise.

It seems like some people think Americans are unable to break out of our culture and eat more healthy and exercise better. Like we're destined to accept the fate of our culture with no ability to do anything about it.

That's what I'm struggling with.

Ignoring the financial factors at play, kids who get fed junk food only know junk food as adults. Especially f everyone around you grows up under similar circumstances.

And once you slide down obesity's slippery slope, it's hard to escape.

Great point. I would think it is super hard for anyone to lose 150 pounds to go from morbidly obese to a healthy weight. And I imagine that very few Japanese nationals (outside of sumo wrestlers) ever find themselves with 150 pounds to lose in the first place. Those that do probably face a lot of the same difficulties as Americans in that position. I imagine the easiest way to get to and maintain a healthy weight is to have always been at a healthy weight to begin with.

 

[bigbottom]

Put simply, culturally, America has normalized overeating, while Japan has not.

And by overeating I mean not only portion size but also calorically dense and nutritionally questionable foods.

 

[3C's]

How about this case study. I have 2 kids who are now well into adulthood. They both grew up in the same household, raised exactly the same. One is very overweight and one is extremely fit. So in this case it's not genetics, not how they were raised/societal/financial factors. Wife and I were always into exercise and staying in shape. Both of us were working parents though so meals might not have always been the best choices. As adults their diet and exercise choices are night and day different. And the "issue" if you want to call it that began well before either hit adulthood but has become more extreme recently.

 

[bigbottom]

How about this case study. I have 2 kids who are now well into adulthood. They both grew up in the same household, raised exactly the same. One is very overweight and one is extremely fit. So in this case it's not genetics, not how they were raised/societal/financial factors. Wife and I were always into exercise and staying in shape. Both of us were working parents though so meals might not have always been the best choices. As adults their diet and exercise choices are night and day different. And the "issue" if you want to call it that began well before either hit adulthood but has become more extreme recently.

Was one into sports and the other not? Were their lifestyles as teens different even while their home environment the same?

 

[3C's]

How about this case study. I have 2 kids who are now well into adulthood. They both grew up in the same household, raised exactly the same. One is very overweight and one is extremely fit. So in this case it's not genetics, not how they were raised/societal/financial factors. Wife and I were always into exercise and staying in shape. Both of us were working parents though so meals might not have always been the best choices. As adults their diet and exercise choices are night and day different. And the "issue" if you want to call it that began well before either hit adulthood but has become more extreme recently.

Was one into sports and the other not? Were their lifestyles as teens different even while their home environment the same?

Both played sports as kids. The fit one actually played into HS and married a college athlete who is a fitness freak so now the differences are extreme. I blame the Internet/video games. One got sucked into the worst of gaming and the other was always out and about, even as kids.

 

[Terminalxylem]

Sustained weight loss is really hard for Americans but not for other cultures??

Yeah, not buying it.

Better diet, more exercise. Americans are lazy and fat.

With few exceptions, obesity is a problem in much of the developed world.

Yeah, the idea of lazy American's as it pertains to obesity is really lazy humans. We are basically the top major world power but just about everybody on the planet is overweight (by BMI) save several African nations and the far East.

Most Obese Countries 2024

worldpopulationreview.com

Thanks. Why do most people think US is 36% and Japan, a very developed country, is 4%?

Cultural differences. And probably genetic differences as well.

Thanks. Can you elaborate? What specific cultural or genetic differences?

Cultural: the types of foods people eat, portion size (e.g., all you can eat buffets - I see all you can eat sushi in the U.S., but not in Tokyo when I was there), how much people walk or exercise (the average person, not fitness focused people), societal discrimination against people who are overweight (including employment). Just off the top of my head.

Genetic: no idea as to the science. But I do have anecdotal evidence that I’d love to hear @Terminalxylem weigh in on as he has a data set a thousandfold greater. My mom is Japanese and is from Hawaii. She was one of eight children and I have a ton of cousins in Hawaii. My cousins who are full Japanese are generally thin. My cousins where my aunt or uncle married a Hawaiian on the other hand are generally not thin. There are exceptions but it mostly holds. Culturally they are living in the same environment. I guess one could ask whether the Japanese people you know who live and have been raised in the communities where you live tend to be thinner or heavier than the average local populace?

There are certainly differences in baseline body composition across different ethnicities. Pacific Islanders tend to have greater muscle mass, for example, while East Asians have greater body fat percentage than people of European ancestry. The latter phenomenon may explain higher rates of diabetes among Asians, and the range for healthy BMI has been adjusted accordingly.

But genetics play a small role in our current problems with obesity. It's much more about diet and culture. We see this all the time with children of immigrants from places with lower average BMIs. Even if they marry people of similar background, access and acceptance of ultra processed foods leads to higher rates of obesity in their kids, and possibly the first generation as well, if they embrace the standard American diet.

 

[bigbottom]

Sustained weight loss is really hard for Americans but not for other cultures??

Yeah, not buying it.

Better diet, more exercise. Americans are lazy and fat.

With few exceptions, obesity is a problem in much of the developed world.

Yeah, the idea of lazy American's as it pertains to obesity is really lazy humans. We are basically the top major world power but just about everybody on the planet is overweight (by BMI) save several African nations and the far East.

Most Obese Countries 2024

worldpopulationreview.com

Thanks. Why do most people think US is 36% and Japan, a very developed country, is 4%?

Cultural differences. And probably genetic differences as well.

Thanks. Can you elaborate? What specific cultural or genetic differences?

Cultural: the types of foods people eat, portion size (e.g., all you can eat buffets - I see all you can eat sushi in the U.S., but not in Tokyo when I was there), how much people walk or exercise (the average person, not fitness focused people), societal discrimination against people who are overweight (including employment). Just off the top of my head.

Genetic: no idea as to the science. But I do have anecdotal evidence that I’d love to hear @Terminalxylem weigh in on as he has a data set a thousandfold greater. My mom is Japanese and is from Hawaii. She was one of eight children and I have a ton of cousins in Hawaii. My cousins who are full Japanese are generally thin. My cousins where my aunt or uncle married a Hawaiian on the other hand are generally not thin. There are exceptions but it mostly holds. Culturally they are living in the same environment. I guess one could ask whether the Japanese people you know who live and have been raised in the communities where you live tend to be thinner or heavier than the average local populace?

There are certainly differences in baseline body composition across different ethnicities. Pacific Islanders tend to have greater muscle mass, for example, while East Asians have greater body fat percentage than people of European ancestry. The latter phenomenon may explain higher rates of diabetes among Asians, and the range for healthy BMI has been adjusted accordingly.

But genetics play a small role in our current problems with obesity. It's much more about diet and culture. We see this all the time with children of immigrants from places with lower average BMIs. Even if they marry people of similar background, access and acceptance of ultra processed foods leads to higher rates of obesity in their kids, and possibly the first generation as well, if they embrace the standard American diet.

Yes, this makes a lot of sense. But you’re a doctor in Hawaii right? Do you see some of the differences that I see in my family? Or not really?

 

[Terminalxylem]

Not over 50 years, I will agree.... how about over 1,000 years??? Or even more??

Not sure over 1000 years.

But what I'm saying is in this particular situation of obesity, the outcome has changed dramatically over 50 years. And because I don't think genetics change that fast, it leads me to believe the change is not caused by genetics. (Said by someone who knows next to nothing about genetics )

I think genetics can impact which foods you crave and how much you need to eat until you reach satiety. If an obese couple had a child and gave it up for adoption, do you think that child would be more likely to end up obese than a child born of two super skinny parents given up for adoption? If so, genetics does at least play some role. But again I’m the furthest thing from a scientist so I’m just making layman observations.

Yes, genetics are important. Here's a twin study:

To assess the relative importance of genetic and environmental effects on the body-mass index (weight in kilograms divided by the square of the height in meters), we studied samples of identical and fraternal twins, reared apart or reared together. The samples consisted of 93 pairs of identical twins reared apart, 154 pairs of identical twins reared together, 218 pairs of fraternal twins reared apart, and 208 pairs of fraternal twins reared together.

The intrapair correlation coefficients of the values for body-mass index of identical twins reared apart were 0.70 for men and 0.66 for women. These are the most direct estimates of the relative importance of genetic influences (heritability) on the body-mass index, and they were only slightly lower than those for twins reared together in this and earlier studies. Similar estimates were derived from maximum-likelihood model-fitting analyses — 0.74 for men and 0.69 for women. Nonadditive genetic variance made a significant contribution to the estimates of heritability, particularly among men. Of the potential environmental influences, only those unique to the individual and not those shared by family members were important, contributing about 30 percent of the variance. Sharing the same childhood environment did not contribute to the similarity of the body-mass index of twins later in life.

We conclude that genetic influences on body-mass index are substantial, whereas the childhood environment has little or no influence. These findings corroborate and extend the results of earlier studies of twins and adoptees.

 

[gianmarco]

Individual vs population health and epidemiology are two VERY different things. This came up frequently in the Covid thread as well.

You can't apply principles and results from one onto the other. There was already a prime example of this in this thread early on.

The statement "diet and exercise don't work for weight loss" is both a completely true and false statement.

If used for an individual's health, it's absolutely false. That individual can institute diet and exercise and will lose weight.

If used for a population (like the US), it's absolutely true. It's been a "treatment" for obesity for years but the overall success rate for the population is poor. Not because it CAN'T happen, but because for multiple reasons it just doesn't. No amount of goodwill or handwringing or wishing will change those results. The greatest motivational speaker in a room full of obese people might influence SOME of them to make lifestyle changes that matter AND stick, but far more won't ever see that success, or even if they do, won't maintain it.

Saying "I just don't accept it's not possible" is just another example of not fully understanding population based health and what's needed to make widespread lasting changes. And this is not an uncommon misunderstanding because individual vs public health are very different things. So it's common for people to think "well, if this person can do it, why can't everyone else?". And we've been trying to answer that question forever.

 

[Terminalxylem]

Sustained weight loss is really hard for Americans but not for other cultures??

Yeah, not buying it.

Better diet, more exercise. Americans are lazy and fat.

With few exceptions, obesity is a problem in much of the developed world.

Yeah, the idea of lazy American's as it pertains to obesity is really lazy humans. We are basically the top major world power but just about everybody on the planet is overweight (by BMI) save several African nations and the far East.

Most Obese Countries 2024

worldpopulationreview.com

Thanks. Why do most people think US is 36% and Japan, a very developed country, is 4%?

Cultural differences. And probably genetic differences as well.

Thanks. Can you elaborate? What specific cultural or genetic differences?

Cultural: the types of foods people eat, portion size (e.g., all you can eat buffets - I see all you can eat sushi in the U.S., but not in Tokyo when I was there), how much people walk or exercise (the average person, not fitness focused people), societal discrimination against people who are overweight (including employment). Just off the top of my head.

Genetic: no idea as to the science. But I do have anecdotal evidence that I’d love to hear @Terminalxylem weigh in on as he has a data set a thousandfold greater. My mom is Japanese and is from Hawaii. She was one of eight children and I have a ton of cousins in Hawaii. My cousins who are full Japanese are generally thin. My cousins where my aunt or uncle married a Hawaiian on the other hand are generally not thin. There are exceptions but it mostly holds. Culturally they are living in the same environment. I guess one could ask whether the Japanese people you know who live and have been raised in the communities where you live tend to be thinner or heavier than the average local populace?

There are certainly differences in baseline body composition across different ethnicities. Pacific Islanders tend to have greater muscle mass, for example, while East Asians have greater body fat percentage than people of European ancestry. The latter phenomenon may explain higher rates of diabetes among Asians, and the range for healthy BMI has been adjusted accordingly.

But genetics play a small role in our current problems with obesity. It's much more about diet and culture. We see this all the time with children of immigrants from places with lower average BMIs. Even if they marry people of similar background, access and acceptance of ultra processed foods leads to higher rates of obesity in their kids, and possibly the first generation as well, if they embrace the standard American diet.

Yes, this makes a lot of sense. But you’re a doctor in Hawaii right? Do you see some of the differences that I see in my family? Or not really?

People of East Asian descent who retain strong ties to their culture, at least wrt diet, tend to be thinner.

Pacific Islanders are bigger people a priori, and have worse diets. When they marry East Asians, their kids tend to be fatter. Hard to know how much of that is due to genetics, and how much from diet.

Regardless, anyone who embraces the contemporary island "plate lunch" diet, is almost invariable fatter, no matter their background.

 

[Joe Bryant]

Saying "I just don't accept it's not possible" is just another example of not fully understanding population based health and what's needed to make widespread lasting changes.

We'll disagree there. I think saying "I don't accept change is not possible" doesn't necessarily mean one doesn't understand. I think it means they don't accept change is not possible.

But thanks for the explaining.

 

[Terminalxylem]

Individual responsibility to address one’s obesity in some manner? Once effective society-wide solutions come into play — as is just starting to happen in recent years — then, yes, I can get on board that individuals need to avail themselves of these solutions. Still some financial/insurance hurdles that need to drop to improve the societal outcomes, but we’ll get there.

The 'then' here is the problem. No need to wait on getting people to eat correctly.

Americans need to change the e kind of food they consume. Eating less of it is wonderful. But not nearly as wonderful as changing one's diet. Ozempic etc. can be part of the answer, but that's not what is gonna happen. What's gonna happen is that people will consider it the ONLY answer, and eat less garbage. Which is better than more garbage, but the only way to get off the Ozempic will be changing diets so one isn't craving that stuff.

Disagree. Some will do that, sure, but you have no idea (nor do I) what % of people will use Ozempic as part of a multi pronged approach to achieve a healthier lifestyle.

 

[gianmarco]

Saying "I just don't accept it's not possible" is just another example of not fully understanding population based health and what's needed to make widespread lasting changes.

We'll disagree there. I think saying "I don't accept change is not possible" doesn't necessarily mean one doesn't understand. I think it means they don't accept change is not possible.

But thanks for the explaining.

But it's not possible from a population standpoint without some kind of radical intervention. This is not a matter of opinion. You may not want to accept that fact, but it is indeed a fact. There's mountains of long-term data that supports this.

Trying to figure out HOW and WHY we arrived where we are is a great question. There's no single answer. There's obviously something given the differences between the US and Japan. But, even if we found the exact answer as to what those differences are, it would take radical changes in culture, food sourcing, and many other factors PLUS significant time to ever arrive there.

 

[gianmarco]

Also, i haven't gone back to check yet and I'm not sure if it's been mentioned, but there's a very strong correlation between poverty and obesity. I would guess this is another huge factor in the differences.

And that's not to say there isn't poverty in Japan, but how those with less income get food and can exercise is going to be very different than here.

 

[Terminalxylem]

Put simply, culturally, America has normalized overeating, while Japan has not.

And by overeating I mean not only portion size but also calorically dense and nutritionally questionable foods.

And we've adjusted our standards for what constitutes a "normal" weight in lockstep with our expanding waistlines.

 

[gianmarco]

For perspective, we have literally had thousands upon thousands of people who have tried to unlock the "secret" of weight loss. No one has succeeded across a vast population level. Not one.

From diets to nutrition programs (weight watchers, nutrisystem, etc) to home gyms to regular gyms to books to memberships (Peleton) to medicine to seminars to motivational speakers to government intervention. There have been SO many attempts to discover the key to get everyone to lose weight. All of the above have different degrees of success. All of them can work for any one individual, either through pure motivation or spending money or whatever. But NONE of them have had any kind of widespread success.

If they ever do, whoever discovers it will be a trillionaire.

We've had brilliant minds and financially motivated people trying to solve this problem in the US but to no avail. And that's not going to change any time soon.

 

[Joe Bryant]

But it's not possible from a population standpoint without some kind of radical intervention.

Nobody said intervention wasn't in the cards in the change.

Some are just tired of being told "I just don't accept it's not possible" is just another example of not fully understanding.

I fully realize you disagree, but not all of us don't understand.

 

[Terminalxylem]

How about this case study. I have 2 kids who are now well into adulthood. They both grew up in the same household, raised exactly the same. One is very overweight and one is extremely fit. So in this case it's not genetics, not how they were raised/societal/financial factors. Wife and I were always into exercise and staying in shape. Both of us were working parents though so meals might not have always been the best choices. As adults their diet and exercise choices are night and day different. And the "issue" if you want to call it that began well before either hit adulthood but has become more extreme recently.

Case study #2

Two kids, a boy and a girl, raised by single mom. Parents divorced when the youngest was 3, eldest 6.

Both latchkey kids, as morbidly obese mom worked several jobs. Only saw their healthy weight dad, former college football player, on weekends. Grew up in the late 70's/80's, raised on meat-and-potatoes and microwave diet. The boy wrestled in high school, girl read a lot of books, and excelled academically.

Fast forward 40 years. Both parents are dead: dad from cancer, mom from diabetic complications. Mom outlived dad by almost a decade.

But what about the children?

The male is lean, and exercises religiously, BMI has never exceeded 24. Eats plant-based diet.

The girl has been heavy most of her life, but now is likely 100 pounds overweight. Still reads a lot, but rarely exercises. Also eats plants, at least around her brother

Not sure what my point is, other than my family also is all over the map wrt diet, exercise, and BMI.

 

[Oracle]

Sustained weight loss is really hard for Americans but not for other cultures??

Yeah, not buying it.

Better diet, more exercise. Americans are lazy and fat.

With few exceptions, obesity is a problem in much of the developed world.

Yeah, the idea of lazy American's as it pertains to obesity is really lazy humans. We are basically the top major world power but just about everybody on the planet is overweight (by BMI) save several African nations and the far East.

Most Obese Countries 2024

worldpopulationreview.com

Thanks. Why do most people think US is 36% and Japan, a very developed country, is 4%?

Cultural differences. And probably genetic differences as well.

Thanks. Can you elaborate? What specific cultural or genetic differences?

Cultural: the types of foods people eat, portion size (e.g., all you can eat buffets - I see all you can eat sushi in the U.S., but not in Tokyo when I was there), how much people walk or exercise (the average person, not fitness focused people), societal discrimination against people who are overweight (including employment). Just off the top of my head.

Genetic: no idea as to the science. But I do have anecdotal evidence that I’d love to hear @Terminalxylem weigh in on as he has a data set a thousandfold greater. My mom is Japanese and is from Hawaii. She was one of eight children and I have a ton of cousins in Hawaii. My cousins who are full Japanese are generally thin. My cousins where my aunt or uncle married a Hawaiian on the other hand are generally not thin. There are exceptions but it mostly holds. Culturally they are living in the same environment. I guess one could ask whether the Japanese people you know who live and have been raised in the communities where you live tend to be thinner or heavier than the average local populace?

To add to culture differences, in elementary school, the children make their own lunches in the classroom. Fresh ( not processed) food is provided. Eating healthy is taught and encouraged from a young age.

Also, Japan has a very inexpensive national healthcare plan and all Japanese citizens are legally required to participate. Since necessary healthcare is not for profit, the costs are kept low. The Japanese government pays anywhere from 70%-90% of the premium. The price that you pay is determined by many things such as income and maintaining a healthy body. If you fail to maintain a healthy body, then your share of the premium is increased. You also have to submit a plan to the doctor for how you intend on getting back in shape. I do not think that would fly in the United States.

I do like that Japan promotes healthy lifestyles. They have gone so far as to produce an electric spoon that imitates the taste of salt, which decreases sodium intake. Even Sake is promoted as health.

 

[massraider]

Disagree. Some will do that, sure, but you have no idea (nor do I) what % of people will use Ozempic as part of a multi pronged approach to achieve a healthier lifestyle.

I am simply going off my observation of the American eater. People are saying diet and exercise don't work in this very thread, so I am pretty confident in that prediction.

 

[bigbottom]

Disagree. Some will do that, sure, but you have no idea (nor do I) what % of people will use Ozempic as part of a multi pronged approach to achieve a healthier lifestyle.

I am simply going off my observation of the American eater. People are saying diet and exercise don't work in this very thread, so I am pretty confident in that prediction.

I don’t know anyone who is (openly) on Ozempic for weight loss, but @Joe Bryant has a couple friends who have had success with it. Joe, do you have a sense as to whether your friends are not only eating less but also eating better? Or is it just reduced caloric intake from the same types of foods?

 

[D-Day]

I just completed a 50 minute walk and my apple watch indicated my VO2 is 46.9. I'm 60, 6'0", 200-205 lbs and already had a heart attack in 2022. Since 2022 I went from 240 lbs down to 190, and now I'm back up to 200-205. Life throws stuff at you that throws you off your game, and sometimes our activities and food intake follow the path of least resistance. I'm considering Ozy or something like that to help make a healthy lifestyle easier to maintain long term.

 

[Terminalxylem]

Disagree. Some will do that, sure, but you have no idea (nor do I) what % of people will use Ozempic as part of a multi pronged approach to achieve a healthier lifestyle.

I am simply going off my observation of the American eater. People are saying diet and exercise don't work in this very thread, so I am pretty confident in that prediction.

Diet and exercise don’t work, in part, because of adaptations the body makes in response to starvation. Who’s to say those adaptations don’t revert, after 5, 10 years of improved caloric intake?

That’s a lot more time to potentially establish good habits, too. And work on the sociocultural climate responsible for this mess, while medical treatments for obesity further advance.

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

 

[Alex P Keaton]

Also, i haven't gone back to check yet and I'm not sure if it's been mentioned, but there's a very strong correlation between poverty and obesity. I would guess this is another huge factor in the differences.

And that's not to say there isn't poverty in Japan, but how those with less income get food and can exercise is going to be very different than here.

Based on this, I’ve evidently spiraled into poverty the past 3 months……

 

[massraider]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

 

[gianmarco]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

I think you're missing a HUGE factor. Government stepped in and made it illegal to smoke almost everywhere indoors. And taxes on smoking jumped significantly as well. And insurance coverage is more expensive for smokers.

 

[gianmarco]

And, to the above, it's why I think if we offered significant financial incentives to maintain a healthy BMI, then we'd see a drastic improvement in those numbers.

That could be in the form of vastly reduced insurance costs below a certain BMI, subsidized gym memberships, and/or negative penalties for high BMI.

 

[Chadstroma]

And, to the above, it's why I think if we offered significant financial incentives to maintain a healthy BMI, then we'd see a drastic improvement in those numbers.

That could be in the form of vastly reduced insurance costs below a certain BMI, subsidized gym memberships, and/or negative penalties for high BMI.

One thing that has always kind of made me wonder is the role of insurance and what they cover and do not cover. As I noted in previous post, my insurance does not cover Wegovy (the semaglutide actually approved for weight loss) or Ozempic. When the first Endocrinologist looked at my insurance to see if it was covered and told me it was not, I was thinking "What is the cost of covering these meds versus the cost of the insured individual not losing weight and undoubtedly having more costs with treatments for obesity related medical issues?"

That also lead to me to wonder, wouldn't it be in the insurance companies interest to basically subsidize gym membership? They follow up to that is let's say that the entire US population now had free gym membership. Do we really think that would be anything but a very slight increase in usage. I don't.

Would a lose 50 lbs and get X amount of money work? I think it could help some people get more focused.

The one thing I know for a fact that the 'answer' is not simple. And the 'answer' is not one thing. There are a number of factors that lead to the high rate of obesity in this country and to turn the tide, there would need to be a number of 'answers' to address it. It isn't simple.

 

[massraider]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

I think you're missing a HUGE factor. Government stepped in and made it illegal to smoke almost everywhere indoors. And taxes on smoking jumped significantly as well. And insurance coverage is more expensive for smokers.

Adds to my point.

 

[Chadstroma]

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

As someone who is morbidly obese, I think it is absolutely horrible and horrendous that there is this idea of 'body acceptance' which is really 'fat acceptance'. Trying to make fat beautiful. Pushing people like Lizzo out into the spotlight. It is just another example of how facts, common sense, data, logic, morals.... anything and everything is now sacrificed on the altar of not hurting people's feelings.

I know I am fat. It doesn't bother me if someone called me fat. My kids in different ways... making jokes or talking about reality... have made various comments about my big belly and being fat etc. It didn't hurt my feelings because I didn't allow it to because it was true. My only concern with them is that they didn't say something similar to someone else thus I would have a conversation with them with the overall idea being given "It is fine to say that to Daddy but you can't say that to other people."

I am fat. It isn't a secret. I am not going to be offended by someone trying to use that to insult me (I can't remember the last time that happened... I guess being 6'1'' and north of 300 does have it's perks). Yup. It is a fact. I am fat.

It is absolutely moronic as a society that there is this push to basically glorify being fat. Should fat people be shamed with people coming up and saying "you are disgusting, my brother died because he was fat" like some may do with cigarettes? I don't think that is a goal either. Unlike cigarettes, eating disorders can go both ways and be as harmful or even more so with Bielema and Anorexia.

What should be championed is being healthy. If you are fat, you are not healthy. That is a serious thing and should be taken seriously and damn any feelings that may get hurt along the way. For me personally, I do not find women that are muscular attractive. I am attracted to women who are fit but there is a line somewhere that I just don't find it attractive. But who cares. I don't need to be attracted to every female out there. If that form of being healthy is what they are all about then great for them- it is healthy for them and it doesn't hurt anyone. In a similar way, I am not attracted to obese women but the difference here is that it is not healthy. I feel sympathy for them as it is my own struggle as well but the real issue is that it isn't healthy. There is no debate about that. There should be no debate about celebrating fat people in the name of 'inclusion'.

The only thing that has been hard on me has been my internal struggle. As I outlined before, how my inability to maintain healthy eating habits was something that I beat myself over about. Not being as active physically was something I gave myself a pass on because of my various physical problems that make is a challenge (A bad back and knee mostly) but losing weight is 90% about what you eat and that was something I could control but failed to do so over and over and over. Getting the help I need to make progress and how much the anti-addiction drug made a difference, really opened my eyes about myself and that struggle. It isn't something that I hate about myself because I am weak now... it is something that I am making progress on with the help of overcoming these challenges.

Ramble over... for now.

 

[Terminalxylem]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

You completely glossed over several other points in my post.

And yes, I think you are wrong about smoking. Regardless, who’s to say public perception of obesity won’t change in the next decade? Drugs like Wegovy aren’t doing anything to promote the idea fat is beautiful.

Surely you recall smoking being considered sexy and sophisticated, right? So we know its possible for societal views to change over time.

 

[AAABatteries]

I have no idea what people are even arguing about in here now.

 

[Sand]

That also lead to me to wonder, wouldn't it be in the insurance companies interest to basically subsidize gym membership? They follow up to that is let's say that the entire US population now had free gym membership. Do we really think that would be anything but a very slight increase in usage. I don't.

Insurance companies' goal is to deliver people to Medicare at lowest cost, not to keep them healthy.

 

[WVU Alum]

I have no idea what people are even arguing about in here now.

Damn, man. Get your **** together. It is the fat people arguing that being fat is unhealthy and losing weight is hard. They are arguing against the skinny people that are saying being fat is unhealthy and losing weight is hard. Pick a side and stop being a fence sitting dullard.

 

[Chadstroma]

I have no idea what people are even arguing about in here now.

I saw a t-shirt the other day...
"Arguing with me is pointless. I knew I was wrong 15 minutes ago. I am just trying to piss you off now."

 

[culdeus]

And, to the above, it's why I think if we offered significant financial incentives to maintain a healthy BMI, then we'd see a drastic improvement in those numbers.

That could be in the form of vastly reduced insurance costs below a certain BMI, subsidized gym memberships, and/or negative penalties for high BMI.

One thing that has always kind of made me wonder is the role of insurance and what they cover and do not cover. As I noted in previous post, my insurance does not cover Wegovy (the semaglutide actually approved for weight loss) or Ozempic. When the first Endocrinologist looked at my insurance to see if it was covered and told me it was not, I was thinking "What is the cost of covering these meds versus the cost of the insured individual not losing weight and undoubtedly having more costs with treatments for obesity related medical issues?"

That also lead to me to wonder, wouldn't it be in the insurance companies interest to basically subsidize gym membership? They follow up to that is let's say that the entire US population now had free gym membership. Do we really think that would be anything but a very slight increase in usage. I don't.

Would a lose 50 lbs and get X amount of money work? I think it could help some people get more focused.

The one thing I know for a fact that the 'answer' is not simple. And the 'answer' is not one thing. There are a number of factors that lead to the high rate of obesity in this country and to turn the tide, there would need to be a number of 'answers' to address it. It isn't simple.

Your marginal tax rate is your BMI - how many reps you can squat or dead lift your own body weight. (Min 15%).

 

[FairWarning]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

Look at the comments from the Miss Alabama contest last week for proof.

 

[belljr]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

Look at the comments from the Miss Alabama contest last week for proof.

The what's this now?

 

[massraider]

The what's this now?

I looked it up. That was a mistake.

 

[gianmarco]

This thread reminded me of this

 

[Snotbubbles]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

Look at the comments from the Miss Alabama contest last week for proof.

The what's this now?

That and a pack of cigarettes is $14 now. I can't imagine a person that smokes a pack a day being able to afford anything else.

 

[culdeus]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

Look at the comments from the Miss Alabama contest last week for proof.

Help me out with a link here

 

[FairWarning]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

Look at the comments from the Miss Alabama contest last week for proof.

Help me out with a link here

Search on X.

 

[3C's]

Think about the difficulty quitting smoking in the 70s, versus today, and the number of new smokers. Nothing has changed about nicotine’s addictiveness in that period.

Yes, think about that. You didn't finish the thought. Nothing has changed about cigarettes addictive-ness. So something has to have changed. What was it?

Like anything else with society overcoming addictions, many things. Education obviously, but frankly, the word was out in the 70s that it was bad for you. We knew soda was bad 40 years ago.

The biggest thing, and this is coming from a former smoker, is how smokers were perceived, and treated. People are quite comfortable going to DEFCON 3 with any smoker in their presence. People are not allowed to walk up to a fat person, and call it a disgusting habit, and tell them about their uncle who died early because he was too heavy.

It was external pressure. Whereas with heavy people, we are trying to lower external pressure. Especially the rude kind.

Which we should be doing. Heavy people feel discrimination all the time, it's hard enough on them. I'm just describing why the changes that led to smoking becoming less of a problem aren't going to fly.

Think I am wrong? Start a thread lambasting smokers, and one lambasting fat people. See which one gets more pushback.

Look at the comments from the Miss Alabama contest last week for proof.

Help me out with a link here

Search on X.

One of the many cesspools of the internet.