Instead of a system that makes these drug available for purchase, I'd rather live in a system that promotes healthy food and active behavior. Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.
All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.
If you have an open mind, I'd like to assign you some homework if you like. Take a look around r/zepbound and count the following:
1. Posts from folks who diet+exercise, or who have tried diet/exercise and nothing's worked so they then turned to Zepbound ("excited to hit the gym," "my diet is finally starting to work with Zepbound" and similar)
2. Posts from folks who haven't tried diet/exercise and turned to Zepbound first. (e.g. "I'm excited to eat dessert and laze around on my couch all day!" or "Zep is so much easier than before, no more keto for me" and similar)
Which group do you think would have more posts?
Selection bias probably prevents us from being able to count "Zepbound didn't work for me, but diet and exercise did" posts, which is why i suggest this.
Here's my hypothesis: I think self-control is generally uncorrelated to losing weight. Perhaps it's necessary to have self-control to lose weight "the simple way," but certainly not sufficient. I know lots of friends who've struggled and found it's not so simple.
GP isn't talking about self-control, they're talking about the fact we've created a system that requires obscene amounts of self-control if you wish to maintain physical health.
People in the 50s weren't slimmer because they had ironclad determination to stay such.
Traveling from a fairly walkable, but still car dependent midwestern city to NYC and also Europe in the last few months, it's amazing how much our living environment contributes. My first day in NYC and Europe I put in about 14k steps and at least according to my phone, one of those days I burned 750 cal just walking around to various places. Just by living my life I was WAY more active.
Making the good choice the easy/only choice is the only way to solve this problem long-term (without drugs)
I agree. I lived in West LA for a few years and noticed that I was just walking around a lot more than in previous locations. I measured it to be typically 5 to 10 miles per day (I don't recall the number of steps but I recall getting close to 30k/day on some days). And I wasn't going out of my way to go walking --- it just happened because I walked to work, to get groceries, to visit friends, to go to the movies, etc. To me, the best long-term answer is also to change the environment to be more amenable to walking.
The amount of food you eat isn't a habit. And I don't know what it is that makes people obese, but I don't think it's simply "bad food" as in the stereotype of bad food.
It seems clear enough to me that there is something - something - in the ecosystem that messes up the body's weight / energy homeostasis and we haven't identified the culprit. It might be a food additive, but it could be something to do with artificial light in the evening or plasticizers in our plastic products or who knows what.
Just my pov as non-overweight person who doesn't exercise (other than flipping my four year old around), doesn't walk or run long distances (but a 5 mile walk every couple of months doesn't phase me), eats very few fruits and vegetables, generally eats mostly meat, pasta, bread, cheese, cream and potatoes, and ends up in a fast food outlet maybe once a week on average.
it doesn't have to be just habit, but cultural/learned factors likely play a huge part.
each generation eats more, gets bigger, obesity runs in the family, (many obesity associated genes are mostly expressed in the brain ... the typical cursed environment-gene interaction), portion sizes got bigger, it became normal to gulp down a lot more sugar, etc.
The vast majority of accessible American foods these days are over-processed, poor quality ingredients with fancy marketing on the boxes. (And stories about how the brand was started by a grandmother a century ago...)
Living in Japan has made it clear to me that cultural attitudes towards food make all the difference. It’s not like there’s a dearth of delicious things here, but obesity rates are more or less a rounding error.
There's a confounding factor to your theory: people in Japan are dramatically less likely to use a car for door-to-door travel. The amount of walking a Japanese person does burns a huge number of calories that most people in the US simply don't burn.
I don’t buy it, putting aside the fact that there are many public transit-heavy countries with obesity problems, the amount of calories you burn from walking is a drop in the bucket, you can wipe out a full day of city walking with a small portion of French fries.
Diet is a way bigger factor in weight control than activity, unless you’re a pro athlete burning thousands of calories a day from exercise because you’re working out nonstop as your job.
You should still walk for general health, but not for weight loss.
EDIT: this report from Time about Japanese food culture rings true.
This is certainly true. Others will quote that exercise is not an effective mechanism to maintain healthy weight with 40 studies to back it. The goalposts seem to move a lot in this domain. Nevertheless, there is a ton of evidence of people in various behavior patterns that do not have such obesity issues in their society. It's wild to me how many people reach a conclusion of helplessness given that fact. The real kicker is that we aren't talking about one population being 5-10 lbs too heavy. We are taking about a difference between healthy weight and pervasive obesity. It's wild that such a delta is normalized
Exercise is good for a variety of reasons. It will burn some additional calories. But most scientists that specialize in metabolic research believe that the constrained total energy expenditure model and metabolic adaption are at least broadly true. You can't exercise out of a bad diet - and it's difficult even if you believe in a fully additive energy expenditure model.
Diet is the overwhelming deciding factor when it comes to weight gain.
Only have the anecdata of being in both Tokyo and NYC, but obesity rates are clearly higher in NYC than in Tokyo. I'm not convinced that relative obesity in Japan vs US is primarily due to walking differences.
As another commenter posted, the amount of walking even a highly active person does is fairly negligible wrt weight loss/gain. As another anecdote - my ambient walking milage is 5 miles/day and I run an additional 20-30 miles a week and still maintain an obese BMI
Do we really have enough information about their daily habits, food availability, ability to survive, etc. from those times? Once you go before easy refrigeration and distribution, you get people dying from famine in bad years. It's going be to be hard to make any actionable lessons from those times that still apply now.
> James Nye, for example, was one of a family of eleven children raised in rural Sussex in the 1820s and recalled how the ‘the young ones’ in his family went ‘very short of food’. Despite his mother’s best efforts, he rarely had more than ‘half a bellyful’ at mealtimes, and ate scarcely anything other than bread.
> Following the harvest failures of 1816, for example, John Lincoln’s entire family was forced to undergo severe privations. His two children succumbed to disease very easily — their quick deaths from measles were likely owing in part to prior malnourishment.
>Whatever, set the clock to the 1820s. Or the 1400s. Or the 1200s. Or the 1990's or 200 BCE, I don't care.
I think they may have taken your prompt and thought about the 1820s, 1400s, 1200s or 200 BCE. Did you mean to direct people to discuss the 1990s by listing the other 4 eras?
I mean to say Homo sapiens has existed for 300,000 years. They have not been 70%+ overweight or obese for most of those years. All the way until the 90s, obesity rates have been WAY lower, even in food-abundant societies.
What is your point? I mentioned drug availability in the 1950s and you dismissed it with an arbitrary list of other time periods. Someone else mentioned food scarcity in a period you mentioned, and you shifted the discussion to the 1990s (and now the past 300,000 years ???).
It seems like you do not want to discuss any factors relating to obesity in history at all, yet you keep engaging in this topic anyway. It is impossible to have a conversation where one side discusses facts like drug availability or food scarcity and the other says “no think about something else” as a canned response.
What do you think is the cause of the increased level of obesity? What do you think is the solution, if any?
My point is that people's health has been rapidly deteriorating over the last 30-50 years especially. Your attempted explanation is essentially, "in every prior period, there was a different period-specific thing that was preventing these health outcomes."
It seems far, far more likely to me that right now is the aberration – in fact we know today is aberrant on several dimensions that are presumably related to obesity, so that's where we should look.
Big, system-wide changes like what we're experiencing are almost always both multicausal and overdetermined.
The causes here are:
1. Production of cheap, extremely palatable, ultra-high caloric density foods (mitigable). Note: This is not the same thing as saying "people used to be thin because they were starving." It is absolutely possible to feed a country amply and not yield the low price/great taste/horrible nutrition profile that dominates the American diet today.
2. Increase in sedentary time due to shift from physically intensive professions (not very solvable), car-centric urban planning (solvable), and the dominance of ass-in-chair leisure activities (probably mitigable)
3. The science is early on this but there's good reason to look further into endocrine-disruptive chemical poisoning (mitigable). We are finding these compounds absolutely everywhere we look and we should be very open to the possibility we are mass-poisoning people and damaging their metabolism: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10003192/
>Whatever, set the clock to the 1820s. Or the 1400s. Or the 1200s. Or the 1990's or 200 BCE, I don't care.
I think they may have taken your prompt and thought about the 1820s, 1400s, 1200s or 200 BCE. Did you mean to direct people to discuss the 1990s by listing the other 4 eras?
Amphetamine(which is what benzedrine was) is pretty overrated as a weight loss drug in the general population. It causes a short window of reduced appetite and probably increased catabolism(due to increased heart rate) which peters out after a couple weeks on the same dose. That leads to a short period of rapid weight loss that pretty much grinds to a complete halt, after which regaining the lost weight is quite typical.
On the other hand, if like me, you have ADHD and weight issues, it could be more helpful. Because it could treat your ADHD enough to help you actually establish and follow a structured diet and exercise regime. Especially if your ADHD includes impulsivity. The last time I was on lisdex treatment, I lost about 5kg from the initial boost, a lot of it was probably water weight. Then I managed to cut about 30kg later with calorie counting and regular cardio.
So the physical effects themselves are largely a pisstake.
In my experience fitness is less about self control or will power and more about creating routines that lead to fitness.
For example, I have a routine of going to a group fitness class at my gym in the morning. I don't need to summon willpower, I just have a morning routine that involves doing x thing at y time. No thought required.
Given the abundance of options for fitness classes and meal plan services, you really can just put this on auto-pilot and have a lifestyle that is healthier than 99% of your peers.
> Given the abundance of options for fitness classes and meal plan services...
This is part of what's fucked up about modern American lifestyles.
We shouldn't be promoting layering healthy behaviors (fresh foods and exercise) on top of our default lives -- we should be doing a better job of engineering our environment to make those things the default for all people.
F.ex. what if we highly taxed automobile entry into urban cores and shopping districts?
Right. Design our cities so that getting around while getting exercise is safe and easy. And restaurants/etc should give you healthy portion sizes by default, not rely on your self-control to stop eating. And so on...
Every yuppy feels compelled to remind you they go to the gym, expecting a pat on the head for being a responsible citizen, when it's really a sign of a dysfunctional lifestyle. Cordoning off a discrete slice of time to "be healthy" is pathetic imo. I'd much rather just be healthy. Gorillas don't work out.
But because I live in suburban Australia and eat the same pesticide laden slop as everybody else, I too have a gym membership.
> Cordoning off a discrete slice of time to "be healthy" is pathetic imo.
What does this actually mean to you? Walking or even running is certainly not comparable to going to the gym, so what, should we lift heavy weights as part of our regular jobs to keep up our upper body muscle mass?
The results I've seen, and please correct me if my knowledge is wrong / outdated, are that modest physical activity (i.e. not gym, but more than our sedentary lifestyles) regularly nets most of the health benefit.
Ergo, we don't need to turn our jobs or built environment into Ninja Warrior.
We just need to build it to encourage that modest amount of activity.
Unfortunately we know that simply convincing people to change their behavior is very, very, very fucking hard. Individuals can and do pull it off, yes, but we're talking about a society level change that needs lots of people to succeed at this.
It is empirically and demonstrably ineffective as a solution.
Routines help because they reduce the impact and uniqueness of the good behaviour. Another approach is to do things that have high positive pay-off but include health benefits you wouldn't target but get "for free". Example: I ride my bike to work because it's awesome, faster and makes me feel superior. That I get exercise and help out the earth is a side effect; I'd probably still ride my bike if it was unhealthy and produced more CO2
Habits are great, but I'm in great shape because what I do is fun. When it's not fun I called it "training" and that's usually for some huge goal that'll at least be fun to look back at 10, 20 years down the line to marvel that I did a thing.
I guess what I want to express is habits are one step closer to a lifestyle change and that's what keeps one ultimately healthy (mentally, too). We can't have nightmare commutes to soul-sucking jobs to continually have people addicted to looking at screens and think that there's no fallout. Adding, "but now there are drugs!" isn't an advancement.
There is still a certain degree of willpower involved in routines. I wakeup every morning and workout, and every morning I have to fight my brain to get out of bed. I've been doing that for 10 years.
That being said - I do feel like reducing the amount of willpower needed is the key. I love junk food, but if I never buy it at a grocery store it's much easier to cut it out. If I have no chips in the house I could still get some at the corner store, but I need to be much less disciplined than if the chips were in my pantry
> People in the 50s weren't slimmer because they had ironclad determination to stay such.
Well, heights increased dramatically for a couple decades so what that meant was that many people in the 1950s were starving. In the 1930s, people died of starvation even in the US.
I don't really think that we want to go back to starving our population just to be thin, thanks.
> a system that requires obscene amounts of self-control if you wish to maintain physical health
That's million years of evolution with food scarcity and modern capitalist world which created unprecedented abundance of food (and other things). And before you compare it to Europe — europeans still smoke much more than americans. Tobacco is also just a chemical that decreases effects of obesity, just in a different form.
And of course New Zealand, Australia, Canada are all in the same boat as well.
Those are all over 30% obesity and climbing (Romania is 38%, nearly at the US levels). The US is of course the leader of the pack, however it's all the same fundamental problem.
My running theory is that there’s more weight-discrimination in Europe, so you’re just less likely to see the overweight/obese in customer-facing positions.
Different European countries have different circuimstances, just like their counterparts, american states. But if we're talking about all of Europe and US, then yes, this is the main reason.
Where are you getting this data from? Nicotine is an appetite suppressant but so is caffeine. I find it hard to believe that smoking alone is the reason for the difference.
> People in the 50s weren't slimmer because they had ironclad determination to stay such.
No. They lived in an overall healthier environment. But they were also subject to much greater social pressure to stay slim and could endure fairly intense social judgment and stigmatization for weights that we consider normal (particularly women).
They lived in a different environment. The universal appetite-reduction drug was nicotine, and the common methods of administration had a number of undesirable side effects.
"Overall healthier environment". Meaning, food was relatively scarce. No Starbucks, Dunkin Donuts, convenience store on every corner. Coca-cola was not available in 2-liter bottles or in 24 packs of cans. No Costco-sized mutlipacks of anything.
In the 1950s, malnutrition was a serious issue that many people in poor areas died from. When was the last time someone died because they didn't have access to food? Obviously, the other side of that coin is that food being so plentiful, people eat much, much more than ever before.
Starvation was not a major issue in the US in the 1950s.
Food abundance is good, but it is not the answer to this question. For example, in America today the richest locations tend to be the most physically fit.
That's kind of the point. Poor people today have no problem obtaining and consuming enormous quantities of food, and jave high obesity rates as a result. Unlike prior eras, being rich doesn't provide an advantage when it comes to accessing food (as opposed to housing, leisure time, luxury items, etc)
Then why are people scrambling for Ozempic? If it were true that "people think being fat is totally fine or desirable now" then this wouldn't be a blockbuster drug.
There was a far more vicious shaming culture 50-70 years ago about things like being obese. And culturally it's still looked down upon to be obese, it's just not as acceptable to be vicious about it (and of course sometimes people still are).
Today however there is a lot more "always on" pressure: social media is a huge component to social, social acceptance, socializing, social learning & sharing, getting to date people, et al. That's a form of individually focused media pressure that didn't exist back then. And sure you can turn it off, not partake, but there are usually serious consequences especially for younger people.
I didn't say it isn't true that people were shamed more often in the past, I said it has little to no explanatory power of the current health crisis because obviously there is no lack of desire from people to be slimmer.
I think it's a little bit of a silly thought to think that just because people want to be slimmer now, they want to do so just as much as they would have facing harsher social pressures in the 1950's.
How big were the 'crash diet' and 'smoke cigarettes to stay thin' and 'use amphetamines to stay thin' industries?
Indeed, we have the inception of Weight Watchers at the start of the next decade, replacing far crazier things like the cabbage diet being used en masse.
Yes, it was easier in some ways to live a healthier life; one reason why was the rampant social policing of each other's weight.
> The prevalence of dedicated dieting or weight loss efforts has increased over time.
Perhaps, perhaps not. But you'd expect that if there's many different causes making weight gain more common and only one is changes in social pressures (as I've already stipulated in each post).
And, likewise, as stipulated above: overt social stigma is not the only reason why people might prefer to be of a lower weight.
> The success of those efforts has decreased over time.
Well, one reason for this is that we've reduced the use of obviously harmful but effective weight loss techniques like cigarettes and stimulants. The 1950s were the era of the rainbow diet pill clinic, where you'd walk in and get a personalized cocktail of amphetamines and thyroid drugs and laxatives and diuretics to help you control weight.
Non sense...
There were not a particularly big stigma about being obese 50 or 70 years ago. Socially stigma were more about gender roles, sexuality etc...etc...
There was a huge stigma about being obese 50-70 years ago. It was wholly unacceptable for children, young persons and women in particular. Exclusively older men were allowed to be obese culturally without being shamed about it.
As recently as the 1980s movies were overloaded with jokes about fat people, it was extremely common. That's stigma in action culturally.
The 80's were 40 years ago...
I am not sure where you get your reference from...
Jokes about fat people and stigma about being fat aren't the same thing
I'm not sure how this applies to my comment. I'm not saying anything about self control. I'm not against individuals taking GLP-1s. But, if we're at a point where we're all on drugs to treat lifestyle diseases, we should at least recognize that these lifestyles are largely chosen for us, and we should consider that doing something about that will reap us the benefits we're after.
Those benefits and a billion more! Better state of nature, richer social fabric, probably less political polarization if people were bumping into their neighbors more frequently instead of going from drywall box to steel box back to drywall box day in and day out.
>> Unfortunately, I have to drive everywhere, work too many hours to have free time for recreation and have no idea which government subsidy is going to help big ag likely at the expense of my health.
At what point do people stop letting the choice being largely "made" for them and choose something else? The gov subsidy has nothing to do with my personal health choices. My grocery store has the same fresh fruits & vegetable sections grocery stores in Europe have. I am lucky to live in a state whose dominate grocery store sources regional meats & produce, sells their own brand of food made fully or mostly with ingredients I can pronounce, and has complete whole food prepared meals for 1-2 people that take 25mins in the oven. [for the same price as fast food]
It's part of the reason I choose not to move. Other choices are a standing desk with a walking pad, which makes it trivial to walk 3-4+ miles a day. I could make more money studying leetcode and living in "elite" tech valley, or hustling for more work instead of choosing myself over the large house in swank community that society has picked as what is "success" for me. Eventually I chose to take less of what "they" told me to choose; at some point we have to realize the only person that is going to live with our choices is ourself. If GLP-1s is needed to help people get back or get to that point of realization, then maybe it's a blessing to undo all the ills we(society made up of our neighbors) all contributed to creating.
I'm happy you don't live in a food desert, live in a good neighborhood and have the means to move somewhere else if you wanted to. Not everyone has these advantages. I think we can all agree that these are good things and I hope we will do what we can to allow others enjoy them as well, because no one chooses to be in that situation, but it is largely a policy choice to keep it that way.
> and have the means to move somewhere else if you wanted to. Not everyone has these advantages.
I debated posting because this is the usual response, instead of seeing the point as, "we" continue to create this society not some magical "others". I am where I am because of my choices + the lucky draw of loving computers and a dedicated family that scrapped and saved and sacrificed to buy me my own computer as a teenager which helped me move out of the situation I was born in. And even that was better than many of the people I grew up with. So no, this wasnt some privileged post of someone who never walked 2+ miles to the corner store with their friend to pick up a half gallon of milk and pasty white "bread" with food stamps so they could have sandwiches for dinner.
[added: while this situation sounds bad it's better than where they (and many of my other friends) came from as they could have been deported back to there if found]
The more important point the comment you're replying to makes is not "what if people could diet and exercise" - i.e. accept the modern American lifestyle as given, plus force yourself to go to the gym and eat chicken and broccoli - but rather that the modern American lifestyle in fundamentally structured to lead to people being overweight.
Instead of being forced to drive everywhere for the most basic possible human needs - like getting groceries, going to the doctor, or dropping kids off at school - as is the case in 90% of America - what if you could walk to those places instead? You would get exercise as part of your every day life, with no extra effort!
What if instead of corn syrup being so heavily subsidized, we could use more filling sweeteners in a lower amount instead? What if people lived closer to agriculture, instead of in faraway suburban tract housing only accessible by car, so they had easier access to fresh meat and vegetables, instead of ultraprocessed package food?
These dreams are not "diet and exercise", they are a fundamental reshaping of American lifestyle that would directly lead to weight loss. We know this, because America used to look like this before, say, 1940. In old photos you see people in huge crowds in streets as they walked to their everyday errands, and menus and recipes of the era are mostly minimally processed food that is mostly local. Americans of the past were not overweight, because the way society arranged its physical existence didn't permit it!
IMHO price of calories is the only thing that needs to change. All the talk about wholesome locally grown foods vs. processed industrial stuff is just moralizing and posturing, when the metric that matters is the price. Just look at Coke, which is arguably not even a good example because of pre-war price fixing, but still it costs half as much as in 1950 when adjusted for inflation.
> In old photos you see people in huge crowds in streets as they walked to their everyday errands
Because they were poor and didn't have a choice. Making driving extremely expensive and inconvenient and prohibitively high taxes on processed food etc. might force people to change their lifestyles, I'm just not sure how politically feasible that.
My 1950+s grandparents drove everywhere and were fit. When we try to shoehorn so many agendas into one thing nothing gets resolved. It's also part of why so many people distrust everyone's agenda and truthfulness nowadays. Also 1940s America was mostly rural, not huge crowds of people walking together.
I was that guy. For a variety of reasons that aren’t relevant i developed insulin resistance over a relatively short time that made it increasingly difficult to lose weight. I’m in my mid 40s, which also makes it difficult.
I got on one of the GLP drugs 18 months ago. I am down 80 pounds, and am running 20 miles a week. I’ll be doing a half marathon in March. Ive dropped the dose twice and still going strong.
Taking the pill made exercise possible. Online everyone likes to apply a moral hazard thing to every discussion. GLP medication twiddled my dopamine system and allowed me to achieve my goals. Period. If you think that makes me weak, I cannot think of anything that I care less about.
> Perhaps it's necessary to have self-control to lose weight
> it's not so simple.
Presumably people who have good self control and are not prone to developing addictions (due genetic or various semi-immutable cause) do not become obese in the first place. It might be fairly easy easy for them to lose weight they just don't need.
But don't you think that it's better to make the changes to prevent obesity rather than focus so much on a cure for after?
I don't have a problem with a cure only if it doesn't reduce the focus and effort on prevention.
There has to be a reason why so many more people are obese today than decades ago. I refuse to believe we can't find out why and make changes to reverse it.
But if it's so easy to cure, will enough people care about figuring out how to prevent it?
I’m not obese, just before (1m75 / 82kg) but I have found self control impossible, except when I do intense sports (like musculation 3-6 times a week). Then only, and this is the magic part, I not only eat less, but also enjoy being more brave, with cold showers, being hungry, going to bed early and other efforts in life.
My hypothesis: this is more cultural than people want to admit. Try to skip out on too many engagements, sorry, meals and see how many connections you still have.
counter hypothesis - the amount of self control exhibited by an average human is insufficient to self regulate when placed into a hyper enriched environment , for example the capitalistic profferings of junk food tv porn etc , we did not evolve around these hyper stimulatory activities, how on earth are we meant to adapt to them? drugs are not an answer, they are another bandaid making someone else money and allowing the underlying wounds to fester, the solution is education and awareness of this fucked up situation
It’s been studied pretty well. Possible effective solutions to the US obesity epidemic are pretty much limited to:
1) Radically alter aspects of food culture, work culture, social policy, and business regulation.
2) Magic pill (/injection)
There appears to be no imminent progress on the many parts of #1 that need serious work, so if we want a big turn-around in the next half-century, #2 has suddenly and surprisingly become a real possibility.
Sounds similar to most major world/cultural issues today. You can make the exact same argument about climate change for example.
But at the same time, part of me wants to ask... why is this a problem? Why shouldn't we just use science and technology to fix human problems and remove any unfortunate consequences from society?
What's wrong with a world where anyone can eat as much of anything as they want, do no exercise at all, ignore their dental health and smoke like a chimney, yet still have perfect health without any downsides?
Objectively, it would be a better society, with everyone materially better off and a system that doesn't need anywhere near as many resources to care of its citizens.
Because some of us want the real thing, not the fake thing achieved by cheaters.
I'm the same in other areas of life. I don't take steroids, I work out in the gym. I don't take drugs to have trips and achieve enlightenment, I tried to find Zen on my own.
I wouldn't partner with someone who had a cosmetic surgery ("fake beauty"), nor someone who wears makeup.
Up to every individual of course, I'm not even saying I will never take TRT (probably eventually, when I'm older, for health reasons), but I, above everything else, value (and want) authenticity.
> Possible effective solutions to the US obesity epidemic
Just wanted to mention that this is not a US problem, and framing it as such won't help find solutions. Even in southeast Asia the rates over obesity are steadily increasing. Europe is already much fatter than southeast Asia. This is a worldwide phenomenon.
I would argue that the US has some fault to why other western nations are getting fatter.
All of the US's worst fast food chains and food products have been exported. In my tiny city a Carl's Jr. Just opened! There is McDonald's, Burger King and Starbucks everywhere. There are also Dunkin donuts in the supermarket as well as oreos. In contrast there arent any Asian or Russian restaurants chains here.
Local foods have become sweeter in order to compete and there are so many local burger restaurants now it's like I have moved to the US.
That's par for the course, the world does love to blame us for their problems. Then they bitch when anyone suggests we've made some choices in the last 100 years that made their lives noticeably better (hello Marshall Plan!).
> have been exported
That's a convenient spin on "have been imported." Do you not make your own choices? If you don't want the crappy fast food, quit making your own copies of it!
Since it's kind of on point for this discussion, I just thought I'd mention one amusing thing I noticed in London -- you can buy higher calorie McDonalds food there. I could get a sasusage mcmuffin with two patties, which isn't a thing in the US. I almost wanted to do it just for the laughs, but frankly the UK version of McDonalds tastes even worse than the US version. I'm not sure exactly how that's possible.
Y'all should stop importing the shittiest excuses for 'American' food. A lot of us never eat at these places in spite of them being so prevalent. We have a lot of great restaurants, even some of the ones that qualify as fast food.
> If you don't want the crappy fast food, quit making your own copies of it!
“If alcohol is bad for you, quit drinking it!”
“If crack is bad for you, quit taking it!”
My point is that there is more to it than that. You make like it’s a choice governed by free will when we know that fatty and sweet foods are addictive and harder to resist.
It is global, but the US is among the leaders and people who move here from skinnier countries tend to get fatter. Something about (odds are, a bunch of somethings about) the living environment we’ve created causes more obesity than the environments in most other countries, though yes, it’s getting worse in those other countries, too.
From the article "Estimates suggest GLP-1s can reduce body weight by at least 15% when taken regularly". That's a 5'10" man starting at 250lbs (obese, BMI > 35) and finishing at 220lbs (obese, BMI >30).
Or a 5'10" man starting at 220lbs (obese) and finishing at 187lbs (overweight, BMI > 26).
It ain't nothing, but that's not a magic pill which will fix the obesity epidemic. And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food.
I lost 100 lbs over 18 months. And, I found it much easier to change my lifestyle on a GLP-1 drug. Naturally thin people / people who don't have some environmental sensitivity are super judgy about GLP-1 drugs, and closet judgy about fat people. It's just not so simple as "lazy/poor diet/no exercise."
I went from nutritionist appointments that were like "are you lying about your food intake? because if not, you have some serious problem with something in your environment" to "yep, it was easy to cut out a couple things that bothered me," and weight came off astonishingly rapidly.
And this anecdote a person on HN[1] "reached a peak of 340, and in exactly a year, while maintaining the same CICO, but changing from the SAD to strict non-Keto Paleo, became 214".
(I want to ask this in a non-combative way, but 3 days later I still can't. How did you know the couple of foods(?) which were bothering you, which were the problem, and your nutritionist did not know about them, and you weren't lying to the nutritionist? I can't make sense of that without also accusing you of hiding them from the nutritionist, or the nutritionist being terrible at their job).
This is work in progress, though. 3rd generation medications are already way more efficient than 1st gen. Saxenda ever was. A further increase in efficiency is likely.
"And these people have skipped changing their lifestyle, exercise, diet, and attitudes around food."
That sounds very judgmental of you, like if they were skipping school. Bad truants!
What about "found the necessary changes too hard/complicated to sustain"? That is closer to reality. People juggle all sorts of obligations, some are doing multiple jobs, commuting 90 minutes each way etc. - they may be just too fatigued to exercise regularly and cook healthy meals at home.
There are 110,000,000 overweight people in the USA and another 110,000,000 obese people. Is it really closer to reality that everyone is a two-jobs no time for exercise, or is it more that Starbucks Mocha Frappuccino has 500 Calories and Starbucks has 15,800 stores in the USA and $36Bn annual revenue? And McDonalds, KFC, and all the rest. Is it closer to reality that people are snacking on some snack food on the couch out of habit and not paying attention to how many calories that is in a week, because it's just habit and gone in seconds? Is it closer to reality that Uber Eats and Door Dash and Domino's advertise to manipulate you into believing that you don't have time to cook at home and they are a good option? Is it closer to reality that there are food deserts with only junk easily available?
> "That sounds very judgmental of you, like if they were skipping school. Bad truants!"
It is judgemental of me, like if you want to pass your exams but skip studying, that would be bad. If you aren't exercising and are eating terribly and are obese, this lets you silence the alarm bells while saying "I don't have time to exercise". That doesn't seem as good as eating better and changing your life to include movement.
I don't perceive health as a reward for virtue, so even though I understand your analogy with exams, I cannot really accept it.
Ask yourself where fast food comes from. It is a) fast, b) cheap. Of course it is going to suit people who a) don't have time, b) don't have much money. A union of those two wants covers a big part of the contemporary Western population.
Composition of food is another biggie, I agree with you on that. Too much sugar everywhere. That said: we are naturally wired to crave sugar, only someone more and someone less. If fentanyl was legally sold on every corner in fancy packaging, starting with kids, would you blame the resulting junkies for being weak-willed? Or acknowledge that the environment is really fucked up?
I personally don't respond to sugar that much and I can go weeks without it, but that's not my virtue. It is blind luck of my genome or possibly microbiome. I don't drink much either, but again, that's blind luck of my genome or possibly microbiome which makes me dislike the taste of alcohol. Not my iron will, which I don't have.
It is my experience that a lot of people are judgmental about the fatties because it increases their own perceived self-worth. ("We are the virtuous ones, unlike them.") Pretty arbitrary, but humans be like that.
But is it time to give up just because there hasn't been much progress yet? It seems now that we have #2 there's little incentive for #1, whereas there was plenty incentive for #1 before even if little action.
I think fourish decades was enough time to see if we’d get our shit together on the pile of problems that need to be fixed to solve this the #1 way. We haven’t, even a little.
So no, I’m thrilled to see #2 show up to maybe get our healthcare system to limp along for at least a couple decades longer than it was looking like it would.
I think it's better not to sacrifice the wellbeing of our citizens at the feet of an ideology about exactly how we should be solving an obesity crisis.
Besides, having healthier people will lead to better infrastructure for healthier lifestyles, purely based on demand. It's a virtuous cycle.
Yes. Looking out 30, 50, 100 years science will further resolve the obesity problem that has plagued the US since the 1980s. There is no scenario where you radically alter such a gigantic, disconnected, complex culture such as the US has. The old joke was that the US would solve this with pills (so to speak), and that's what is going to happen.
If you have a tiny, homogeneous culture it is still very difficult to radically alter it in the span of a couple decades (think: Sweden, Finland). For something the scale of the US, with the diversity of the US, there is no possibility. Anything suggested as comprehensive would be fantasy. There are only small changes that could be done, eg relating to sugar consumption limits in drinks and food; some would have a meaningful impact, however you still won't fundamentally change the culture's calorie problem.
Getting thinner will do extraordinary things for rebooting the malfunctioning US. Obesity does a lot of harmful things to work ethic, longevity, quality of longevity, productivity, mental capabilities, to say nothing of course diabetes and cancer and so on.
I know someone who has lost about 60lbs. The reaction of most people is 'what pill did you take'. They find out it is basically no sugar and limited amounts of food with some mild exercise. Pretty much every one of them is 'thats hard' and do not do it. And frankly it is hard. Like 95% of a grocery store has way to much of what you need for your daily intake in some form or another. It is that 5% you have to dig thru the whole mountain of crap to find. Then once you find it hope like hell the manufacture does not stop selling it. Or enjoy making everything from scratch (even that is a pain).
I would not jump on that current pill yet. Wait and see. There are probably serious side effects that we mere plebes do not get to find out about yet (that is for 20 years from now). Like what is the side effects when you stop taking it? What if your dose is too high/low? What is the long term usage like for other parts of the body?
> "Osbourne said when she first began using the drug she felt nauseous for two to three weeks."
> “You don’t throw up physically, but you’ve got that feeling,” she said.
> She was also very thirsty and did not want to eat.
No, it doesn't appear that some famous person almost died. The drug seemed to be effective for her. She noticed some mild nausea - she even said she didn't throw up. That's mild nausea. She was thirsty - this makes sense. Food contains water, so she was probably dehydrated which contributes to the nausea. She should have drank more water. Finally, she did not want to eat. That is the intended effect of the drug. Sounds like it did exactly what it was designed to do.
Yes, gastroparesis can happen. This is not a shocker, as GLP-1 agonists affect the rate of gastric emptying. Gastroparesis is ... a slowing of gastric emptying. 750 out of nearly 150,000 GLP-1 patients experienced gastroparesis. This is about double the incidence in the general population. In very rare cases of gastroparesis you can experience blockages, but that is very much the exception, not the rule. Even so, this is why it's important to meet regularly with your doctor, discuss how you're feeling while on the drug, and get medical attention if you discover you're not shitting and normal methods don't improve things.
There are many useful, common drugs that have side effects that seem scary but are rare. ACE inhibitors are wonderful, well-tolerated drugs for controlling blood pressure, but long term use can cause kidney issues in very rare cases. Monitoring potassium levels allows for this side effect to be controlled well before kidney damage results.
> If there were effects, we'd have seen them by now.
You just authored a screed in response to me pointing out that there are effects.
Sharon Osbourne didn't just have mild nausea she now claims she can't put back the weight she lost that she didn't intend to lose.
> Gastroparesis is ... a slowing of gastric emptying.
I can't help but point out the syntax choice of internet snobbery. I'm not sure when people started sprinkling ellipses for dramatic effect because they seem to think it makes them authoritative but I think it's worth highlighting since it's such a reliable heuristic for internet troll.
? All I can find are a bunch of articles about one or more interviews she gave where she complained it made her too skinny (if you’re on it for weight loss rather than diabetes, you can simply adjust the dose down if you’re finding it too effective), nothing about almost dying.
> “I’m too gaunt and I can’t put any weight on. I want to, because I feel I’m too skinny,” she went on before warning people, “Be careful what you wish for.”
She abruptly stopped after losing much more than she wanted to lose.
I run three miles a day, never drive anywhere (bike or bus), eat reasonably healthy, and I'm still 20 pounds overweight. And what really scares me is that running is the only exercise I enjoy and if my weight fluctuates up just 5 pounds or so, I start getting hip/knee/foot etc pain. If I gain 10 pounds through some lapse in morality, I won't be able to run anymore and I'm cooked. If that happens, I'm banging down my doctor's door for a pill.
Which will burn somewhere on the order of 400 excess calories - about as much as a typical North American muffin (or two of the big cookies from Subway). But worse, your body was probably going to use most of those calories on something else (fidgeting, running a higher body temperature, other immune responses including inflammation) anyway, assuming that you haven't been gaining weight with your current habits. Exercise is healthy and reduces stress, but it just isn't effective for weight control. Humans are animals, and animals have on the order of a billion years of homeostasis technology behind them.
>eat reasonably healthy
Hardly anyone has any accurate picture of how much they consume, as measured in calories, except for those with actual explicit experience of measuring and accounting it.
If a pill happens to end up helping you eat an amount that lets you maintain a healthy weight, I'm all for that. But it's important to have your mental model properly calibrated.
So I'm a distance runner, who is on these drugs.. and yeah, It sucks, I LOVE running.. but running heavy SUCKS. Most people run to lose weight, I lose weight to run.
honest to god i wish i knew what it was like to be like you —i have always hated every step of a run, and im halfway convinced the notion of a runners high is a convenient fiction cooked up by nike.
There are a few things that happen here, but the most common one is not having someone helping you with form, and running much too fast. If you talk to a physical therapist and run with a distance runner and have them help you keep your heart rate in zone 2, you will probably feel much better.
This took me a long time to figure out: it's ok to not like running. There are other forms of physical activity that may appeal more to you, which you can do in place of running. I'm personally into biking, which gets me more than enough exercise.
Second the other commenter. Measure your heart rate and stay within a lower zone.
Most likely this means you will be walk-running at the beginning or even just walking up a steep hill.
Running is an activity of many small incremental gains. Every week you can go a little tiny bit further but if you amortize that over a year it makes a big difference.
Many go into running too fast and hard which leads them into not liking it because they feel absolutely miserable the entire time or they injure themselves due to bad form.
I had a good physical therapist which took me from nothing and for the first few months I wasn’t even running but doing foot and ankle strengthening because that part of my kinetic chain was so weak.
To paraphrase: Instead of relying on medication that helps with issues caused by our society, let's completely change the society so it's no longer the issue?
What is a realistic path to this? Being from Europe I visited US last year and was horrified at the quality of your food. You see a lot of documentaries/youtube videos/etc... discussing the problem, but how do you even go about this?
We have good food, but you won't find it on "The Easy Path."
The Easy Path is that gentle encouragement to hit up Chipotle for lunch, because it's "right there."
The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave.
The Easy Path is entropy. The Easy Path is self-care over struggle. The Easy Path is simple carbs shown on prominent display in store shelves. The Easy Path is advertising.
Hitting the gym isn't on The Easy Path, but forgetting to cancel your gym membership is.
These days, big food companies love "The Easy Path" because it's so easy to commoditize, it's the "Path that Americans are Expected to Take." For financial stewards, being on The Easy Path turns lack of willpower into your ally.
On the other hand, getting good food in the US requires passing the marshmallow test: you have to meal prep, or you have to shop around the sides, or you have to get something on the salad menu. You have to say no to advertising. You have to expend willpower, the most limited of resources to the average American. You have to Go Hungry or Suffer, or have An Upset Stomach. You frequently have to spend more money or time.
Semaglutides are not currently on The Easy Path. Maybe they will be someday. I personally doubt that, because putting GLP-1 on The Easy Path would require big food companies to rethink their entire portfolio.
But you're not wrong in that they could be Easy Path-ajdacent. The dialectic would shift: food companies would shift around to be Organic and Nutritious and Less Calories and find other ways to stay on The Easy Path. Sugar and fat's addictiveness is highly Easy Path-enabling, and that's a pretty big vacuum to fill.
I think you're making this sound harder than it is.
If you count calories and stick to a budget, you will lose weight, even if those calories come from deep-fried fast food. Sure, it's good to eat more whole fruits and vegetables, and you should, but weight loss doesn't require some kind of Edenic perfection. Stick to a calorie budget and you will lose weight, the end.
We can add some second and third order provisos, sure. The next tip would be to go low carb. And to keep a spreadsheet with calorie numbers for everything you eat. Track what you're doing.
But basically, if you eat 1500 kcal/day for nine months, you will be much thinner. We don't have to make it harder than that. It works. Perfection is not required.
If we're talking about this as a public health issue, then I agree with you. You can't really expect much of people as a herd or mass.
(Hell, look at the state of elections.)
If we're talking about this as individual, rational people, though, then it's different. You can absolutely maintain a reasonable weight if you just attend to it.
2.
There's actually some knowledge embedded in the "count to 1500", which, if you're not in the habit of thinking about, may be surprising. Specifically, the kcal amounts themselves.
Say you just go with the flow of society, and you eat "normally" without thinking about what you're doing:
You wake up, and you have something marketed as "a meal" for breakfast. A breakfast sandwich can easily be 550 kcal. If you add a venti latte to this, especially one with sugar, then you could easily add another 250 for that. Now you're at 800 kcal just for breakfast.
Then consider lunch. Even a "small" meal from a healthy salad place, like Sweetgreen (which is expensive), is going to be like 900 kcal. Say that's what you eat. Now you're at 1700 kcal.
The afternoon comes, and you have two chocolate-chip cookies. Two cookies isn't excessive, right? Just a little treat. But each one is probably 120 kcal. So that's 240 kcal. Now you're at 1940 kcal.
Finally you have dinner. Some microwaved thing, relatively small. It's probably like 600 kcal. So now we're at over 2,500 kcal for the day.
Everything you did in the course of that day was relatively normal. Probably only the venti latte at breakfast was obviously excessive. But now you're substantially over your calorie budget.
Now, 2,500 kcal is still salvageable. Every mile you walk on flat ground is about 100 kcal. If you live in the city, you could easily have walked a mile and a half during your commute to work, and another mile when you stepped out for lunch, and a mile and a half on your way back, giving you four miles. You're almost at breakeven. Just need a little more exercise, and you'll maintain your current weight.
(In the burbs, though, you probably drove to all these places and now it's on you to go to a gym, which is a pain in the butt.)
Anyway, my point is, if you weren't attending to all this, how would you know? You'd probably just be doing all these habits without thinking about them. Most parts of this routine seem pretty reasonable. But you'd still be getting fat. Because you're going with the flow instead of counting.
So, there's a little (easy) knowledge involved, but mostly it's not an issue of intellectual ability, it's a matter of attention.
>The Easy Path says dinner's hard and you've had a long day, so get something simple, like take-out or microwave. The Easy Path is entropy. The Easy Path is self-care over struggle.
If you see this sort of food as "self-care" then that's where the war has been lost.
>or you have to shop around the sides
Sometimes I wonder if I'm the only person in the world who enjoys this. Discovering, for example, the versatility and cost-effectiveness of skim milk powder was a real game changer for me. Similarly for dried legumes and fruits.
The Easy Path is a meal service like Factor that delivers healthy food directly to your door step.
The Easy Path is signing up for a fitness class on a regular schedule and baking it into your morning routine.
The Easy Path is not buying extra snacks - just don't have them laying around the house for you to eat when you're bored.
The Easy Path is the path of least resistance. However, you have some agency over the environment you create for yourself, so that path of least resistance is to some degree under your control.
Get ground beef in the supermarket, it’s cheap and takes 7 minutes to cook. If that’s all you eat you can’t be fat and out of shape. You also won’t be hungry.
At some point blaming society isn’t going to cut it.
At some point "have willpower" isn't going to cut it. That point was decades ago.
Blaming society sounds fatalistic, but yes we absolutely can change society. There are mechanisms to do it, and the first step to utilizing any of them is people getting pissed off about the state of things and talking to other people about how pissed off they are about it.
I’ve done plenty of grinding it out in my life with no energy or time to spare.
Even in that place you can do better than ground beef.
Get an instant pot and invest in some rudimentary cooking skills. I’ve spent a whole year making variations on the same dish in 15 minutes, using that cooking as end-of-day stress relief. Shopping for the same handful of things once a week.
It wasn’t fine dining but it was healthy, cheap, and a few steps up from ground beef. Come now.
I love fatty meat and salt. I can’t think of many things better than that. It’s also the only staple us and our ancestors have eaten for millions of years.
I think the instant pot is too imprecise a tool for cooking by recipe, it’s for speed and convenience. I’ll improvise a curry with what’s on hand, sometimes the result is fine and sometimes it’s great :)
It’s not the only thing. You can eat any meat, eggs, or many dairy products. Probably most fruit is fine too, although I don’t eat carbs myself.
Yes, all the processed grains and seed oils and artificial sweeteners and chemicals should never have been invented. But I’m not too fussed about that. What I can do is come here and write these comments about the diet that changed my life for the better. If only one person who reads them tries it out, I will already have succeeded.
The US is a huge country (9,833,520 square kilometers!), so I find it curious that such generalization can be made about the food available here, or even the eating habits of 334,914,895 humans. I could say that I visited Amsterdam 2 years ago and I was shocked with the quality of the food.
But I would never do that, since I mostly ate at the Red Light District, and I couldn't possibly generalize the country eating habits with stores in a major tourist area.
Maybe I'm too European to understand why not, but seems to me that regulations around food and what companies are allowed to put into it is really helpful in avoiding companies from just stuffing whatever down people's throat.
There's plenty of high quality food, you just have to know where to look. For example, come to the Bay Area and check out Whole Foods and any number of high-end restaurants.
That's overkill. There are very marginal health benefits to eating organic watercress vs. eating whatever dark leafy green is currently on sale at the discount supermarket.
The problem isn't that people go to supermarkets and they can't find any healthful ingredients to cook with. The problem is that they go to supermarkets and pass those over in favor of convenience foods that have been optimized for "craveability" [1].
GLP-1 drugs can alter this behavior by reducing food cravings. Someone who's no longer craving the most craveable food can make more objective by-the-numbers buying decisions the next time they go grocery shopping.
was in greece for three months. the quality of the BASIC fruits and vegetables at the regular local market down the street from where I was staying was on par with wholefoods. It was surreal how cheap it was to eat HEALTHY.
Almost any ethnic grocery store will do since they cater to immigrant communities that are likely to be lower income. Here in SoCal some are cheaper than others but they're all way cheaper than Ralphs/Vons/Trader Joes/Costco/etc (I don't shop at WalMart so I'm not sure how they compare)
There are also native stores that are increasingly entering into low cost produce like Grocery Outlet and then there are the usual like Food4Less but they tend to eventually move upmarket.
Why is the quality of food in Europe so much worse than southeast Asia?
Because you guys are way, way, way fatter than e.g. the Japanese.
Back on topic -- we have excellent food in the US, but regulations allow for highly processed crap to be sold too. Pretty sure most of the crappy processed foods are easily available in Europe, too.
eu and canada have stringent laws on advertising to children, and laws on nutrition and additives to their products
even things like bread in the US have an insane amount of sugar
but the other reason is suburban/car culture & zoning, which means more hypermarkets and shopping not every few days for fresh food but every week or two for more processed food that lasts longer because going to the store is a bigger PITA than a quick 5 min walk to the neighborhood stores; which also means mroe walking rather than driving, another area of calorie burning and lean muscle maintenance which maintains high metab
The first thing that would help is actually having a realistic discourse about food, and not the idiotic - "You shouldn't be eating processed food, its not good for you".
Like most of the food that we eat is not really that bad. Its not optimal for sure, especially for sedentary lifestyles, but a lot of the health problems are not directly tied into the actual food, rather the over-consumption of it, and passing down of bad genetics (for example, children of obese people are more likely to be obese).
European obesity tripled in the last 40 years as well, despite higher quality of food.
But you already live in a system that promotes that, quite heavily. Healthy food and active behavior make you more physically attractive, which is in turn linked to better life outcomes along almost every metric you can care to think of.
There is, in fact, already an enormous, fully endogenous incentive to do those things. The fact many people are not keeping in shape (myself included) suggests the allure of food really is just that appealing.
> But you already live in a system that promotes that
Correction. We live in a system that *rewards* that. The infrastructure and system itself expects us to drive everywhere (because it's either faster or literally at all possible), eat overprocessed food (because it's tastier (literally designed to be hyper-palpable) and faster), and to work for absurd hours.
If you somehow have spoons after all that, then you're expected to workout, etc, to gain the additional benefits; but the systems in play do not facilitate that, at all.
I see no difference between "promotes" and "rewards" here. If it's a difference of intent, I'll point to everyone in this thread consciously "promoting" a lifestyle of fewer working hours, cleaner food, and less driving as a much more salient viewpoint than the opposite. And if the difference is because of "the system", well, you're going to have to differentiate between the system of living in human society and ... some subset of that system, I guess. Some subset
Luckily there's a precise term from economics we can use here to split the difference: Opportunity cost. I can certainly concede that in some people's lives the opportunity cost to working out is higher. In some lives you make a lot more money per hour worked than you do working out, and so it's not a surprise more people on the margin in those situations choose the former over the latter. If you dislike even having that option on the table, the good news is you can move to someplace where you make less money, and then that opportunity cost will go down, because working out is pretty much the same wherever you go.
One more sophisticated take of course is to claim people don't really know what's good for them, and they discount the true value of working out far too heavily. (s/working out/eating less/g, or whatever other health promoting difficult activity you wish to sub in here.) But, if we're going to claim that -- which is actually pretty reasonable -- then why would we consider a miracle drug that seems to directly counteract that irrational discounting a bad thing? That should be a godsend.
I’m a standard-issue stress eater. I also like to work out.
When I’m really feeling the stress, even though I will tell myself at that time to just hang on and hit the gym later, the food is that much more of an instant fix that it wins out more often than not.
I’m sure that’s not just the actual food itself, but also the easy availability of it, and probably subliminal cultural factors such as advertising. But partly, yeah, it’s that my ancestors evolved to love eating when they had food, and their gift to me is that same desire in a world of endless plenty.
Of course it is impossible to live a healthy lifestyle and have healthy weight, if you ignore the 3/5ths of Americans that are not obese and the 7/8th of the global population.
Are the 3/5ths of Americans who are not obese actually living a healthy lifestyle? Or are they just living a different unhealthy lifestyle?
Is a skinny homeless methhead with a great BMI healthy? Or the blue collar dude who has terrible blood pressure from chain smoking and pounding energy drinks on his way to the job site?
How many Americans who are not obese are on their way to becoming obese?
There are lots of paths to unhealthiness and overeating / eating poorly is only one of them
Yes of course, but the point I'm making is that people who aren't obese aren't necessarily healthy.
People aren't born obese. They get that way through mistreating their body for a long period of time, and it is quite possible for them to die before they become obese to other maladies related to that mistreatment.
> Impossibly unrealistic to change zoning to disincentivize car-dependent urban design?
Those zoning issues are the same reason for any number of other problems, including housing prices that are supposedly the #1 concern for a huge number of voters, and yet voters in many cities have only doubled down over time on making it harder and harder to build in efficient and high-density ways. "Impossible" seems like a fair way to put it.
Yet some cities are making progress on exactly that issue.
I haven't done the statistics on it, but I'll bet cities full of people who want zoning reform are more likely to reform than cities full of people who do not want it.
No city has implemented anything like zoning reform. There are a handful of cities which, to great fanfare, have made tiny changes. Minneapolis has made the most impact, but it's hard to rule out correlation with falling demand for that city.
This change ultimately allowed something like 10% more units in the city on a 100 year horizon.
This is what I'm calling out - these changes sound big but they are nearly meaningless. Cities need periods of explosive growth to remain affordable (see Jane Jacobs, 1961 and 1970).
I said "Raleigh doubled its zoned density overnight." You said "No they did not" and "No city has implemented anything like zoning reform." Both of these are false.
You can refer to the text changes. They doubled the zoned density in nearly every residential zoning type in the city. It is a huge change, though I suppose you can claim that's not "reform" if you want. It is sufficiently reformative for my purposes of increasing urban density over time.
Changes will take time to kick in, and obviously they should take time to kick in because simply clicking a button and doubling actual built density would crater the economy. It makes no sense. The zoning change removes an artificial restriction on the natural supply/demand curve, so now supply can grow as-needed in the forms desired.
I don't think it really does to the supply/demand curve what you think it does.
In general, when new construction occurs, it's taking low density and replacing it with more like 10X density. A very tiny amount of land gets developed at once, so you need each new development opportunity to generate as much supply as possible.
What this did was make people think gosh, that means a lot of housing! But in actuality, very few of these ever get built. Only very old housing stock ever makes sense to replace with only a doubling.
I appreciate what you're trying to say, but what I said was actually true. This won't have much impact. I can give you drips and drabs of information this way to help you understand how development works, but I can't give you an entire primer, unless you'd like to get on the Zoom and talk about it for a couple hours.
Maybe true in an area that requires redevelopment to grow, but in Raleigh there are huge, huge swaths of totally undeveloped land that are now much more valuable even within the same zones. You do not need ultra-high density towers to create true urban density.
I think you're setting up a false premise there about towers? Not sure where that came from.
Can you show me land that is now much more valuable than before? I suspect the places you're thinking of aren't really changing on value or buildability the way you expect.
> In general, when new construction occurs, it's taking low density and replacing it with more like 10X density. A very tiny amount of land gets developed at once, so you need each new development opportunity to generate as much supply as possible.
Naively, you're talking about converting a one story building into a ten story building. That == a tower.
You're skeptical that higher density zoning increases land values?
> Now, let's talk about the multi-family sector. If you thought single-family homes were hot, wait till you hear about this. Land suitable for apartment development in downtown Raleigh and Durham has seen price increases of 50-100% in the last five years alone.
> And it's not just apartments. The demand for townhomes and condos has sent land values for these types of projects through the roof, with increases of 30-40% in prime locations.
Of course we can quibble about what amount of that appreciation is caused by zoning changes, but from first principles it is obviously the case that given the same exact plot of land, the expected value of developing 10 houses on it is much higher than the expected value of developing 1 house on it, ergo a lot that allows 10 will have a higher price than that same exact lot constrained to 1 home.
These are two completely different things.
One thing is solving the problem for the world as a whole. That’s the ideal scenario, the one we should aim for. It might get resolved, it might not, but it will definitely take a good amount of time, maybe a very long time.
The other issue is your personal situation.
If you're living in a country with intense conflict or in a war zone, you can’t just try to survive for 40 years while “waiting” for the country to make progress. You move, and that’s it.
Plus, given that people’s freedom is constantly increasing, and they have more and more options available, expecting that everyone will autonomously choose a healthy lifestyle is like waiting for Santa Claus—unless you plan to take that freedom away from them.
Well no, you often can actually. You can have positive information about the impossibility of something, for example the prospect of winning a chess game after losing your king. You don't need to play billions of games of chess to see whether it's possible.
Zoning changes happen all the time. Tax changes happen all the time. Subsidy changes happen all the time.
"The UK has seen its obesity rates increase faster than the US. In the UK, obesity has risen sharply since 1990, when it affected only 14% of adults. The UK is also considered one of the most overweight countries in Western Europe."
So yes, other countries (just like the US), have introduced programs to try to encourage healthier behaviors, and have seen similar outcomes from them.
the UK has basically become the US by most metrics. This includes the increasing privatization of health services, transport, etc... and the excessive commodification of basic necessities like housing.
I find that saying that health initiatives don't work by vaguely gesturing at a country, is not a structurally sound argument. Its like the sentiment here is: "is the fact that we include Pizza as a vegetable in American schools part of the problem? Nooooo, that can't be it. it must be a moral issue!" and thats just one example.
The obesity problem in the US is tied directly to our relationship with highly processed (and CHEAP) food. Along with the stranglehold those companies have over state and federal institutions that allow them to directly sell these foods in schools and institutions, and heavily skirt FDA regulations via lobbying.
The US is uniquely bad when we have a ton of chemicals and ingredients in our foods that are banned in most other countries. It is largely a systemic problem and a problem that can easily be solved. Poorer people tend to eat cheap food, cheap processed food isn't well regulated and is directly tied obesity and a whole host of health problems.
The claim was about promotion, not effective promotion. (As a sibling comment points out, effective promotion is not unrealistic either. It won't happen on its own, but nothing does.)
As compelling as the theory that "unhealthy behavior" is root cause of the obesity epidemics, at this point it seems to me that the weight of evidence suggests an actual physical disruption. It's not supposed to be _this hard_ for (some) people to maintain their weight; something is actually not working right.
It would be interesting to run an experiment where everyone in first world countries was able to (and had to) walk to the grocery store to buy their groceries. It seems like that would promote useful exercise while self regulating consumption.
I walk to the grocery store all the time. This was part of my weight loss strategy and I chose to walk to a farther grocery store. And yes, I did attain my weight loss goals.
I choose to interpret the post as saying "start small, and be consistent". If you were to tell someone to go for an at least 30 minute walk every day many people would balk at you.
Start with a minute walk. Make time in your day for it. Extend to a 2 minute walk. 5 minute. 15 minute. Etc.
When the majority of the population is so far gone from being in a healthy weight, promoting healthy food for the masses is not going to help that majority. Yes, walkable cities and so on would be great, and promotion of healthy food and habits is great (remember Michelle Obama asking "why are you people so fat wtf?") for future generations, but Ozempic et al. provides a solution where otherwise, a lot of people are simply "lost".
The problem is that you can't undo millennia of evolution that has pushed us towards the situation where people are obsessed with food and struggle to limit themselves. We also shouldn't forget that not more than a century ago famine and rationing was still commonplace. Certainly my parents were still raised in an environment that hadn't gotten used to food being plentiful and were always forced to eat everything they had at all times and rewarded with food, this has been engrained in myself since I was young as well. I'm lucky that I managed to move away and isolate myself and lose a lot of weight but the important thing to note is that once I got down to a lower weight, everything was easier, getting up in the morning, walking, jogging, working out, talking to people, going outside. Now I've probably gained back 30% of what I lost and if I could take Ozempic to lose 5kg the rest would come a lot quicker because I'd be able to run further and have more energy generally.
All that is to say, these two are not mutually exclusive and if people receive this drug everything we already do to promote a healthy lifestyle will become much more realistic for many people, as far as I understand Ozempic removes the desire of hunger, it's not like people can continue their bad habits and take the drug and lose weight. Furthermore once they assume these habits, the generational cycle of raising children and over indulging will likely come to an end and we will probably not need the drugs as much.
TL;DR, people want to be healthy, they just don't have the tools or motivation to do it. Losing weight will likely be a gateway to many health improvements and benefits for future generations
I've struggled with weight loss my entire life. It's gotten to the point where I'm on multiple blood pressure medications, and the dosages are creeping up. And yet I still find myself thinking about eating constantly. Then I took Zepbound. It was revelatory. It was like a curse was lifted, and my hunger was silenced. I'm down 45 lbs in 4 months.
Perhaps if I didn't have responsibilities or trauma or stress or a thousand other things I could put all my energy into self control. Unfortunately, I only get so many years on this planet, so I'm going to keep taking the drug and spend my mental energy on other persuits.
> Perhaps if I didn't have responsibilities or trauma or stress or a thousand other things I could put all my energy into self control.
This is so relatable. Right before Covid, I was working really hard at counting calories and was looking at going below 200 lbs for the first time in my adult life. Then Covid hit, my life was upended, and I prioritized other things; I'm up about 40 lbs from then.
I can only devote so much energy to this kind of intensive lifestyle change, and other things have been taking precedence (including, recently, working out—that's been a huge lifestyle improvement [other than Wednesday being leg day and my legs still yelling at me], but hasn't led to weight loss).
As with everything I'm sure there is a spectrum. There are surely folks who have food addictions, there are surely folks who are not taking accountability for their habits, and there are possibly folks for whom this could be the best or safest option.
What a naive way of looking at things. Sure, everyone that's fat is lazy! There cannot be any other explanations, right?
You seemingly forget not everyone is as privileged as you are. Clearly by your take, you can afford to eat healthy and have the leisure time to exercise. A lot more people can't.
It doesn't follow that your body, when running at a calorific deficit, will continue to run the life support systems at optimal levels. In principle, it's possible (unless you're actually fasting, which is a whole different kettle of fish) for a reduction in energy-in to lead to putting on more weight, if your basal metabolic rate drops more than the food did.
It's complicated. What's true for some people isn't necessarily true for all people. Sure, I'm willing to bet a lot of people – probably most people – are able to choose how fat they are by adjusting their diet and exercise regime, without adverse effects on their health, but that's not a law of biology. I know as many people who struggle to put on weight as struggle to lose it.
I've been running distance most my life. I stopped when my wife had our first kid to concentrate on working hard and give her as much time off from the kid as I could, then after 6 years I had enough and started running. Two years ago, I hadn't been losing any weight, and I was put on these drugs to help me.
I lost more weight.
I run, walk, and move more than you imagine. It didn't work, but these drugs worked.
Not everything is black and white or fits into your preconceived notions.
> Like..you can't bother to take a walk, eat healthier, so you shell thousands on drugs..
For many of us in the United States (and elsewhere, I'm sure), our built environment makes driving the only feasible mode of transportation. Sure, we can walk for recreation, but at some phases of life carving out that time is extremely difficult.
Regarding food: there are brilliant people devoting their careers to coopting our natural processes to buy their products—and many of those products are unhealthy foods. Fruits and veggies don't have that kind of marketing.
Late stage capitalism is what got us in this place.
Add sugar to everything, advertise anything and everything to kids so they are hooked up early, make healthy food expensive so the poor have no choice but to eat unhealthy and so on. Profit!
Now they'll profit once again at the other end "fixing" the issues they caused in the first place. Genius. There's no limit on human ingenuity when it comes to exploiting others.
That's not even close to true. I can easily pop into HN for 5 minutes while taking a mental break at work, that's not an option (and would be utterly ineffective) for the gym.
> If you truly only have 5 minutes of free time in your entire week,
I was responding to your claim that if you can browse HN you can go to the gym, and it's obvious with any sort of thought that they are not similar activities.
> then why is it ineffective to do 5 minutes of pushups?
What is your goal? Fitness or weight loss? Either way, that won't be effective. Sure, it can be part of a larger fitness regimen, but just 5 minutes of push-ups ain't cutting it.
Pointing out the obvious: the conversation isn't about GP and their own time allocation. It's about the empirically observable fact that we've built a civilization that turns people into lethargic, sedentary, chronically afflicted mush.
People and officials have been talking about healthy eating for generations. Hard to get more mainstream than every doctor talking about diet and exercise.
Politicians have been protecting big ag for decades. Now independent farmers are getting criminally prosecuted for selling their raw foods directly to consumers.
All things being equal, I'd prefer to spend less money on prescriptions and have fewer trips to the doctor.