13 votes

Everything you know about obesity is wrong

12 comments

  1. [7]
    Greg
    Link
    This left me a bit confused. It starts with an incredibly strong thesis: just as we knew but ignored the cure for scurvy in the past, we're now ignoring what we know about obesity. That...

    This left me a bit confused. It starts with an incredibly strong thesis: just as we knew but ignored the cure for scurvy in the past, we're now ignoring what we know about obesity. That immediately sets me up to expect an ending of "here's how we should be treating it" - and there kind of is a conclusion, which seems to be "focus on health regardless of weight, and learn to accept obesity without shame or stigma".

    The thing is, the author had already given a lot of powerful reinforcement on how few people actually manage to lose weight, how people are remaining overweight while barely eating, how many nations are broadly gaining weight and none are losing it. All of that does fly in the face of accepted wisdom, to the extent that I find it hard to believe, and I mean that in the most literal sense: I don't want to denigrate the author, but I struggle to accept that one can be significantly overweight while eating so little, for example.

    But then there's nothing done to convince me, none of the education that the title implicitly promised. Part of the reason I clicked was for a better understanding of managing my own weight. I've struggled with it over the years; if that's all been for nothing, I want more than just their word for it.

    The increasing weight of American society is taken as an inevitability; the inability for individuals to meaningfully lose weight is taken as an inevitability. Why are these things true? Why can't we turn back the clock?

    I appreciate the message of acceptance. I think the teardown of the harm being done by current approaches is valuable and important. I accept the thesis that health is more important than just weight.

    But the fact remains that weight is creeping up, and I was implicitly promised a "cure" equivalent to vitamin C for scurvy. If you're going to open with that analogy, and then tell me that there is no cure, I expect a much stronger defence of the point.

    Obesity should be accepted and not shamed? Absolutely, yes, no arguments there. We can't reverse obesity and it's foolish to try? Convince me. Tell me why it's happening in the first place, and why it's irreversible.

    25 votes
    1. [3]
      mundane_and_naive
      Link Parent
      I think the reason the article offered so little in terms of personal weight management is because the point is that the solution cannot be applied at an individual level but at the food system as...

      I think the reason the article offered so little in terms of personal weight management is because the point is that the solution cannot be applied at an individual level but at the food system as whole. Healthy diet is known to work, but personal diet programs in practice don't. It's not that we can't reverse it but we can't do it on an individual basis, we need systemic change. So in the meanwhile, we can stop giving tough love to fat people because it doesn't help anyway.

      One thing I notice about US is how ubiquitous fast foods are everywhere. It may seem like a trivial fact but as someone who doesn't live in the US (or the West in general), it absolutely fascinates me. Where I live there's no fast food but there are street foods, so I can only assume that fast foods fills a niche there that street foods do for us here. When your nation's default food sources are highly processed, concentrated fat and carbohydrates, it's no wonder that a significant portion of your population are overweight.

      10 votes
      1. NaraVara
        Link Parent
        When I was in Japan the Konbini culture there was fascinating. Americans usually remark about how clean and comparatively nicer the 7-11s and Lawsons are compared to convenience stores here. But...

        When I was in Japan the Konbini culture there was fascinating. Americans usually remark about how clean and comparatively nicer the 7-11s and Lawsons are compared to convenience stores here. But what shocked me was how much healthier their "grab-and-go" snacks were. Instead of old hot dogs, fried chicken, and potato chips it was onigiri, an appropriately sized sandwich, or nori crackers. I often find myself just wanting a small snack to tide me over until my next meal and wish I could just stop and pick up an onigiri or something small but it's basically impossible. Everything is either 700+ calories and effectively a meal in itself or it just won't satiate since it's empty calories that leave you hungry again in an hour.

        I think over my entire three weeks in Japan I saw maybe 4 people who would have been considered properly "fat" by American standards. And it doesn't seem like most people spend much time worrying about what they're eating or working out.

        7 votes
      2. guts
        Link Parent
        As someone who is from the West and lived abroad in Europe (The Netherlands), my first culture shock was the lack of fast food convenient stores like 7-Eleven. In the city i lived stores close...

        As someone who is from the West and lived abroad in Europe (The Netherlands), my first culture shock was the lack of fast food convenient stores like 7-Eleven. In the city i lived stores close early and did not open on Saturdays. In my city before the pandemic fast food convenient stores were open 24 hours all week.

        3 votes
    2. [2]
      NaraVara
      Link Parent
      She talks quite a bit about how the real culprit is food policy around what we subsidize what we don’t and how this encourages healthier or unhealthier lifestyles. The subsidies fructose and cheap...

      She talks quite a bit about how the real culprit is food policy around what we subsidize what we don’t and how this encourages healthier or unhealthier lifestyles. The subsidies fructose and cheap carbohydrates rather than fruits and vegetables, for instance.

      8 votes
      1. Greg
        Link Parent
        Yeah, I was hoping that would build to something bigger, actually. Making a convincing argument that the source of calories matters as much as the number? Or that GI matters more than calorie...

        Yeah, I was hoping that would build to something bigger, actually. Making a convincing argument that the source of calories matters as much as the number? Or that GI matters more than calorie count? That would've been meaningful. We're told again and again that less calories = less weight, and challenging that orthodoxy would be big.

        That would clash with their argument that obesity isn't reversible, though. They said that healthy food plans, lettuce-heavy diets, and the rest didn't reduce obesity (despite other positive effects, at least for the former). So maybe the answer is more along the lines of what @nukeman said: it's all about the gut microbiome. That could lead to either of two powerful conclusions: perhaps the answer to obesity is measuring, cultivating, and potentially transplanting healthy gut flora; or perhaps that's not plausible, and the big reveal is that overeating is like asbestos, dealing cumulative, irreversible damage to our guts that manifests in excess weight.

        Again, though, that's not the answer they give. Perhaps I'm being too harsh on the author; I don't think it was a bad article, by any means. It's just that it promised revelation, and to me it absolutely failed to deliver. I've been patching together a working knowledge of nutrition and fitness for many years, and I've hit absolutely huge amounts of misinformation, some probably accidental and a worrying amount seemingly commercial. I'm pretty sure that I still believe a lot of things that'll turn out to be wrong. The promise of correcting some of those mistakes was exciting, and I think that's why I feel short-changed.

        7 votes
    3. nukeman
      Link Parent
      One major reason I’ve heard for obesity being difficult to fight is that your gut flora change. Don’t remember much in the way of details, however.

      One major reason I’ve heard for obesity being difficult to fight is that your gut flora change. Don’t remember much in the way of details, however.

      7 votes
  2. NaraVara
    (edited )
    Link
    Interesting and detailed article about the counterproductive and destructive ways our culture and the healthcare industry fails to adequately address the obesity epidemic. It goes over how our...

    Interesting and detailed article about the counterproductive and destructive ways our culture and the healthcare industry fails to adequately address the obesity epidemic. It goes over how our tendency to default to shaming and treating obesity as a moral failing both makes obese individuals less likely to make constructive health interventions for themselves AND distracts us from the actual macro-level policy interventions it would take to fix it.

    It does tend to belabor the point on shame IMO. After the second example I was like "Ok I get it" and then there's like four more. But otherwise I find it very persuasive.

    9 votes
  3. vord
    Link
    I haven't even read the article yet, and I'll post some life experience because I can confirm just on the title and opening blurb. My wife has a high BMI, confirmed thyroid issue that went...

    I haven't even read the article yet, and I'll post some life experience because I can confirm just on the title and opening blurb.

    My wife has a high BMI, confirmed thyroid issue that went untreated for years (thanks America!). When she got pregnant, the vast majority of doctors ignored her perfect blood pressure, heart rate, an normative weight gain. Presumption of gestational diabetes and other high BMI risks before even glancing at chart. For the second time, they skip over previous perfect pregnancy and almost perfect labor. They see 'C-section' and 'BMI' and don't bother glancing deeper to see that C-section was only needed due to umbilical cord around baby's neck.

    Many doctors, nurses, and admins take one look and think "Oh a fatty, guess I better pull out the fatty script."

    This is not to say all do, by any stretch. But we've seen enough to know it's a pattern.

    I'll check back in after I finish reading.

    9 votes
  4. [2]
    spit-evil-olive-tips
    Link
    For anyone who enjoyed this piece, the author (Michael Hobbes) has two podcast series that are each in their own way sort of spin-offs of this article: Maintenance Phase with Aubrey Gordon aka...

    For anyone who enjoyed this piece, the author (Michael Hobbes) has two podcast series that are each in their own way sort of spin-offs of this article:

    Maintenance Phase with Aubrey Gordon aka "Your fat friend" talks about the junk science and misconceptions about obesity, weight loss, "wellness", etc. For an introductory episode I'd recommend either Dr. Oz or Fen-Phen.

    You're Wrong About with Sarah Marshall takes the "everything you know about X is wrong" framing of this article and applies it to other pervasive cultural myths. For an introductory episode I'd recommend Disco Demolition Night or Human trafficking.

    3 votes
    1. arghdos
      Link Parent
      Even as someone who has never struggled with the issues they discuss in Maintenance Phase, I highly recommend it. It’s equal parts hilarious and educational. Helped give me a peek at a lot of...

      Even as someone who has never struggled with the issues they discuss in Maintenance Phase, I highly recommend it. It’s equal parts hilarious and educational. Helped give me a peek at a lot of built in biases I didn’t even know I was harboring.

      4 votes
  5. [2]
    Comment deleted by author
    Link