Obesity, Discrimination and Public Helath: What is the right balance to strike with government policy?
One of the stress points that seems increasingly correlated with modernity is a rise of obesity in many developed nations (most notably the United States, but also the United Kingdom, Canada, China, Mexico, and elsewhere). Japan instituted a fat tax that requires periodic weight measurements as a way to combat obesity. Denmark and India have taxed certain foods. New York City, while Michael Bloomberg was mayor, famously taxed soda as part of a policy package to address weight gains.
Meanwhile, groups have organized to attempt to reduce the amount of stigma associated with being fat, arguing that stigmatizing obesity and arguing for aggressive dietary change often creates runoff mental health issues among fat people, or worse that doctors' obsession with weight blinds them to other more serious health issues whose symptoms are being reported by fat patients.
This question is for everyone hailing from a nation dealing with some form of rise in obesity: What is the right balance to strike with public policy when it comes to dealing with the rise of obesity?
The biggest problem in the US is that there are a large number of people living in poverty and it is much cheaper to load up on cheap, processed goods, pre-packaged meals and fast food than it is to purchase healthy foods. Not to mention many poverty stricken areas are also in food deserts or food swamps where there are limited options for healthy/fresh foods and poor access to transportation to such options. Obesity is much less common among the wealthy.
This is another culprit. Find products in the supermarket without HFCS, and compare them in price to similar products that contain it. The products without are branded with buzzwords and cost more.
It's also the fact that people don't have the time they used to to devote to cooking a healthy meal. Usually all parents in a household work, and then people have extracurriculars which leaves little time for family dining.
A lot of single people work odd hours and multiple jobs to make ends meet, with no guarantee of when they can cook something on the stove and not in the microwave.
So many health problems are caused by being obese. I think that's where we should start.
I think the crux of the issue is that there is a lot of misinformation about nutrition, diet, healthy eating, and medicine that exist even in official texts. In the '90s the gov't introduced the Food Pyramid which gave an easy-to-understand guide of what to eat and how much. It was then totally rewritten dozens of times for a variety of reasons. First and foremost, to advance the agendas of companies like Coca-Cola and Kellogg. Eventually they gave up and said 'it's different for everybody, we're all special snowflakes.'
The issue is that we blame food instead of ourselves. So many health problems are almost entirely unrelated to the food we eat and more to do with how much we eat. We just plain eat too much and that's the issue. We have to identify that most of the food we eat is, for the most part, okay. Few foods are intrinsically 'unhealthy' (plenty of notable exceptions to this, notably high fructose corn syrup), just foods that are good decisions and bad decisions.
The way we should attack this is to first dispel all government writing on what foods to eat and not to eat and enforce a greater emphasis on calorie intake. Exercise is important for being fit and healthy, but weight is so much more important than being active. Instead of the emphasis we put on exercise and going to the gym, we should teach how to measure out portions with a scale. We should teach macros of common foods. We should know how many calories we burn in a day, how many calories we burn during intense exercise as well. These numbers can guide up to understand that exercise can help lose weight, but it's far easier to eat 1000 calories less than burn 1000 calories more.
We also need to consider that often times fat is a symptom of something else, either poverty or another health issue. Educating kids to build healthy habits both in terms of eating and exercise is definitely a good place to start. However I believe we need a lot more support from the medical field and not just fat shaming, which to me is what the Asian countries in particular are doing.
I agree that fat shaming is bad. I originally wanted to say that it's a bad idea because it actually does marginalize the obese by bullying. No one gets bullied into being better, it only works to re-enforce the idea that it's out of their control. As a people, we need to understand that we are responsible for our health. Most people are obese because they eat too much, for one reason or another, and that's what we should learn to accept.
We need to get rid of farm subsidies. These are incentivizing using unhealthy food such as high fructose corn syrup through corn subsidies and changing the farming industry into the behemoth we have today. It is one of the major causes of the dissapearance of the small farm
I hear ya on that. That was one of my favorite things about Ted Cruz' candidacy in 2016's primary. He had the guts (and it does take guts in the US) to take this topic and elevate it within the Republican party. I think he was primarily focused on soy subsidies as memory serves, but I would not mind phasing out a bunch of the crop subsidies put in place nearly a century ago to manage the problems of nearly a century ago. Nearly all of those industries have changed and centralized since then.
The problem is that, for farmers at least, we probably would need to replace the subsidies with programs that are better tailored to helping smaller farms succeed, maybe by giving credits for equipment upgrades or something. IDK.
Is there anything else we can do to help address obesity rates?
We need to stop treating fat people like they're worthless. Positive reinforcement is the best motivator. Perhaps we could take from the farm subsidies and give an incentive to people to get healthier. Subsidize some workout locations, give out vouchers for fruits and veggies. Open more community gardens so people can become invested in the food they eat.
I get where you're coming from here, but I'm not sure how much education matters. There was the food focused fads of the 90s and early 2000s, but those have largely died out in favor of calorie trackers and diets that emphasize quantity and macros. We have more people with more access to accurate information about how to craft an effective weight loss diet than ever before, with more trackers and technology alongside to help people achieve those losses. So why aren't they working? Is there any data that measures education penetration when it comes to healthy diets and weight loss?
Despite increased availability of good information on diets, and trackers to help people keep to them, the upward push of obesity rates in the US has been largely unabated. It's been a slow, steady creep. Last time I dived into these stats it was data up thru 2014, and it was showing that increases in obesity were coming from overweight people getting fatter, not from people at a "healthy weight" getting heavier (as measured by BMI which is not very indicative of any particular health risks until you get into the obese category).
I feel like another aspect of health that is regularly overlooked is that it isn't the weight that gets people the most in trouble, it's the body fat. BMI, the easier to measure approximation of body fat, measures only weight and height. It is a very imperfect measure for a person's overall health. It says nothing about how much that person exercises (which is part of a healthy lifestyle and helps maintain lower body fat).
So whatever solution we come up with to this intersection of issues, I'm not sold that education alone is enough. We have to create incentives and structures to encourage people to make healthier decisions. I don't think Japan's waist measurement is too bad an idea (waist, unlike height alone, can give enough information for a meaningful approximation of body fat), but people might see that as the government benefiting off of people's diet and lifestyle choices.
I know of the incentives Asian countries but I don't know much else about them. I don't think they would work in the US. Not because it's a bad idea, but it is as you say: people pointing the finger at the government attempting to profit off of obesity.
My point about education rests on the idea of improving our education system to include practices. Most people stop putting effort into education the moment they leave school, so I don't think my solution would help people who are already very overweight but perhaps the next generation.
To put a point on what I'm trying to say let me explain my experience with diet and nutrition in school. When I was in high school and college only 10 years ago, the only thing I learned about was "fats bad, proteins are made of amino acids, sugar is carbohydrates." That's the crux of the nutrition programs in public schools. It's not all wrong but it's certainly misguided. Instead of focusing on teaching the mechanics of nutrition, we should teach the practices. Portion control, different types of diets, macro management, and the importance of vitamins. None of that was really taught while I was in school. I remember a girl in my college nutrition class that no one could eat 2000 calories in a single day, it was just way too much. The worst part was that most of the class agreed with her! She had no idea what she was talking about. This person was in college and becoming an adult.
I think the soul of the problem is teaching the boring parts of nutrition and leaving out any amount of practical advise. Instead of teaching height/weight charts and BMI, we should learn about macros and portion sizes.
I don't mean to say that this is the core solution to this problem, it is a start. I don't think any one move is enough to combat the issue. Whatever solution there is will be on many fronts, but I think we should help the children first.
The focus on kids makes sense (and already is happening, with mixed success). I thought I'd challenge you a bit on the other part of the initial question: fat acceptance movements. All of our exchange has accepts the premise that the rise in obesity is a health problem. What if another facet of the problem we face is the speed with which doctors discount patient symptoms because of their status as obese? It's really no secret that, at least in the US, doctors have increasingly little time to spend on direct-to-patient interaction with the advent of digitized health analytics technologies that require more and more doctor time on data entry rather than patient interaction.
Do people in fat acceptance movements have a point worth considering? What should be done about fat stigma if so?
The fat acceptance movement is a problem, clear and simple. It has no merits.
I believe that most of the people involved in fat acceptance are people who are young, 18-40, who have few health problems related to weight. Health problems from being overweight don't start when you get fat, they start because you have been fat for a long time. People with heart problems and diabetes have those problems because they have been obese for 30-years, not because they ate the wrong foods or didn't exercise enough. Many problems exist just from being very overweight.
The issue is that people who are fat feel marginalized by society. Many people blame their weight on reasons beyond their control, or at least that's what they want to believe. This is why I think education is so important. Calories In, Calories Out (CICO) has gotten a bad rep recently because it's not 100% accurate, but it is an idea that holds true most of the time. People just don't know how to count calories. They don't know how many they have to eat to maintain their weight, they don't know how many they eat in any given day. Because of this belief that weight is an outside factor, unreliant on diet and activity level, it makes people feel marginalized the same way that Blacks, Hispanics, or Jews feel marginalized.
As it stands, I don't think there is an easy way to combat the fat acceptance movement. I think over time it will go away as the people who fight for the right to be fat start to experience health problems caused by their weight. I think eventually they'll see the error in their ways, pariahs will surface from the movement and change will happen from within. People in the movement won't listen to their doctors and they'll eventually find the doctor that tells them it's okay to be fat, and that one doctor will see all the fat people and will watch all of them die from weight related problems.
I don't know what I'm trying to say any more. The Fat Acceptance movement might as well be called the 'Diabetes Acceptance' or 'Early Death Acceptance' movement because that's what it is. There is no benefit to being very fat. You can accept being fat on your own, but it's because you choose to be that way. We shuoldn't drag down everyone.
No. Health problems related to obesity can start within a year of gaining weight. Extra adipose tissue around the internal organs makes it harder for them to work, causing internal stress. The physical weight causes stress on bones and joints, causing pain that can lead to decreased activity and more weight gain. It becomes a nasty cycle. Not to mention @BuckeySundae is correct that the marginalization experienced by obese people extends to physicians who can and do miss other health concerns due to over focus on weight, without enough time/effort toward intervention or education to patients regarding weight loss.
I've been all over the spectrum of weight currently a little chubby at 150 lb and 5'4". At my heaviest I was over 200 lb, and never once did a physician or a nurse attempt to provide me with education on how to lose weight or even tell me my weight was unhealthy. That's a problem. Physicians don't have time to spend with patients on these issues and often don't have the correct information to give because the information keeps changing.
I don't mean to say that obesity is some kind of extended equilibrium where people are fat and healthy, and suddenly fat and dying. Many of the health issues of being fat become part of normal life in the early stages of obesity. People who are obese don't mind not being able to be physically active because they wern't active to begin with. It's certainly a nasty cycle like you said, one I have also seen myself a part of (I'm currently pretty obese and working hard to change. It has taken a lot of education and a really hard look at myself, but I am changing for the better.)
The real issues of being obese, the kind which will end the fat acceptance movement eventually, happen later in life. They come on slowly, but also all at once. Life seems to change overnight. A patient collapses from physical exertion of climbing stairs that they were able to climb the week before. Suddenly a doctor tells them they have diabetes, very high blood pressure, cholesterol issues, and may have experience a very mild cardiac event. That's the kind of health problems I'm talking about.
To your point about physicians over focusing on weight, I think there is merit to it. I don't know how much because obesity is a real problem. A lot of problems figure themselves out when obese people loose weight. However, sometimes there are other issues a doctor should see. There was an interesting House MD episode about a very fat man who suddenly fell very ill. Everyone tried to tell him that he was just too fat, but it turned out that he had (spoiler) small cell lung cancer.
Not to mention the immediate impact obesity has on one's immune system and ability to fight infections. Obesity has also been known to lower the ability of the immune system to respond to and "remember" pathogens/antigens. Also, vaccinations/immunizations are significantly less effective when someone is obese. In addition, obesity leads to chronic inflammation, which can stress and damage tissues over time.
To a limited degree that's actually true. Different people have different gut bacteria, different bioavailability for different substances, etc. Now these differences are usually not huge, but all it takes is for example a consistent 10% (just an example, actual numbers may differ) higher or lower absorption of some macro nutrient to cause problems in the long term for somebody trying to stick to a standardized diet that don't account for individual differences.
If you thought you were getting less calories than you actually are, you might not realize why you fail to lose weight.
http://scitechconnect.elsevier.com/bioavailability-bioaccessibility-bioactivity-food-components/ (doesn't cover individual differences, unfortunately)
Other frequently ignored facts: when you've been obese and start eating as you should, even after you've lost the weight and stopped dieting, you'll be feeling much more hungry than average people.
https://www.livescience.com/61703-weight-loss-hunger.html
Your body also tries to maintain the highest level of body fat it has had. Increased body fat leads to presumably permanent changes in body chemistry. Our bodies treat weight loss as dangerous, because historically it was. Most notably, our bodies will reduce their energy consumption just to fight it.
Your body doesn't really know its ideal weight or fat level. It just knows where it's been.
https://www.livescience.com/53942-weight-loss-biology.html
My point about the pyramid is that since its inception it was a pack of lies and hard to follow. It was very generic advice manipulated by the food industry to further 'big sugar.' I mean to say that we should give less respect for the government's say in what we eat since they've done a real shit job.
I don't debate your points about everyone being different. I didn't mean to say that we aren't different. All things affect all people differently. Personally, I'm unaffected by caffeine. It doesn't make me feel awake or keep me awake. I can drink a cup of coffee and go to bed. I've met people who can barely get down a cup of coffee before they're bouncing off the wall.
And trust me, an obese person, I know what it's like to diet and feel hungry, staring at the clock and waiting for my next meal only to feel hungry after I've eaten. Surgeries like gastric bypass are used to reduce our hunger pains for people who can't manage on their own. I know of devices that are basically blood pressure cuffs that sit on the stomach to make it expand less. I hope I never have to do anything like that, but I can understand people who do it and feel like they have to. Eating 1/4 as much as you had before isn't easy when you're 500lbs.
I'm in agreement with this. Once I found paleo/keto all I had to do was make a few simple changes in my diet and I dropped over a hundred pounds without doing a stitch of exercise. I was borderline hypertensive and had a few early symptoms of insulin resistance. Both of those problems vanished completely, my blood pressure is fantastic now. Fat is not the enemy. Sugar is the enemy.
I agree with you here. However, it can be difficult to prep for that lifestyle if you're already pressed for time as it is. Keto is a lot of cooking for yourself and experimenting.
I agree, however there are people in lower income areas who would prefer to eat healthier food, but can't as healthier food is also more expensive (for the most part). You can see the disparity of health between lower class and middle class families.
I believe that better welfare programs should be pursued, rather than not trying to solve the problem at all because we are afraid of a "slippery slope." I would rather everyone have the choice to eat healthy, rather than only the wealthy.
Regulatory capture and capitalistic corruption. The well-intentioned agencies become cohorts in the dominant industry, because it pays better every time. We've known this is a science-based problem with an education-based solution (avoid sugar, eat the better types of fat and a diverse diet of vegetables) for a while now... yet the industry is fighting not to change to reflect this new information. Doctors have started to come around, though.
I haven't had the most time to dedicate to this topic's thoughtful comments, so I thought I'd try to make up for that now.
I would like to know more about what you see as the edges here. Do you mean you'd prefer for something more like Robert Thaler's and Cass Sunstein's "Libertarian Paternalism" where choice architecture is designed in such a way (where the government does have a say, such as with school lunches) to allow people to choose whatever they wish, but to encourage a healthy choice? Or do you mean perhaps just that the decision-making should be as far away from any centralized process as possible?
If you're talking more about Libertarian Paternalism when you talk about pushing decision-making to the edges, then can you think of any examples where we might design choices to encourage healthy choices while not disallowing any particular choice? Should there be regulations on the sorts of food that can be shelved in a supermarket at eye-level?
And if you're talking about decentralizing this decision-making as much as possible, do you see any role for government when it comes to reducing the nearly inevitable healthcare cost increases and burdens that people's choices to eat are likely leading us as a country?
I'm tired now so I'll just say that when it comes to reaching for unhealthy food, a lot of the issue comes down to poor planning and just pure lack of imagination.
Will you buy a single prepackaged frozen meal on sale for a dollar plus change or will you buy 12 eggs for the same price?
Will you buy a pack of "proper" noodles or will you get a five pound bag of wheat flour and make cheaper dumplings for your starch?
Are you willing to eat some nice, cheap carrots for a snack?
Do you use food for comfort when you've got people who are willing to listen all around you?
Those kinds of decisions, they're important.
But that's not the only decision you have to make. Eggs take longer to make than a frozen dinner. Eggs are a common allergy.
"Proper noodles", you let boil in a pan and you do other things. making your noodles takes time.
Someone's grocery may not have good produce.
Do you think you're all alone because you're fat? Do you think people listen to you? Do they really understand what you're going through?
You certainly hit on the time versus convenience problem, which leads into time budgeting. Of course there is unequality in much of life. My previous post (and this one) is not meant to be exhaustive, however pan cooked eggs can take maybe five minutes and rivel noodles are pretty quick to mix and cook.
I would say no, yes, and yes. From experience I'm better off talking to a friend or therapist about life's problems than setting myself up for a food binge.