Could obesity possibly be a two-tier problem?

In My Humble Opinion
1

Okay, I fell half in love with paleo, fell one-quarter out of love with that half, have studied low-carb, low-fat, and now my head’s in a spin. You thought battles about religion and politics were fraught and murky? Those about diet and obesity are just as much!

I’m gonna try to keep this short. I am letting the paragraph above stand in for a lot of musings on both sides of the wide divide (as if there are only two)!

Current, potentially incorrect thinking on weight loss:

• Obesity is often treated as a linear problem. If you are 10 pounds overweight, you are 10 pounds overweight, and if you are 50 pounds overweight, that’s 5 times worse than being 10 pounds overweight and 5 times as difficult to solve.

• Nevertheless, at the same time, it is widely recognized from personal accounts (which I confirm with my own situation) that weight gets harder to lose the closer one gets to one’s “correct” weight. That final 20 is quite hard to drop, and that final 10 is, well, pretty close to impossible.

• It is widely recognized that people in the past were thinner than they are now. Obesity wasn’t a big problem then, but it is now, at least in the West.

• But in the East, those people are skinny!

But I think the following might be true instead:

• Obesity is a two-tier issue, and the tiers may have different causes. There is “spare tire weight” and “genuine fatness weight.” Probably most people who are obese have the “spare tire weight,” and a smaller number have “genuine fatness weight.”

• I accept that the rate of people with “genuine fatness weight” has gone up over time, and that may be due to range of complex factors.

• But I further theorize that the number of people with “spare tire weight” has not really changed over time very much. I.e., the notion that people used to be all skinny and healthy and now we’re all fat slobs is not really true, and there are many confounding factors that make it tough to determine if it’s true:

-Until we get into the 1930s or so, it’s tough to tell how thin people were because photographs of people in a state of undress where you can tell become few and far between. It’s very hard to tell how fat a man in a suit or a woman in a billowy dress are.

-People smoked a lot. A huge fucking lot. In my dad’s yearbook from the 50s, under all the senior pictures (at least the guys) they made sure to mention the brand of cigarettes the lad smoked. There’s no question that smoking was a great fat-prevention strategy for a lot of people: it provided oral satisfaction while acting as an appetite suppressant. In the 70s, when I was a kid and a lot of people were quitting (remember the “Smoking Stinks” campaign?), many adults were complaining about gaining 20 pounds. I.e., that spare tire weight.

-A lot of people were skinny-fat. We love beating the shit out of ourselves today about how fat we are, but it’s easy to forget that, until the 70s, nobody fucking worked out. Nobody did yoga. Lifting weights was confined to a very small bodybuilding community. People were out of shape. A lot people had higher percentages of body fat while looking svelte than people today who don’t look so hot. I have also read this about Asians: many look skinny but are obese based on body fat percentages.

-And I also lived in Japan for 8 years and had plenty of time to contemplate just how fat and skinny everyone was. Note that smoking rates for men were still huge there: in the high 60s in the 1990s, while for women it was a little under 20 or so. And middle-aged men still had the spare tire weight, and yes there are genuinely obese people in Japan as well. The idea that the Japanese diet is conducive to losing weight doesn’t really hold water in my view: convenience stores are open 24/7 everywhere, and they are junk food paradises. The fast food market is huge there. There are certainly some cultural things that help one not overeat, such as smaller portions at restaurants (on average), but to get into why there are few morbidly obese people there, one would have to get into same set of complicated issues to explain why morbidly obese people have increased in the US.

Thus, my guess is that our understanding of obesity in the US is confounded by the false impression that “spare tire weight” is a modern, US problem when really it was an issue in the past (though one people probably barely thought about) and it’s an issue in other countries as well. To the extent that it used to be less of a problem, smoking probably played a big role. It sucks, but it’s something that tends to happen to a lot of people as they age, due to changes in metabolism, insulin resistance, whatever.

Someone walking around with 20 extra pounds they’d like to lose probably has a qualitatively different issue than someone with 300 extra pounds to lose. I would guess that there is some overlap in terms of causes, etc., but again: even if you really clean up your diet, exercise, etc., that final 20 is a beehontch to get ride of. I do Pilates, and I am watching a pretty young teacher who works out basically as her job have a gut creeping onto her, and I have heard other teachers complain about being unable to lose some final weight. These are people who live fitness.

The above is speculation and food for thought (put not intended). I think it’s likely to be true, but I’m not sure. I’m fairly confident that the “everybody used to be so skinny!” meme is overstated. I grew up in the 70s in a fairly unusual situation. I was an adopted skinny kid in an all-fat family. My perception was never that they ate like hogs, but they were just always fat and always trying to lose weight. In any case, yeah, there were fat people back in the 70s. Plenty of them. I never even thought about it until my late 20s, when lo and behold, that spare tire weight crept onto me. I’ve been able to lose a good chunk of fat by working out very consistently and putting on a lot of muscle since 2012. But I too would love to lose 15-20 pounds, as then I would truly be ripped and awesome-looking.

Thanks for reading, and thanks for your thoughts!

2

I’m not really clear what you think the implication of your two tiers is. If people were modestly overweight in the past, what would that change now about how we deal with obesity?

Sure it would change things if the standard recommendation for moderate weight loss was to live a 1930s lifestyle, but I’ve never heard anything of the sort. When people recommend diets heavy in low starch vegetables and avoiding heavily processed foods, preferring lean meats, etc., it’s because we think that’s the healthiest diet, not because we idealize the past.

I mean, paleo of course is the one diet I know of that idealizes our past, but that’s a fad diet. If you meet with a registered dietitian or a doctor who specializes in obesity, they make sensible recommendations based on the best evidence we have about good nutrition. It doesn’t really have anything to do with whether people were overweight in the past or not. If you’re overweight and hypertensive and pre-diabetic, etc., your doctor is helping you lose weight in hopes the weight loss reduces those problems, not because of how much your grandparents did or didn’t weigh.

3

No, obesity rates really were lower in the past. We have clothing artifacts that show us that, as well as medical records. There’s no question that there have always been some obese people (the Venus of Willendorf shows us that people knew what fat women looked like) but there were nite more obese people as a percentage of population.

Hypotheses on why range from an unidentified virus to intestinal bacteria to cheaper food and less walking every day. But no one seriously questions the fact, just the reason why.

4

Fair question!

I think expectations get messed up for a large percentage of the population. If people attained the recommended BMIs today (a shitty measure in its own right), we’d have a nation of very skinny people.

Let me put it this way: Morbidly obese people increased in number as a percentage from, say, 1970 to 2010. This was correctly seen as a problem to be dealt with. But in doing so, we ended up recommending everyone to be pretty damn thin, which is an unrealistic expectation, since the percentage of people with “spare tire weight” in 1970 and 2015 is not all that different (with most of the difference probably due to smoking).

The trouble is that a “healthy diet” is not enough to nix the spare tire weight. That’s another false expectation that’s been introduced and widely promulgated.

Oh, I think it’s quite common for people to say things, “Look at pictures of people from the 1950s–no one was fat!” with the implication being that those people were doing something right, and we’re doing something wrong.

I’m saying that both then and now are pretty much the same, although outlier morbidly obese people are more common and push up the average rate of obesity today. In that sense, yes, people in the 1950s were doing something right in that there were fewer morbidly obese people then. As to why that is, no one seems to have a clear answer.

5

Nothing you say really challenges the hypothesis, however. I agree that morbidly obese people have increased in number. They certainly push up the average. I’m saying that probably a similar percentage of people in, say, the 1950s were carrying around an extra 10-30 pounds, with the probably lower rate then mostly attributable to smoking.

6

Two quibbles:

One problem with “clothing artifacts” is that in the time before cheap, disposable clothing that was not sewn at home, any clothing would be used and re-used, which means it was cut down (much of the wear happens along seams) for wear by smaller and smaller people. So clothing that survives from the 1800s is likely to have been larger initially, then cut down to fit smaller people until it finally didn’t fit anyone in the family. We don’t have a lot of clothing left because after clothing didn’t fit anyone, it was often sold to the rag-picker or used for rags in the home.

And a quibble: the Venus of Willendorf is thought to be a fertility figure – her figure is one that a swould get as the result of multiple childbirth without post-natal juice cleanses, ab exercises, and tummy tucks.

We have a higher obesity rate, yes. But I’m not convinced that we know how much higher. Art shows us that a lot of people were certainly fat, though probably in good shape by today’s standards because of the need to do everything manually.

7

People may have not worked out, but they worked: heavy manual labor was common. And quite a few of the people who did and were muscular were beefy-fat: a lot of padding on a lot of meat. Think of how pro wrestlers looked back in the 1950s. Almost nobody was “ripped” as in very muscular AND very lean. IIRC we’ve had threads about why women back in the nineteenth century all looked like female wrestlers: they worked constantly but didn’t bother to limit calories.

8

It’s sometimes not easy to tell exactly how fat women were from photos, or how it was distributed, since in pre-1970s eras, women wore foundation garments (which could be heavy-duty) every single day. It was understood that proper foundation garments were necessary to make that dress you bought look right on you. Pantyhose got rid of some of the foundation garments for the very young, but older women certainly wore them.

9

That’s true.

Right. But she’s obese. And she’s pretty anatomically correct obese (unlike, say, many pin up drawings with very curvy hips but no fat pads on top of those hips, or “bingo wings” under their arms), which means there were obese models for the carver’s inspiration. People have this idea that cavemen were NEVER obese, and this just ain’t so.

I agree. I’m not suggesting a number, that we know precisely how much higher. But I think we do know it was somewhat higher. Even for the last couple hundred years we have numbers written down by doctors to show that.

I remember one researcher who spent some time measuring caskets, too. Morbid way of determination, but apparently caskets have gotten bigger recently, suggesting that the people inside them have, too.

10

I mostly with you. I think before the 20th century, people just didn’t give a shit about their weight unless they were so big it was causing them physical trouble. Men would be described as “portly” and it wasn’t a put-down. Now there was probably a level of fatness where people stopped finding it sexy, but I highly doubt it was as it is today, where someone being 20 pounds “overweight” is seen as unattractive by many people.

With respect to “skinny-fat,” I am referring to a pretty narrow time period, mostly in the 20th century from say 1930-1970, the era about which people will exclaim, “Everyone was so thin!” You will have more office workers and whatnot in those photos, and decent percent of those “skinny” people did have particularly favorable body fat percentages (same deal with many Asians right now).

11

Another good point. We forget that in the 50s many women were wearing corsets and stuff for that nice wasp waist.

12

Better nutrition is another confounding factor. Japan is a case in point. Everyone there was noting in the 90s that the younger generation were much taller, etc., because they had grown up eating meat. And that certainly seemed to be the case. Young people do seem taller there, to the point where, at 5’11" I never really felt all that tall.

OTOH, you see these wizened old men and women who are like 4’11" there, and sure, they’ve shrunk some, but those people were never tall.

A lot of people well into the 20th century didn’t fulfill their genetic potential due to poor nutrition. So I think casket size would be tough to use. Also, people died of tuberculosis (“consumption”) and other diseases that could have made them smaller at the time of death.

13

All right, so it took a couple read-throughs for me to understand what you meant by “spare tire” weight and “genuine fatness weight.” I think what you’re saying is, essentially, that spare tire weight is a little extra weight, but not a whole lot? Like 20 lbs. overweight is spare tire weight, and a hundred pounds overweight is obesity?

Thing is, 20 lbs. overweight isn’t obese, even by BMI standards. You have to be at least 30 lbs. heavier than the maximum recommended healthy weight to be obese (at least at my height, I didn’t check for other heights). When we hear the stat that obesity rates are higher in modern times, I don’t think “spare tire” people are even counted in those rates.

14

I’m not a doctor, but it seems to me that it’s likely a combination of behavior and cheap & easy availability of highly caloric foods in huge quantities.

I mean, my grandparents were thin. My grandfathers were in good shape- not “skinny-fat” either. My parents have been obese as long as I can remember (I’m 43).

I suspect that at some point things like potato chips started coming in larger and larger bags, fast food became prevalent, and in large part, food companies competed on portion size (“20% more for the same price!”). I’ve seen this within my own lifetime- back in about 1987 or so, if you went into a gas station and got a bag of potato chips, it was maybe a 1/2 oz or maybe 1 oz bag, and the “big” bag you could get at the store was 8 or 10 oz. Now they come in 2 oz bags as the “standard” small size at convenience stores, and grocery store carry 16 oz bags.

Sodas are similar- back in the day, you got 8 oz glass bottles, but then that switched to 12 oz cans, and now to 20 oz bottles. You can still get those other ones, but the 12/20 oz varieties are much more common. The “large” size for home were quart bottles. Now they’re 2 liter. Cans were sold in six packs, not 12 and 24 packs.

Restaurants were much the same way- when I was a kid, Big Macs, Quarter Pounders, Whoppers and Jumbo Jacks were all the “big” burgers. Nowadays, they’re kind of on the smallish side relative to the chains’ other offerings.

Prices seem to have fallen somewhat, and the net effect of all this is that what was once the “normal” size is now viewed as the “kid” size. This overfeeds both adults and children, in that the “kid” size is anything but “kid” sized, but that’s the modern standard. So most everyone ends up succumbing to some degree of portion-size creep and eating more than they should, especially if they’re well-indoctrinated in the idea that they have to “Eat everything on your plate”.

I’m not convinced there was any more exercise going on in the 1940s-1960s in suburbia either; the suburbs are still there, and every bit as car-centric as the modern ones. But people were thinner back then.

I kind of think the people who harp on corn syrup, etc… are desperately looking for a “smoking gun” type reason, when I suspect it’s more complicated and will probably take some combination of legislation and possibly medical/pharmaceutical intervention to solve.

15

You may be right, I’m not sure how the statistical sausage is made.

But I’ve definitely read different articles about studies arguing whether 20-30 lbs. overweight is harmful or actually beneficial to health. And when people talk about losing weight, losing 20-30 lbs. is generally talked about as if it is in the same category as losing 100 lbs.

And when people do the “people were so skinny!” meme, the are definitely including the spare tire weight.

Also, my definition is not meant to be exact. It could the percentage of people up to 70 lbs. overweight hasn’t changed much, etc., but there has been a spike in 70+ lbs. overweight. Or it could be a three-tier issues, etc.

My gut is simply that the issue has probably been mischaracterized both on the scientific and popularly understood level.

16

I think this can explain a certain fairly small sliver of the population: those who genuinely overeat. It certainly is less expensive and much easier to eat a lot today, especially compared to the time before electric fridges when you had a tiny ice box and very few convenience foods.

But there are a lot of obese people who try not to eat a lot and end getting/staying fat because they’re eating when they’re hungry. I think even in the 1950s it would be easy enough for such people to buy potato chips and candy bars and find themselves in the same spot as today.

17

Just because there were folks back in the day who had “spare tire” fatness doesn’t mean this is a healthy state to be in. Similarily, just because our caveman ancestors lived off of raw meat doesn’t mean eating raw meat is healthy.

I’m not saying carrying a few extra pounds is necessarily unhealthy. But it’s not like our ancestors were all pictures of health.

18

It could be, but I think our perception of weights has become extremely warped. I constantly see articles about a plus size model where the point is that we must have really bad body image expectations if SHE passes for plus sized. To me they look like perfectly attractive but very clearly plus sized women. To a sizable portion of America it’s offensive to even acknowledge they’re plus sized because her size is far smaller than them.

None of this would be relevant to your point if it was self-acknowledged morbidly obese women getting offended, but it’s usually obese women who consider themselves slightly overweight, or naturally curvy, or plus sized etc.

So I don’t doubt your supposition that being slightly overweight isn’t medically important and for all I know people have always been slightly overweight. But in my experience what people today want to be “slightly overweight” is “extremely overweight to moderately obese”.

All the data I’ve seen has shown people being seriously overweight though. About 1/3rd of the country is obese, 1/3rd is overweight, and 1/3rd is technically a healthy weight (including a lot of skinny-fat people). So of the 1/3rd overweight camp, how many are just marginally overweight? I have no actual knowledge of it but it seems unreasonable to think it’s weighted to the ‘barely-overweight’ end.

It’s true maintaining a healthy diet is really unlikely to deliver lasting weight loss. My point was just that the diet we define as healthy now isn’t primarily based on our beliefs about our ancestors. It’s just what we think is healthy. I’ve never heard anyone say something like you quoted except for Paleo advocates. And they’re talking about cavemen, naturally.

I’d be interested in seeing some statistics, but this doesn’t fit with my experience. People have gotten so fat we don’t even have a good sense of what healthy or ideal is.

19

I think the crux of the matter is the “try not to eat a lot”. I think most people have a really seriously skewed idea of what proper portion sizes are, and how many of those they should be having per day.

A cup of rice, 3/4 of a chicken breast, a cup or two of green beans, and tea for dinner is probably pushing 500 calories if anything was cooked using any butter or fat. 3 meals like this a day with two 250 cal snacks (like maybe a clif bar or a pot of yogurt), is right around 2000 calories a day. 2800 is around the right amount for active men, and sedentary men should be eating around 2400, with women being even lower across the board.

Know many obese people who keep that kind of diet up day in and day out for an extended period? Not me.

Most non-obese people I know have two behaviors that reduce their caloric intake- they leave a significant portion of their food on their plates, and they often skip meals. Most obese people I know do neither of those behaviors.

20

I’ve never been obese or fat. And I can’t say I go around leaving food on my plate. Wastefulness isn’t my style. Nor do I skip meals. I’d be a unhappy person if I went without food throughout the day.

The thing that I has kept me from being fat: counting calories for most of my meals. I’m always aware of roughly how many calories I eat for breakfast, lunch, and snacks (including my evening dessert). I let my hair down for dinner, but I’m always keeping a mental tally of what I’ve eaten leading up to that point. Which means rarely will I eat a sumptuous dinner feast if any of my previous meals for that day could be described the same way. Of the obese people whose eating habits have fallen on my radar, it seems like most of their meals are heavy and over-filling. And their snacks are more like meals.