Could obesity possibly be a two-tier problem?

In My Humble Opinion
21

What monstro said, above.

A lot of people have no idea what a proper portion size is. That’s step one. Step 2 is to figure out what you’re overeating on and try to find a substitute. Like crunch and salt? Carrots and seasoned salt. Sweets? Fruit. It works. As my doctor told me (when he asked how I’d lost weight without going on about it or having any “counseling” or “treatment”, “No one ever gained weight by eating cherries.”)
Step 3 is to take some exercise. It won’t make you lose weight on its own, but it sure doesn’t hurt.

Anyway, I think that our more sedentary lives, **plus **easy availability of junk food, **plus **the normalization of huge portions, all add up to people moving from “plump” into “needs mobility scooter”/“corpse being weighed on the large animal vet school scale”/“needs extra-large hospital bed” territory.

I also suspect that Americans’ use of drugs might play into this. As far as I know, studies are done on particular medications and side effects reported for those meds. And maybe studies are done on two medications being taken at the same time. But it’s normal for reasonably healthy people to take multiple drugs, all the time, and we don’t know how those might be affecting our appetites or metabolisms long-term.

22

Genetics does play a role in whether or not an individual is obese. How big a role, I don’t know, but the science is starting to support the idea that obese individuals have slightly different genetic material than slim individuals.

In college, I lived in an athletic dorm my freshman year, along with the other members of my team. We ate the same food, had the same amount of exercise, and for the most part, led virtually identical lives. Yet there was one girl on our team who struggled constantly to keep her weight down. She worked just as hard as we did during practice, she didn’t sneak snacks, she ate what we ate, and yet she just didn’t metabolize her food in the same way that the rest of us did.

It’s possible that evened out for her when she matured. I didn’t keep in contact with her, so I don’t know. But I think it’s foolish to think that some people are more prone to obesity than others…and not just because they eat differently or don’t exercise.

23

My pet theory is that the reason Americans are so fat is because of sugar. Drinking sugared pop is bad enough, but even more so is how ubiquitous sugar is in all our processed foods. It’s everywhere. Bread? Usually has sugar. Processed meat liked sliced luncheon meat or hot dogs? Sugar. Any kind of soup, sauce or condiment? Yep, more sugar. Our bodies spend most their time rezzed from sugar like we were fattening up on fall berries before the onset of winter.

ETA: I wish someone would do an experiment: Have some volunteers eat anything they want except sugar, and have a crew of chefs standing by to prepare anything they want, from raw ingredients with no sugar added. I’d bet that the volunteers would go through sugar withdrawl the first week.

24

I’ve been on the borderline between heavy and obese, and getting bigger every year I age (I’m in my early 50’s now). Granted, I have arthritis so getting proper exercise is a problem. But for the last few decades (or more) I cut out sodas, excess salt, excess sweets, joined Weight Watchers and learned about portion sizes and healthy eating, and none of that helped me get my slowly increasing weight under control. I was getting really frustrated about it.

Last year someone told me about Paleo. I have to admit that all the Paleo info is full of woo and I don’t buy most of it. But I experimentally gave it a try starting last November and cut out most starches and glutens from my diet. I eat meat and fresh veggies, dark chocolate and lightly salted nuts for snacks, drink water, diluted juice and herbal teas. I dropped 10 pounds over the holidays without even “dieting” and that impressed me, so I’m still doing it although I’ve been slipping with the breads and need to be more disciplined again.

One thing about the Paleo/Adkins diets that I do believe: the body processes different foods differently. I saw and felt it in my own body: when I eat sugars (and starches) they go straight to fat and I feel hungry in an hour and snack a lot. When I eat meat and vegetables, I feel satisfied longer, snack less, have more energy in general and less arthritic aching. I don’t think I have a gluten allergy, but there is some kind of sensitivity. With my old eating habits I was also struggling with near constant burping and stomach acid. That’s gone with this new diet, but when I have too much bread one day, I get stomach acid/reflux later that day.

Bottom line: with my old eating habits (with portion control, no sodas, few processed foods) I couldn’t get my weight down or even stop it from increasing. By eating Paleo/Adkins, my weight is under control and I can easily drop a pound or two a week with a little bit of discipline.

Regarding historical trends of weight in the population, I do believe it’s the prevalence of processed foods that is a problem in our society. Not just the HFCS in everything, but also the trend to find industrial alternatives to things. I’m thinking of when “they” decided that saturated fats were bad for us, so encouraged us to switch from butter to margarine. Then there was the back and forth between mono-unsaturated fats and poly-saturated fats, both of which can be found in various brands of margarine. Now they’re saying both of those are bad and maybe we should switch back to saturated fats (real butter) but just in moderation, of course. Industrial formulas to replace various foodstuffs are probably a bad idea. It’s annoying to me that they experiment on the population like that.

25

Question for Aeschines. From the title [Could obesity possibly be a two-tier problem?], I was expecting the proposal of a two-tier solution. But it looks like your proposal is more ‘and don’t worry about the first tier.’ Is that accurate?

26

Can any of this be that the super-obese people prior to 1990 or so died off very quickly without statins and quality hypertensive meds? We just didn’t see them because they hit age 30 or so and had the grabber? They didn’t get out of the house without scooters, etc.?

I only knew three people in this range 40 years ago. Two were aunt and nephew, the third was a former football player who never gave up eating like one. But this was out of a sample size of 1,500, tops.

Personally, I think that >20 lbs. level has epidemiological evidence for an infectious cause, but I think it’s more likely to be antibiotic related. What medication do (did?) they give sufferers from stubborn acne? One of the tetracycline family. What percentage of the girls may really have had PCOS? Years ago when you went in to the doctor with a sore throat, you got an antibiotic before the strep tests were ready. Think of all the babies with ear issues that just get scrip after scrip of antibiotics instead of tubes.

And what do you feed livestock as growth promoters? Not hormones any more. It’s either ractopamine, or antibiotics. Yes, antibiotic resistance is the primary reason to ban this antibiotic use, but some of these compounds must be showing up in the food chain at a level which can kill susceptible gut flora.

It’s not just availability of fast food and sugary drinks. There’s something more, because even before the Great Depression there were sodas, candy bars and Crisco.

27

‘Your fist is about how much food your stomach can take’ says I.
‘Well’ retorts my oversized friend, ‘I’ve got very small hands so that can’t be right’.

28

Good question!

Yes, I think there needs to be a two-tier solution and the recognition that weight loss is not linear in difficulty.

A bad habit of human cognition is that we like to pretend we have a solution with the knowledge and tools we currently have available. So the shtick of dietitians is that, if you do what they tell you to do, you can get down to your desired weight no matter what weight you are at now.

I think there is a moderate number of people they can help moderately and a small number they can help a lot. The latter would be people who are fat truly because of bad eating habits: they overeat, they eat to satiety with the wrong foods at higher calories levels (i.e., eating to satiety on 1,000 calories worth of potato chips when perhaps they could have eaten to satiety on 800 calories worth of chicken breast, broccoli, etc.).

For a lot of people in both tiers, nothing is going to work. Or stuff could work that isn’t good for one. E.g., people used to take meth pills for weight loss, and it really worked, but doctors aren’t going to do that any more, for good reason.

If you’ve seen the movie Elysium, which I don’t recommend, I think the medical system they have is basically what humans will come up with (it just fixes everything bad about you in an instant). And such a system will just scan unwanted fat out of your body. Eat all you want. Until then, maybe a drug that is truly an effective appetite suppressant without messing up your body. There have been times when I have lost weight at a scary-fast pace, simply because I had totally lost my appetite.

29

This is such a tricky area, and one issue is conflating Paleo with low-carb, which you did here. :slight_smile:

You can do paleo without doing low-carb; you can do low-carb without paleo. They do, however, match each other very well.

Here’s the thing: I’ve read a lot about low-carb diets, and they are very seductive because they can work very well for up to a year and then not work! They end up majorly effing up how your body uses cortisol and adrenaline and they can have some pretty mean side effects:

• Low body temperature
• Low libido
• Feelings of anger and aggression
• Inability to react to surprising stimuli: what would have made your heart jump now does nothing
• Just plain old gaining the weight back and looking and feeling like shit

I can’t do low-carb. I get insane carb cravings and my sexual potency goes way down (not to be confused with “going down”).

So be careful!

Because of the paleo/low-carb conflation, all paleo success stories are suspect. You just don’t know how big a part of the success was due to low-carb and how that’s going to play out over the long term.

30

I think that’s a fair question. Also, prior to the 1920s, diabetes was fatal. Since diabetes goes hand in hand with obesity, a lot of fat people were probably taken out of the population.

31

An excellent blog that is all about anti-low-carb:

Even though I am not really a paleo fellow traveler any more, I still read Mark Sisson’s blog:

Why? He writes intelligently about food, nutrition, etc.

Even over the couple years I have been aware of, reading about, and to a certain extent practicing paleo, I think it’s been significantly watered down. I think now, in terms of its dietary recommendations, it can be summarized as: Don’t eat processed food, sugar, grains with gluten, and high-PUFA vegetable oils. I still follow this more or less. I have been gluten-free since 2012 with almost no cheating, I cook mostly for myself, I don’t eat a lot of extra sugar (though I probably cheat on this the most), and I avoid seed oils.

The position on other grains, especially rice, has greatly been softened, and no one seems all that anti-legume any more (peanuts and peanut oil still seem pretty bad, however). Then the question is how much low-carb gets added into the mix.

Whether you think gluten-free is a fad or not, it remains an excellent hack for avoiding a lot of bad food and stopping and thinking about what you’re eating. I’m pretty sure I did have gluten sensitivity, however, so I’m sticking with it. I would get very, very ill, for example, after eating Indian food with naan and lots of seed oils used. It was an inflammation cocktail. My heart rate would go up and I would just feel siiiick for hours.

32

The catch is, it has to be something that doesn’t make you feel good. There are drugs that are very effective in suppressing appetite, but since they feel good, they have to be illegal because drugs are bad, m’kay?

Likewise, there are drugs that shift your body composition toward muscle rather than fat, but people like taking them, so have to be made illegal because drugs are bad, m’kay?

33

I with you on that.

It’s nonsense that people can’t get prescriptions for roids and PEDs if they want to do that.

34

Obese women ***are ***“plus-sized” when it comes to buying garments. “Plus size” starts at a 12 in some lines. I was a 12 when I was 145 lbs. I’m 5’9".

35

A lot of us who are following the keto/ketogenic lifestyle go through this first week; it’s often called the “keto flu.” It’s not strictly a sugar withdrawal, though, but a carbohydrate withdrawal. I can’t account for everyone, but even pre-keto everything I made was raw, fresh ingredients, or frozen, or canned tomatoes (only canned stuff I would use). But everything was carbs: bread, pasta, tortillas, paratha, potatoes, carrots, corn, beer (oops, the only other canned thing I would use).

I’m not going to go into a keto debate, try to defend it, try to suggest it to others, etc., etc., other than to say that it’s actually easy for me, and it’s worked to the tune of 40.2 kg as of this morning.

I live in China now and cook most of my food at home (and eat in the company canteen for lunch), but I was on home leave to Michigan, Nevada, and California last month. That meant that I ate out for nearly every, single meal for three weeks. And oh my God!, I had forgotten how absolutely huge the portions are at American restaurants. Actually, that’s not true; I hadn’t forgotten, but I’d never realized. Splitting some jalapeño poppers and a Greek salad, then eating four slices of a Detroit pizza, cheese cake for dessert, and sharing two pitchers of beer used to be completely normal and easy to accomplish, and it was just a normal expectation of a night out at a restaurant. Or like another thread indicates, at home, make the whole package of spaghetti (with my own, homemade sauce instead of the entire jar), and consume it all.

Instead, I felt like a bad customer at home: no apps, no beer, hold the potato, give me the girlie-sized 8 oz. filet, no dessert. And you know? Even with two cups of wine, it’s terribly hard to eat an entire 8 oz. filet these days, especially when the nice server is able to substitute some cauliflower for the potato for me.

36

One line of thinking is that it’s offensive and counter productive that the traditional definition of plus size is the same as the average American woman’s size. With this line of thought, it is apparently irrelevant that the definition of plus size has remained the same and Americans have grown into it. The average american woman now weighs as much as the average man did in 1962.

I find this way of thinking really asinine. There’s no problem with the definition. The problem is with the reality that on average we are plus sized.

The reason I brought it up is that I don’t believe many of us are capable of evaluating Aeschines’s spare tire weight tier anecdotally. In just 50 years we’ve gained an average of 30 pounds. As an average it doesn’t disprove the possibility that all that gain is driven by the super obese, and we’ve always had lots of slightly fat people. It still makes me wonder if there’s any evidence at all for the stable spare-tire tier theory.

37

I have difficulty getting beyond my belief that - other than a very small percentage of folk - most people who are overweight/obese would benefit from eating less and healthier and exercising more. A lot of morbidly obese people do not grossly overeat. It does not take a huge caloric intake to maintain fat. But many morbidly obese lead extremely sedentary lifestyles. Of course, carrying weight around contributes to physical difficulties which make exercise problematic.

Personally, I have a bit of an issue with BMI and terms like overweight and obese. I’m 6’3 and weigh somewhere between 200-210#. That gives me a BMI from 25-26.2 - overweight. When I look at myself in the mirror, I don’t think I look obese - certainly given my age. And folk consistently describe me as thin. No one has ever suggested that I was overweight, or needed to lose weight. I’m not saying I’m perfect or anything, but it really seems twisted to suggest that I am overweight.

I know I ought to eat better and exercise more, and I guess I would like to get below 200#, but I’m apparently not willing to put forth the effort I know would get me there. I weighed 185 when I ran my last marathon, so I know I could get there. If I added another run or hard bike ride in each week, and eliminated a bowl of ice cream or two, I’d get there.

Another issue I have is folk who seek a magic diet, instead of acknowledging that they need to change their mindset and overall lifestyle. Walk or bike instead of getting in the car, do your own chores instead of hiring someone, drink water or eat a salad when peckish, or simply get used to not minding the feeling of being a little hungry in between meals instead of having to feel sated 24/7. Not rocket science, and countless ways to skin that cat. But food serves many purposes other than mere nourishment, and many aspects of our society encourage unhealthy food choices and being sedentary. It is easier to sit around a lot and eat crap, than to actively do otherwise.

38

One thing that people are overlooking here is that the problem isn’t centered around the super-obese, waddling, mobility-scooter using people. They’re sort of the canaries in the coal mine here.

The real problem is that the population as a whole has become fatter. I was overweight in 1991, and still am. In 1991, men’s 38" waist pants were about as big as they came in normal stores. To get 40" pants, you had to go to the big and tall store. Now, you can get up to 42" in normal stores, and that’s not taking vanity sizing into account.

For another I looked at my sister-in-law’s old college yearbook from the fall of 1992 (my sophomore year), and found some group photos of groups I’d been part of - I was astounded at how SKINNY everyone was, male and female, because nobody’s that thin these days, not even 18-19 year olds.

Next time you’re out and about, take note of how many people have a few extra pounds, or are plump, or are fat, but not enormously so. I’d bet it’s about half or more, and that’s what the problem is, not the relatively small percentage that’s morbidly obese.

39

I once had to work at a RV trade show, which involves sitting at a booth watching thousands of people walk around you for about 24 hours over a couple days.

It had never occurred to me before, but virtually every adult at an RV show is at least middle aged and the vast majority are retirement age. I never realized how fat older people are. Virtually every single person, man or woman, was substantially overweight. Not obese, and not even necessarily extremely overweight, but not “a spare tire” either.

Contrarily, if you ever start to doubt how fat America is, go to NYC or another major city. Someplace without a lot of tourists. It’s shocking how used to fatness we can get until you’re surrounded by thin fit people.

40

This issue is a lot like abstinence as a pregnancy prevention technique. I mean, I realize there are people who literally think that basic metabolic rules don’t apply to them, but they’re a minority of deluded people.

Sensible people realize that consuming fewer calories and physical activity could end obesity the same way abstaining from sex will end unplanned pregnancy. The problem is when researchers look at long term weight loss maintenance empirically they find only tiny minorities of people who’re able to maintain weight loss in the long term even when the long term is defined as a mere 1 year. Obviously it’s primarily a matter of non-compliance with lifestyle changes, not magic metabolisms, although weight set-points are fascinating to me.