I just don’t buy it. As I said, I great up in a fat household as an adopted skinny guy, and I never thought about weight. I wasn’t one of those people. Then, lo and behold in my late 20s, suddenly eating just pretty regular amounts of food made me gain weight quite easily. And I was not the sedentary type. I was living in Japan, walking to and from the station and often just walking home from work–a 40-minute hike. None of that ever made a lick of difference to my weight.
I have worked out since 2012 probably more than 98% of the population, put on a good amount of muscle, and I still would like to lose 20 pounds.
Something has happened. Even people who eat well and exercise a lot have a hard time being the weight they want to be. Frankly, it’s almost like a cosmic prank being played on humanity. You eat right and exercise too? Well FUCK you, hahahaha, be a fat fucker anyway!
But once again, I will cite the great drop in smoking as a key reason why the population has gained an average of 30 pounds in 50 years.
Sorry to be so late to this thread. Where to begin?!?
It is widely understood that obesity is not linear. It is very well established that an obese person does not need to become “normal weight” to gain the health benefits of fat loss: losing 5 to 10% of body weight and keeping it off with improved nutrition and exercise habits gains most of the health benefits. Two people with the same weight and the same percent body fat are in very different circumstances from a health POV if one has gotten there by having lost weight and one has gradually gained to get there and has not lost weight. It is indeed widely understood that exactly where the fat is matters a lot.
Most people who are obese, i.e. BMI 30 and over (not overweight, BMI 25 to 29.9) have “genuine fatness weight” not just a spare tire. “Overweight” is much more of a mixed bag with some being seriously fat and some with only a spare tire with a good amount of muscle mass, and “normal” (BMI 18 to 24.9) includes a few who are fat as well.
Indeed the spare tire numbers are pretty stable. As you can see in the figure here “overweight” has been pretty flat from the 60s on. Obesity (clear genuine fatness) however has increased mightily and extreme obesity has increased 7-fold since the 60s. The decrease has been those of “normal” weight. They used to be over half of the populations and are now the distinct minority. (“Underweight” has not changed much.)
Your idea about blaming smoking is just simply plain wrong. Yes, in the 50s smoking was huge. Really 40s to 60s. What you are not appreciating is how much of an outlier time period that was. Scroll all the way down to Table 2 here. Per capita cigarette consumption early 1920 and before? Under 1000. The big jump occurred in the 40s, hitting over 3000 by 1944 and over 4000 by 1959. 1963 was the peak and it has steadily dropped since. If smoking was the major factor then the 1920s to 30s would have had as much obesity or more than we have now. Also obesity has increased in a wide variety of non-Western countries across the world … not to our levels, true, but major increases. The increases have not correlated with decreased cigarette consumption but with the introduction of the food industrial complex and into the cultures.
Your speculation that people used to be “skinny fat” (and are more muscular now) has no basis other than in your imagination. You may be shocked to know that most Americans do not lift weights or belong to Pilates studios.
Most people who are fat overeat. That is pretty much a tautology. Overeating just means taking in more calories than the body burns and uses for not-fat tissue growth. The issue is why do they overeat, and why is overeating so much more prevalent now. The answer is NOT that people are now much less disciplined than they were. One major part of the answer is that the Food Industrial Complex has surrounded us with hyperpalatable low satiety food … highly processed foods that sell more because they are eaten more because the combinations of fat salt and sweet overstimulate the brain’s food related pleasure centers (the “eat more of me” parts) while minimally stimulating the brain’s satiety centers (the “whoa, fulla uppa” part). What worse is that these actually make physical changes to the brains and that brain changes can even be passed on through the generations, predisposing developing fetuses to obesity even while in the womb. Other potential factors include less physical activity and antibiotic exposures across the life cycle including in the environment and many others.
Bottom line? You eat right and exercise too? Well fantastic! If you are 20 pounds “overweight” Say you are 5 ft 9 inches and weigh 189 (BMI 27.9) instead of 169 (BMI 25, top “normal” BMI) then you are healthy and doing great! No fat fucker you. You eat a bit less right and exercise a bit less often and creep up to 209 (BMI now over 30, i.e., obese), well, not as healthy. You someone who has been 5 ft 9 inches and 209 plus for years and have not been exercising so much and not eating so healthy (and likely you didn’t get there doing those things)? Start eating healthier and exercising more and lose in the process 5 to 10% of your body weight, say to low 190s and you are doing great, even though "normal BMI is more than 20 pounds lower.
Makes sense, but I’m not sure that message really reaches the “ground floor,” so to speak. The nutrition advice from official sources that reaches the masses tends to be fairly low on “frank talk” and high on idealism.
Thanks, good to be validated a wee bit.
Makes sense.
No, I think it makes sense. The 1950s and 1960s is when a lot of convenience foods came into being, when electric fridges became predominant. Before then, you had a literal lump of ice in your icebox and very little storage capacity for frozen foods. So smoking helped tamp down obesity rates just when a whole host of fast foods, convenience foods, and temptations were coming on the scene. You get to the 70s and smoking really gets attacked, and BOOM, obesity epidemic. Sure, it’s not just that–it’s a lot of different factors. But I wouldn’t dismiss it as one important one.
That doesn’t mean that things would be even worse without smoking, chewing betel nut, etc. Some countries with lower obesity rates have coffee consumption that would make your head spin (Finland, e.g.). Lots of different things in the mix.
It’s not just comparing Americans with Americans, past or present. I read that a lot of Asians are skinny-fat and not really metabolically healthier than their Western counterparts, although they (the Asians) look thinner.
Good point, I fully agree. It’s been a death of a thousand cuts as Biz creates through trial and error concoctions that get and keep us addicted. Further, even though there were candy bars and potato chips in the 1930s, it takes gradual cultural change across generations for people to make such foods a habit.
Right on. You speak very rationally here, but I don’t see this message getting out: “At least try to do this much…” As I said, nutritional advice tends to be very idealistic and simplistic.
So pick a few of those with increasing smoking rates: thinner over time? No. Saudia Arabia, for example, dramatically more smoking and an obesity epidemic in progress. Canada decreased smoking rates with obesity rates staying pretty flat while Mexico deceased and went up. No real relationship between country trends in smoking rates and trends in obesity rates.
Well that’s what sells. And people love to witness.
If you put food in front of a dog or cat 24 hours a day, there is a good chance it will become obese.
What I’m getting at… food is very cheap (as a percentage of income) and very available. For many it is essentially free. Ergo, people will eat more of it. Why? I don’t know. Why will a dog or cat eat more food if you give it more food?
The only way to decrease the percentage of people who are fat & obese is to make food much more expensive and more scarce. And that’s not going to happen…
My personal theory (subject to change with new information, not scientifically rigorous) is that the following factors are at work:
**1) Greater availability of food. ** In the industrialized world food has gotten cheap and crops failures no longer mean famine, you just import the stuff from somewhere that had a successful crop that year. Even the poor have easy access to sufficient (and more) calories. When my mother was growing up in a poverty-stricken family they sometimes were down to 1 small meal a day, and that a scanty one because they simply had no money for more food so everyone in the family was skinny. Used to be the stereotype of the poor was of rail-thin people. These days, the poor are just as fat, if not more so, as the rest of the population.
2) Sugar in goddamned everything! Due to food allergies most of the food I eat I make myself from scratch and I seldom add sugar. As a result, processed/prepared food often tastes sickly sweet to me but it’s “normal” to the majority because that’s what they’re used to. The added sugar is just added calories, completely unnecessary from a nutritional standpoint. It’s not the entire story, but add in a half dozen or more unnecessary spoonfuls of sugar (or the equivalent) per day and it certainly does contribute to the problem. This is also linked to “low fat” foods, which often compensated for the altered taste of foods with lowered fat content by adding in sugar, often resulting in the same amount of calories and sometimes more.
3) Convenience food. This has exploded in recent generations, food that is easy to get, easy to fix, easy to eat. Used to be that if you wanted a snack you either had to actually make it, or you grabbed something ready to eat like an apple or carrot. Not always - you could also grab a hunk of sausage or cheese, but you didn’t have this huge range of things like bags of chips/crisps, fried stuff, microwavable mini-meals, and so forth that are either ready to eat or you can nuke and have ready in literal minutes. It’s a lot easier to snack if you don’t have to make the food up first.
4) Less physical activity. Used to be everyone did more physical work. Before the era of kitchen gadgets, elevators/escalators everywhere, and the ubiquity of cars even wealthy city-dwellers got more on-going exercise simply by using the stairs and doing more walking. Sure, you can go to the gym, but how many people walk there instead of taking their cars? Maybe low-level but near constant physical effort is more beneficial than a one-hour burst of frantic exercise at the gym followed by a return to the life of a barnacle.
**5) Better health. ** This is counter-intuitive, but think about it. People used to get ill more often, stay ill longer, and suffered from serious diseases we now vaccinate against (well, the saner of us do) or avoid by public health measures. Being seriously ill can take weight off you, and it may be humans evolved the “spare tire” tendency as a guard against falling seriously ill for a few weeks. Now that we don’t get sick like that nearly as often as in the past the weight stays with us for life instead of being periodically used during illness.
Is smoking a factor? Probably a very minor one, as there have been plenty of overweight/obese smokers over the years.
I really hate BMI as a measure of obesity. It’s basically a height/weight chart by another name and terribly overused.
It breaks down with athletes where the “extra” weight is muscle and not unhealthy (up to a point - there is a number where it’s impossible to be healthy but it’s pretty high up there) and is masks problem where people are “normal” BMI but have high percentages of bodyfat. It makes no allowance for differences in robust vs. gracile builds - some people really do have a heavier or lighter bone structure than average. Someone with a lighter frame can be “normal” weight but also fat - skinny-fat, as noted - where someone with a heavier frame with the same body-fat percentage might show up more clearly as overweight. Likewise, someone with a heavier frame who is more muscular than average is more likely to wind up in the “overweight” category even with a lower body-fat percentage.
Hate to to be repetitive, but what you mention is why BMI is a poor measure for individuals as a measure of unhealthy overweight (or at least overfat). It is a fairly good tool for populations as wholes, and for obesity. It is not “impossible” to have a BMI that is solidly in the “obese” range and have it be because of muscle, but is extremely uncommon and fairly obvious when you meet them … yes serious weight training athletes and actually fairly few of them who do not also have excess fat. If you are “The Rock” you and everyone else knows it; that much muscle mass is a very uncommon cause for a BMI of over 30. Tracking say the population of American non-Hispanic Whites, or Chinese, etc. with BMI numbers trending over time functions on the assumption that it averages out the noise of those exceptional cases. One has to speculate, as our op did, that the populations have become more muscular on average in order to explain increasing “overweight” or “obesity” over time.
Oh, I get that it’s a useful statistical tool for entire populations.
The problem is that in practice it’s being applied to individuals. My health insurance company is constantly sending propaganda to members extolling the virtues of achieving a “normal weight BMI” whether or not that should be applied to the individual in question.
I don’t object to it as a screening tool - it’s a very rough measure. But if someone falls outside the norm you should still look at the person as a whole rather than dictating “lose 10 pounds immediately!” and even if they fall into the “normal” category they still need to be checked for indications that even if their weight is “healthy” their bodyfat or some other indicator points to a problem.
The other point that DSeid made is that at extremes, like obesity/BMI over 30, those unusual outliers become quite rare. There are lots of athletic individuals falsely accused of being overweight because of BMI, but there’s very few who fall into the obese or greater categories and don’t have a serious problem with body fat.
Yeah, sure, I’ve even mentioned that myself, but I’m not talking about a BMI of 40, I’m talking about people who are 26 or 27 being automatically told to lose weight based solely on that number when in reality there are probably quite a few people at those numbers who aren’t overweight but actually fitter/more muscular than average.
Given that the insurance that my employer offers uses financial incentives based solely on those numbers I’m not convinced that’s truly a good use of the BMI system.
Likewise, people who are at a BMI of 16-17-18 shouldn’t be automatically told to gain weight, there are people who are naturally thinner than average, or who would not benefit from simply gaining fat rather than muscle.
But insurers always approach things from a statistical point of view. It’s what insurers do. I’d be more worried about an insurer that was trying to give me specific individual medical advice because that’s way overstepping what I want my insurer to do. If they’re just making general recommendations based on things they think are statistically likely to reduce they’re costs, I’d say they’re fulfilling their duty as an insurer.
For individual care, turn to your doctor. When I was in that 26-27 range my doctor said “Ok, your blood pressure and cholesterol look great. Try not to gain any more weight or we might have to look at making some lifestyle changes if those increase.”
Eh…my cats and my mom’s cats all have free access to dry food 24/7. None has become obese.
Or make it less acceptable to eat everywhere. There used to be rules about these things. You don’t eat in workplace meetings, you don’t eat while walking down the street. You don’t need three cookies, you take one, otherwise you’re a glutton.
Yes, giving specific medical advice is EXACTLY what I’m objecting to.
Some of the incentives I’ve seen over the years are things like a lower premium if a person loses 10 pounds, or giving monetary rewards for achieving goals set by the insurance company and not the doctor. This is clearly pressuring people to do things that may or may not be in their best interest without a doctor being involved.
Granted, the lawyers are usually on the spot about how these things are worded but they don’t always get to the text-writers in time. It’s no different than how my own insurance company every year mails “information” and calls me on the phone urging me over and over to get a flu shot despite the fact that the last flu shot I had provoked a serious allergic reaction. They have access to my medical records, so why is this done? It’s cookie-cutter medicine. If they were TRULY doing what they should as an insurer they should either STFU entirely or being calling me to remind me NOT to have a flu shot. Or better yet, be willing to cover my going to an allergist and possibly paying to cover a flu vaccination less likely to kill me.
Health insurance companies flirt with crossing that line all the time, and do slop over it on occasion.
Those flu shot campaigns are basically a marketing campaign to get people to lower the average cost insurer’s pay out by avoiding unnecessary trips to the doctor for flu symptoms. Do you really want your insurer building marketing campaigns based on information from your personal medical record? I do not.
And encouraging people with an overweight BMI to lose 10 pounds isn’t going to hurt anyone.
The real danger here is that anyone would think their health insurer is trying to give them useful personalized medical advice when they run some generic marketing campaign intended to reduce their costs. They’re not and you shouldn’t give it any weight. Just see your doctor if you want to know if you need to lose weight.
I’d rather they NOT be engaging in such marketing campaigns at all - leave that to health agencies, not private companies. Nor are these randomized or general mailings - they have my personal contact information, to start, and for the flu shot campaign they invariably start with “since you have been diagnosed with asthma…” meaning they are, indeed, basing it on my medical records. Therefore, they should also have access to the fact I am allergic to flu shots and the cost of even a single ER visit for allergic shock will far outweigh the average cost to my insurer for a bought of the flu.
If someone has an “overweight BMI” but is NOT actually overweight there is no benefit to telling them to lose weight because then they’d be most likely taking off lean muscle mass, which is usually not a good thing.
My doctor is quite fine with my weight, thank you very much. Please go back where I state that my insurer is, most definitely, trying to pressure me into something contra-indicated based solely on one item taken out of context. They really do this sort of thing, and they should not.
My health insurance company does this, too. Four years ago, they decided I had diabetes and flooded me with unsolicited information about diabetes plus I received a marketing call offering me a slot in their new diabetes management program. I’ve never had diabetes or even come close to it.
Even funnier, last year they started flooding me with unsolicited information about pregnancy and childbirth. I even received a box of samples of diapers and formula. They must believe I’m capable of miracles as I endured menopause about 4 years back.
Broomstick just then to make it clear … your problem is not with the BMI per se, but with how it is (mis)used.
Please do not take the following as a defense of what the insurance company does, but recognize that they are not looking at your individual chart or concerned at all with your individual well being. They are dealing with statistical populations. All policy holders whose BMI is > X, or all policy holders with claim of Y. Send … support service information, flu shot encouragement, whatever … to all with label A, or B, and hope that it results in either a) improved cost expenditures for the population overall, or b) the ability to report some improved number on an equally arbitrary population healthcare metric that can get advertised to the corporations that purchase the insurance products for their employees.
No they are not cross referencing to exclusionary diagnoses. Your individual health is not their target.
Financial incentives solely on BMI less than 26 or 27? That’s effed up.
