# How would YOU solve the obesity crisis? **URL:** \ **Category:** In My Humble Opinion\ **Created:** [April 28, 2015, 9:13pm UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746 "2015-04-28T21:13:54Z")\ **Posts on this page:** 11\ **Page:** 9
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 2, 2015, 9:06pm UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/161 "2015-05-02T21:06:26Z")
> [@iljitsch](#): > > It would help to be able to say with more certainty at which levels of overweightedness/obesity and unfitness people should be starting to worry about increased risks. … Not really, which is why I phrased how I did. The illnesses associated with obesity also occur in some at normal BMI ranges. Statistically, for populations, they increase significantly above 27 and rise more over 30 but the individuals within the groups (especially that 25 to 30 “overweight” one) are very heterogenous, varying in where they store the fat they have and how much muscle mass they have. Better to avoid the circumstance in the first place than to worry about being there. OTOH 1: identifying and modifying behaviors in individuals that predispose to the obesity related illness _at any weight_ - lack of fitness, poor nutrition choices with lots of low satiety and hyperpalatable choices in the personal environment, few vegetables and fruits - will help. OTOH 2: decreasing the degree to which our society’s structure is obesiogenic will help. **Wesley Clark** I know by now that you must know that I care less about sustained weight loss per se than the impact of sustained behaviors on the meaningful health outcomes. And indeed behavioral changes can improve obesity related health outcomes such as the rate of [diabetes](http://www.nejm.org/doi/full/10.1056/NEJM200105033441801#t=article) - modest weight loss achieved and maintained but dramatic decreases in the rate of progression from prediabetes to diabetes, even in those that did not lose weight but who maintained the behaviors. > [@](#): > > The average amount of weight lost was not large, yet the difference between the incidence of diabetes in the intervention group and that in the control group was substantial. The low odds ratio for diabetes among those who lost at least 5 percent of their initial weight reveals the importance of even a relatively small reduction in weight in the prevention of diabetes. > Our counseling regarding physical exercise included components designed to improve both cardiorespiratory fitness and muscle strength. Achieving a relatively conservative target of more than four hours of exercise per week was associated with a significant reduction in the risk of diabetes in the subjects who did not lose weight. … [Heart failure too](http://jama.jamanetwork.com/article.aspx?articleid=184310), another obesity related illness, is decreased the more of the listed healthy habits one kept, only one of which is normal body weight. > [@](#): > > Healthy lifestyle habits (normal body weight, not smoking, regular exercise, moderate alcohol intake, consumption of breakfast cereals, and consumption of fruits and vegetables) were individually and jointly associated with a lower lifetime risk of heart failure, with the highest risk in men adhering to none of the 6 lifestyle factors (21.2%; 95% CI, 16.8%-25.6%) and the lowest risk in men adhering to 4 or more desirable factors (10.1%; 95% CI, 7.9%-12.3%). Yes the behaviors can impact weight some, but the behaviors are not so much the means to losing and maintaining weight loss as they are the means of achieving and maintaining good health _themselves_. At any weight. ---
**Author:** ![iljitsch](https://avatars.discourse-cdn.com/v4/letter/i/77aa72/32.png) [@iljitsch](https://boards.straightdope.com/u/iljitsch)\ **Post date:** [May 2, 2015, 9:17pm UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/162 "2015-05-02T21:17:14Z")
> [@DSeid](#): > > varying in where they store the fat they have The good news is that the dangerous visceral fat is the first to go. Which means that if your weight (well, amount of fat) is on the way down, you’re probably largely in the clear, while if you’re on the way up, your risk of problems is much, much higher. Your absolute weight doesn’t matter too much as sub-dermal fat doesn’t cause much trouble, except perhaps strain on the joints if there’s a lot of it. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [May 3, 2015, 1:13am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/163 "2015-05-03T01:13:57Z")
> [@DSeid](#): > > **Wesley Clark** I know by now that you must know that I care less about sustained weight loss per se than the impact of sustained behaviors on the meaningful health outcomes. And indeed behavioral changes can improve obesity related health outcomes such as the rate of [diabetes](http://www.nejm.org/doi/full/10.1056/NEJM200105033441801#t=article) - modest weight loss achieved and maintained but dramatic decreases in the rate of progression from prediabetes to diabetes, even in those that did not lose weight but who maintained the behaviors. > [Heart failure too](http://jama.jamanetwork.com/article.aspx?articleid=184310), another obesity related illness, is decreased the more of the listed healthy habits one kept, only one of which is normal body weight.Yes the behaviors can impact weight some, but the behaviors are not so much the means to losing and maintaining weight loss as they are the means of achieving and maintaining good health _themselves_. At any weight. As the poets would say ‘I know that you know that I know that you know’ and so on and so on. However as far as losing weight, for people with issues like arthritis, joint pain, sleep apnea or pinched nerves actually losing mass and pounds is a desired goal (not just losing 5% of bodyweight). Right now medicine doesn’t have much to offer them other than surgery. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 3, 2015, 1:58am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/164 "2015-05-03T01:58:56Z")
> [@iljitsch](#): > > The good news is that the dangerous visceral fat is the first to go. Which means that if your weight (well, amount of fat) is on the way down, you’re probably largely in the clear, while if you’re on the way up, your risk of problems is much, much higher. Your absolute weight doesn’t matter too much as sub-dermal fat doesn’t cause much trouble, except perhaps strain on the joints if there’s a lot of it. A very good point well made. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 3, 2015, 2:29am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/165 "2015-05-03T02:29:52Z")
> [@Wesley\_Clark](#): > > As the poets would say ‘I know that you know that I know that you know’ and so on and so on. > > However as far as losing weight, for people with issues like arthritis, joint pain, sleep apnea or pinched nerves actually losing mass and pounds is a desired goal (not just losing 5% of bodyweight). Right now medicine doesn’t have much to offer them other than surgery. Well let’s take those one at a time, and do some literature searching … [Arthritis?](http://onlinelibrary.wiley.com/doi/10.1002/art.20256/full) Seems like 5% loss (but still obese at the end) by a combination of diet and exercise (but not diet alone) significantly improves a variety of functional and pain measures. [Sleep apnea?](http://www.atsjournals.org/doi/full/10.1164/rccm.200805-669OC#.VUWB8NNVhBc) Significant improvement with an average of 10% body weight lost but still on average a BMI of about 30 … also an achievable goal to maintain with improved nutrition and exercise. Pinched nerves? No idea. But overall documented evidence that fairly modest loss (5 to 10%) maintained with a good nutrition and exercise, can do more for even those conditions than you may think. Losing massive amounts is not required. No question though that establishing the habits and avoiding the obesity before it causes a health problem or even raises the risk of one is preferable and, with some attention to systems issues, achievable. BTW while looking those up came upon [this](http://jap.physiology.org/content/112/9/1612) which is pretty dang cool. > [@](#): > > Aerobic exercise reduces neuronal responses in food reward brain regions Agreed though that short of bariatric surgery there is little that will consistently achieve and maintain the 20% plus (sometime plus quite a bit) weight loss needed to become no longer obese, let alone “normal weight.” ---
**Author:** ![Unauthorized\_Cinnamon](https://avatars.discourse-cdn.com/v4/letter/u/bc8723/32.png) [@Unauthorized\_Cinnamon](https://boards.straightdope.com/u/Unauthorized_Cinnamon)\ **Post date:** [May 3, 2015, 2:45am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/166 "2015-05-03T02:45:51Z")
Is there any quality research out there on the effects of weight loss surgery beyond the first year or two post-surgery? Given the ever-increasing evidence that specific behaviors improve health regardless of weight, I’d need an awful lot of evidence that WLS works long-term to improve health outcomes overall before considering it - it sounds quite terrifying honestly. ---
**Author:** ![the\_diego](https://avatars.discourse-cdn.com/v4/letter/t/7bcc69/32.png) [@the\_diego](https://boards.straightdope.com/u/the_diego)\ **Post date:** [May 3, 2015, 3:00am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/167 "2015-05-03T03:00:03Z")
Deplete your guano reserves. Ooops sorry, that’s Nauru. ---
**Author:** ![Wesley\_Clark](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/wesley_clark/32/20581_2.png) [@Wesley\_Clark](https://boards.straightdope.com/u/Wesley_Clark)\ **Post date:** [May 3, 2015, 3:10am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/168 "2015-05-03T03:10:46Z")
> [@DSeid](#): > > Well let’s take those one at a time, and do some literature searching … > > [Arthritis?](http://onlinelibrary.wiley.com/doi/10.1002/art.20256/full) Seems like 5% loss (but still obese at the end) by a combination of diet and exercise (but not diet alone) significantly improves a variety of functional and pain measures. > > [Sleep apnea?](http://www.atsjournals.org/doi/full/10.1164/rccm.200805-669OC#.VUWB8NNVhBc) Significant improvement with an average of 10% body weight lost but still on average a BMI of about 30 … also an achievable goal to maintain with improved nutrition and exercise. > > Pinched nerves? No idea. > > But overall documented evidence that fairly modest loss (5 to 10%) maintained with a good nutrition and exercise, can do more for even those conditions than you may think. Losing massive amounts is not required. > > No question though that establishing the habits and avoiding the obesity before it causes a health problem or even raises the risk of one is preferable and, with some attention to systems issues, achievable. > > BTW while looking those up came upon [this](http://jap.physiology.org/content/112/9/1612) which is pretty dang cool. > > Agreed though that short of bariatric surgery there is little that will consistently achieve and maintain the 20% plus (sometime plus quite a bit) weight loss needed to become no longer obese, let alone “normal weight.” Thanks, those were interesting bits of info. ---
**Author:** ![DSeid](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/dseid/32/20194_2.png) [@DSeid](https://boards.straightdope.com/u/DSeid)\ **Post date:** [May 3, 2015, 3:28am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/169 "2015-05-03T03:28:28Z")
> [@Unauthorized\_Cinnamon](#): > > Is there any quality research out there on the effects of weight loss surgery beyond the first year or two post-surgery? > > Given the ever-increasing evidence that specific behaviors improve health regardless of weight, I’d need an awful lot of evidence that WLS works long-term to improve health outcomes overall before considering it - it sounds quite terrifying honestly. [Some](http://www.ncbi.nlm.nih.gov/pubmed/23235396://) [long term](http://www.jcomjournal.com/outcomes-research-in-reviewlong-term-outcomes-of-bariatric-surgery-in-obese-adults/) follow-up studies. > [@](#): > > There was 47.1% of excess weight loss (% EWL) at 15 years [n = 54; 95% confidence interval (CI) = 8.3] and 62% EWL at 16 years (n = 14; 95% CI = 13.6). There was a mean of 47.0% EWL (n = 714; 95% CI = 1.3) for all patients who were at or beyond 10 years follow-up. > [@](#): > > Main results. Participants were between the ages of 18 and 78 years. The majority of participants were female (79%) and white (86%). Median BMI was 45.9 (interquartile range [IQR], 41.7–51.5). At baseline, 774 (33%) had diabetes, 1252 (63%) had dyslipidemia, and 1601 (68%) had hypertension. Three years after surgery, the LAGB group exhibited greater weight loss (median 41 kg vs. 20 kg). Participants experienced most of their total weight loss during the first year following surgery. As for the health parameters assessed, at 3 years 67.5% of RYGB patients and 28.6% of LAGB patients had at least partial diabetes remission, 61.9% of RYGB patients and 27.1% of LAGB patients had dyslipidemia remission, and 38.2% of RYGB patients and 17.4 % of LAGB patients had hypertension remission. > > Conclusion. Three years following bariatric surgery, participants with severe obesity exhibited significant weight loss. There was variability in the amount of weight loss and in resolution of diabetes, hypertension and dyslipidemia observed. [OTOH](http://www.medscape.com/viewarticle/779675) (albeit a debated result): > [@](#): > > Bariatric surgery does not reduce overall long-term health costs for obese individuals, a 6-year analysis of private health insurance data has found. … ---
**Author:** ![Urbanredneck](https://avatars.discourse-cdn.com/v4/letter/u/ea5d25/32.png) [@Urbanredneck](https://boards.straightdope.com/u/Urbanredneck)\ **Post date:** [May 4, 2015, 4:43am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/170 "2015-05-04T04:43:29Z")
> [@grude](#): > > The early posts in this thread, and some later ones are terrifying. The authoritarianism on display would make Stalin blush. > > Obesity is not something you solve through force of law, if someone against all rational advice wants to be obese that is their family and friends place to talk sense into them. Yeah, I kind of been wondering - what ever happened to the old feminist line “Keep Your Hands Off My Body!”? I mean if a person wants choice in their sexual lives, why cant they have it in their food choices? ---
**Author:** ![Rhiannon8404](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/rhiannon8404/32/17929_2.png) [@Rhiannon8404](https://boards.straightdope.com/u/Rhiannon8404)\ **Post date:** [May 4, 2015, 4:59am UTC](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746/171 "2015-05-04T04:59:06Z")
> [@Bill\_Door](#): > > Have you even met a two year old? An hour car ride with one would be enlightening. I have a son. I did not constantly feed him snacks in the car. He played with toys or a book. I talked to him or we sang songs. He did not constantly eat or have a sippy cup with him. Food is not entertainment. [Previous page](https://boards.straightdope.com/t/how-would-you-solve-the-obesity-crisis/718746.md?page=8)