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This is probably as good of a space as any, what do you guys see as politically feasible solutions to our obesity problem? Politically feasible would probably e

This is probably as good of a space as any, what do you guys see as politically feasible solutions to our obesity problem? Politically feasible would probably entail not angering food lobbies. Or is taxing corn/soda/meat really the only way?

overcast 9y ago
Fat tax, just like Japan. You want to be a fat ass, and drain resources, then you pay for it. Just like car insurance. You want to drive dangerous sports cars, then you pay a higher price to cover liability.
- frankc 9y ago
  Well, I don't think that is going to "solve" the underlying problem. It might help the government pay for things, but it's not going to solve the obesity epidemic. There are already huge intrinsic and extrinsic negative impacts to your life if you are obese. One more negative impact is not likely to suddenly make you thin. What we need to do is figure out why people are getting fatter despite how much they don't want to be fat.
  - NikolaeVarius 9y ago
    Sedentary lifestyle, cheap food (and not just junk food, calories in general are insanely cheap), eating too much of said cheap food.
    - frankc 9y ago
      Those are hypothetical causes but they don't actually line up with all the observations. For instances, poor people are fatter than rich people. Shouldn't rich people be fatter since they 1) don't have to work as much manual labor 2) have more access to food. You can try complicate the explanations to account for this but the fact is that it shows that the 'obvious' reasons most people surmise are not so clear cut and need to be tested like any hypothesis. It's a hard problem to test and there are several other competing hypothesis. The best I can say for my own beliefs is that we need to have more studies that need to be done before I'm convinced of any of them.
      - linkregister 9y ago
        I suspect there is no one-size-fits-all solution for obesity: some people experienced sustained weight loss only after undertaking a vegetarian diet, some only by a ketogenic diet, some only by getting into sustained exercise, and some only by a laproscopic band. For some people, obesity isn't even associated with poor health.
      - antisthenes 9y ago
        What? It makes perfect sense. I explain this here: https://news.ycombinator.com/item?id=14353914 https://news.ycombinator.com/item?id=14353914 It's cheaper to not exercise.
        overcast 9y ago
        Sorry, but exercise doesn't require a gym membership, that's just nonsense. Look at the guys in prison. Go run around your block, do pushups, and pull-ups in your house. I've never spent a dime in a gym, and I exercise five days a week. Also exercise is not for weight loss, it's for exercise.
      - overcast 9y ago
        There have been poor people throughout the history of time, why is it that obesity rates have been going up? Shouldn't they stay the same, or decrease, as more people move away from the have not, to the have something? Spent a month in India, tons of poor people, very few fat ones. The majority of overweight people were the affluent, that just didn't care, because they were well fed, and had essentially slaves working for them to do all of the hard physical work.
    - humanrebar 9y ago
      I'm not sure this sort of calculus is helpful: Eat less and exercise more, duh! Also works for saving: earn more and spend less, duh! Making friends: be nice more and mean less, duh! Stress: sleep and relax more and worry less, duh! Marriage: communicate and date more and fight less, duh! Fat people want to be thinner. There are plenty of negative incentives to being fat. There's something subtler and more complex going on here.
    - VLM 9y ago
      Hyper levels of advertising with the primary messages being lack of self discipline is the definition of having fun, and sensible time preference judgment, or application of any judgment at all, is for boring low social status people because cool people live for this instant only and never judge anything ever. Not too surprising that being immune or actively avoiding that toxic culture, results in both wealth and fitness. Advertising Kills.
  - overcast 9y ago
    You're right, having them pay more, isn't going to make them thin. People are going to do what they want regardless, just like smokers. People will smoke, while they are hooked up to oxygen keeping them alive. However, the cost of that shouldn't be redirected to people who have made an effort to live healthy their entire lives.
- samirillian 9y ago
  Cold blooded! I don't know if it's more or less efficacious/probable than dinging the corporations, but it certainly seems less moral.
- positr0n 9y ago
  The problem with that logic is that people with unhealthy behavior actually cost the system less. It's way cheaper to be relatively sickly for a few decades then die of lung cancer or heart disease at 50 than be relatively healthy and die of cancer or alzheimer's at 90. Not saying something like that might not be a good idea from a public health perspective. I'm not educated enough on those issues to have an opinion.
  - antisthenes 9y ago
    > I'm not educated enough on those issues to have an opinion. Yet here you are, posting things like this: > The problem with that logic is that people with unhealthy behavior actually cost the system less. Without any data.
    - positr0n 9y ago
      > Yet here you are, posting things like this I posted what I am educated about, and did not post an opinion about what I am not educated about. > Without any data. Apologies. I posted a nytimes story that links to a study in another comment in this thread: https://news.ycombinator.com/item?id=14353347 https://news.ycombinator.com/item?id=14353347
  - legulere 9y ago
    I have seen studies go in both ways, depending on which costs they include or not
  - overcast 9y ago
    Cancer, and Alzheimer's are generally not preventable. Being fat is. If you want to compare fat people dying of heart disease, and smokers dying of emphysema, fine. But don't compare an avoidable problem, with an unavoidable one.
    - positr0n 9y ago
      Why not? We're talking about average lifetime medical costs, so who cares if one is preventable and one isn't? From a public health perspective yes that absolutely matters, but all I'm saying is this narrow claim: You will not save money on medical costs if you get your population to act healthier and they die of unpreventable diseases instead of preventable ones.
- logfromblammo 9y ago
  If you want to be fat, please raise your hand. Those who think being fat is fun or desirable, hands up. Nobody? Really? What you're proposing is to pile additional hardship on people who are likely already unhappy with their current situation, and may also feel powerless to fix that part of their lives. On its face, your proposal lacks both compassion and efficacy. It's also horribly authoritarian, and would likely discourage people from seeking preventative health care, just because the nurses weigh you at your office visit. Think about the potential unintended consequences before firing off a glib, "fix it with market incentives" proposal, paired with reasoning by [car] analogy.
mindyourbetters 9y ago
it's interesting that you considering telling people how to live "for their own good" to be politically feasible. Authoritarians abound!
- jfaucett 9y ago
  When you have a national health care system its no longer the case that each person's health decisions only affect themselves. A person who eats healthy, exercises and takes care of themself ends up paying for those who don't.
  - positr0n 9y ago
    That isn't true: On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people. Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on. The cost of care for obese people was $371,000, and for smokers, about $326,000. http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html http://www.nytimes.com/2008/02/05/health/05iht-obese.1.97488... (numbers from 2008)
    - jfaucett 9y ago
      Interesting. I went and read the study which does support what the NYT is saying more or less [1]. The main factor as to why this is the case is important though. The longer you live the more costs you incur on the system because you end up getting another sickness which costs a lot more to treat, they specifically quote Alzheimers, than obesity and lung cancer. One thing they did not take into account though is the lack of productivity i.e. the costs of being disabled (possibly b/c it is a dutch study using dutch data and parameters), in the USA diabetes is a disability and incurs significant other costs on the system which were not taken into account. It would be interesting to see what the comparisons would look like once that is taken into account. But its certainly the case that smoking is much cheaper overall. It doesn't lead to disabilities and people die younger and incur far less costs. [1] http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050029 http://journals.plos.org/plosmedicine/article?id=10.1371/jou...
robertcorey 9y ago
We could just stop our _massive_ subsidies for these industries instead of taxing them.
- utternerd 9y ago
  Came here to say the same thing, it's absolutely INSANE how much we subsidize, for example, corn. So it's no wonder there's plentiful cheap corn being stuffed into processed foods (incidentally also increasing the amount of processed food) and overwhelmingly what our cattle are fed with.
RangerScience 9y ago
Popularization of walking...? The only thing (about which I know little) that comes to mind the... Nancy Reagan (?) anti-littering campaigns. But the right fix is definitely the food situation. Everybody already eats.
jay-anderson 9y ago
The most politically feasible solutions to help I can think of are education and better school lunch policies. I'd think the food lobbies would love if we provided free lunch to our students (other political factions maybe not so much). We'd of course need stricter guidelines to ensure the meals are healthy. Another issue is it's expensive to eat healthier foods. Addressing income inequality feels like one aspect that could help as well. It's much harder to come up with a good, politically feasible solution to that.
- nradov 9y ago
  Expanding free school breakfasts as well would really help some students whose parents tend to give them sugar cereals and too much fruit juice.
  - douche 9y ago
    Have you seen what is in the school breakfasts and lunches that are provided to students now? It's sugar cereal, donuts, pastries, and fruit juice. The only thing nutritious is the carton of milk, and three-quarters of them opt for the chocolate milk. Still, as bad as it is, it's better than nothing - I grew up in a pretty depressed, white-trash area where better than 50% of kids were on free-and-reduced lunch subsidies, and for not a few, breakfast and lunch at school might be the only meals they got some days. But for god's sake, we can do much better than we're doing, and it shouldn't cost any more than the sugar-blasted packaged garbage we're shoveling at kids today. Make a big batch of scrambled eggs, give them a piece of toast with peanut butter (although I supposed peanut allergies have ruined that), oatmeal, something with a little protein or complex carbohydrates in it, a piece of fruit. It's not rocket science.
jfaucett 9y ago
Well, we know the following: If people lived active lives and didn't eat too much we wouldn't have this problem. So I guess those are the only two vectors you can attack it on. As far as eating goes, you can't really dictate quantity but I think one thing you can do is subsidize healthy foods and make them cheap and affordable so everyone can have access to them. I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive. As far as physical activity is concerned, we've had unhealthy foods for a long time and people have eaten unhealthily since the 50s. Look at this chart: http://wellandtrue.com/the-world-has-changed-so-have-our-waistlines/ http://wellandtrue.com/the-world-has-changed-so-have-our-wai... and you'll see that we only start getting a big spike after the 1980s when everyone basically started moving to fulltime desk jobs in front of a PC all day. So I think some kind of nationally mandated PE routine kids had to do M-F would be a start even though it'd probably never get support.
- Denzel 9y ago
  > I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive I feel that's a common misconception. Sure, you can't buy fresh, organic foods but I'm able to build muscle on about ~$10/day and stay healthy as a horse. Frozen peas (most frozen veggies) are $1 for 4 servings; canned black beans and chickpeas are $0.89 for 4 servings; whole-wheat bread is $3-4 for 18 pieces; 1 gallon of water is $0.89 (if you faucet water isn't drinkable); etc. You certainly can eat healthy on the cheap. It's just that most people don't want to make the sacrifice.
  - cadlin 9y ago
    $10 a day is $300 a month, which is a lot to someone near the poverty line (~$1000 a month). The maximum SNAP (food stamps) benefits for an individual is $194. I know SNAP is supposed to be supplemental, etc., but the government has decided someone who is very poor shouldn't have access to the level of nutrition you're talking about. You can eat on $200 a month without much problem. I received max SNAP benefits for several months and I spent about $120 a month on food, so I had money left over at the end (being a vegetarian helps). This really isn't relevant to the point at hand (or maybe it is, who knows?) but I think poor people would have an easier time if the means testing for food stamps were looser. The benefits fall off steeply. If someone is making a thousand dollars a months and working full-time or close to it, the government can chip in more than $10-20 to give them access to healthier food.
Consultant32452 9y ago
You don't have to tax corn. Removing subsidies would be more than enough. Oh, and the government should STFU about what it thinks is healthy. The last time it tried to interfere with the market it told generations of kids to eat a pound of bread every day. Don't tax anything you think is "bad" and don't subsidize what you think is "good." If you absolutely must do something bring home-ec back to public schools. Teach kids how to cook. Then let them figure out on their own what they want to eat.
- wahern 9y ago
  > The last time it tried to interfere with the market OTOH, the first few times it interfered with the market they solved widespread nutritional deficiencies that were killing, crippling, and otherwise substantially harming hundreds of thousands of people every year. I'm speaking of the fortification programs: https://www.nal.usda.gov/sites/default/files/fnic_uploads//45-55.pdf On balance I'd prefer they keep at it. Anyhow, the government was simply echoing the advice of the medical establishment. At worse they've merely been a few years behind those recommendation, which is nothing on the scale of a lifetime. If you have a beef, it's with he medical and nutritional sciences, which invested too much confidence in what should have been recognized as problematic research results.
  - Consultant32452 9y ago
    >Anyhow, the government was simply echoing the advice of the medical establishment. No it absolutely wasn't. It was echoing the advice of the agriculture lobby. The medical establishment sent its information in and the FDA altered it. And guess what? The food guidelines from this year were manipulated by the agriculture lobby too. http://time.com/4130043/lobbying-politics-dietary-guidelines/ http://time.com/4130043/lobbying-politics-dietary-guidelines... I only skimmed your article, but it appears those instances were almost entirely labeling guidelines. Example: What constitutes "enriched" flour? I can see the value in that, but I hope it's clear that's very different from marketing enriched flour via the government provided education system.
    - 9y ago
afarrell 9y ago
Given that large numbers of obese people don't actually know a way to sustainably and healthily lose weight, focusing on figuring that out would be a good idea. Note that if the solution is "develop the habit of X", we'd also need to figure out how to actually develop that habit alongside raising kids, holding a job, and not alienating your spouse by hangrily shouting at them. (I include myself in the set of people who don't know the solution, though I've never had this problem. My very naive intuition is that http://slatestarcodex.com/2017/04/25/book-review-the-hungry-brain/ http://slatestarcodex.com/2017/04/25/book-review-the-hungry-... is a... reasonable jumping-off point?)
dmurray 9y ago
Why does shaming people not work? If we learnt there had been a secret government policy to reduce obesity by subtly promoting thin musicians and actors at the expense of their fatter competitors, and saw how successfully they promoted this idea of a healthy weight - we'd be in awe of this feat of propaganda/marketing/behavioural economics. That part has been done really well: in the West, fat people aren't beautiful and, with exceptions, successful people are not fat. Gym memberships are at a high. The amount of time and money people invest purely in their fitness is at a high. Yet so is obesity. The behavioural forces making people fat are stronger even than the social, sexual and economic pressures driving people to be thin.
- s_ngularity 9y ago
  The problem is fitness alone is not a cure for obesity. I think diet is the biggest factor in American obesity, even though lack of exercise is obviously a big problem as well. Portion sizes are inflated compared to other countries, soda is cheaper than water in some places, and high sodium and high fat foods are consumed daily by many people. Not to mention high-calorie "coffee" from places like Starbucks.
  - darpa_escapee 9y ago
    People are down voting you but the cold hard truth is you can maintain a healthy weight by diet alone. No amount of excerise is going to offset eating a whole pizza and cheeseburgers everyday unless you're training at Olympic athlete levels. You aren't going to put on weight or maintain an unhealthy weight if you aren't eating excess calories.
  - nugget 9y ago
    I'm shocked whenever I find myself in a Starbucks early in the morning - it's essentially a constant line of folks ordering milkshakes for breakfast.
bitwize 9y ago
Public-service advertising campaigns similar to those used for cigarettes. If we can convince the public that sugary/processed foods are icky, deadly, and pushed on an unsuspecting public by Big Evil Corporations, we might have a chance.
- humanrebar 9y ago
  I'm not sure the propaganda did as much as the heavy tobacco taxes and having friends and relatives who died early and painfully from disease.
nradov 9y ago
The Affordable Care Act (ACA / "Obamacare") allows medical insurers to give premium discounts to members who keep their BMI at a health level. We could expand on that. Some people do respond to financial incentives.
- zeroer 9y ago
  BMI is a terrible metric for weightlifters.
  - nradov 9y ago
    That is a tiny fraction of the population, essentially irrelevant from a public health policy standpoint.
    - zeroer 9y ago
      It's relevant to me.
      - gm-conspiracy 9y ago
        I found the anecdote.
    - douche 9y ago
      It's really not. BMI is wildly outdated, and especially doesn't deal well with anybody who has a larger body frame. At the thinnest I've ever been in my life, when you could see every rib hanging out, I was still forty pounds heavier than what BMI charts calculated my weight ought to be.
      - nradov 9y ago
        That is false. BMI has been shown to be highly correlated with body fat, and remains the only practical method for large scale screening. https://www.theguardian.com/society/2017/may/17/obesity-health-no-such-thing-as-fat-but-fit-major-study https://www.theguardian.com/society/2017/may/17/obesity-heal...
ams6110 9y ago
Probably I'd argue that "politics" should GTFO. The USDA caused the obesity epidemic with their low-fat, high-starch food pyramid. Let people eat what they want to eat. Quit trying to micromanage other people's lives.
- humanrebar 9y ago
  I'm also wondering why people have the impulse to solve other people's problems whether they asked for help or not (compare this map with a Trump voter map and see how much they tend to like things like the ACA).
antisthenes 9y ago
Obesity/lack of exercise problem is still a poverty problem. Exercise is costly in time, and, therefore, money. As a sort of self-performed experiment, I've exercised regularly for the last 2 years, on average of 3.5 times a week (every other day). This required 1.25 hrs for the workout itself, another .25 hrs for the added commute, $60 for the gym membership per month, an increase in calorie consumption to compensate of about 30%, hence additional food costs of around $100/month. That's a total of 273 hours in a year in opportunity cost and $1920 in various expenses. Assuming a semi-skilled wage of $15/hr, that's $4095 + $1920 ~ $6000 opportunity cost per year to exercise and stay healthy. $6000 is a make or break amount of money for poor people. I can afford it relatively easily, considering how much health benefits I receive from it, but living paycheck to paycheck, most of them likely can't.
- humanrebar 9y ago
  ...you can also factor in the time value of money since the goal, at least in this conversation, is to increase lifespan and health decades in the future.
  - VLM 9y ago
    And in a hyper-youth centered culture, "I'll have a lot of fun when I'm 25" counts for a lot more than "I'll be dead at 75" Assuming exercise isn't fun. Physical therapy is supposed to be a brutally painful and exhausting way to repair damage that you'll feel better about in the distant future. Exercise should be fun. If you're not having fun, with fun people, you're probably doing it wrong.
    - antisthenes 9y ago
      Fun was not accounted for because of different preference curves for different people. There are people who genuinely don't enjoy exercise, despite no indication that they would somehow not benefit from the effects.
- johnbrodie 9y ago
  Your example is just one way of exercising, though. There's no getting around it requiring some time, but you can likely do a decent bodyweight-style workout without a gym membership, without a commute, using only implements you can find in your community. Some space to jog, do pushups, something you can hang from to do pullups, etc. People have been training themselves to have fairly large amounts of muscle and endurance in jail, in 3rd world countries, and plenty of other places besides expensive gyms.
jjt-yn_t 9y ago
[ why is >> was this text in a SCROLL RIGHT to read ?? ... and then not? ]] What is it tied to? Fun anecdote. Waiting for an x-ray, after strenuous exercise fall, having walked to the medical office, co-workers broke ice with each other by congratulating each other on having eaten large meals I long ago swore off of, or having supplemented such with 'desserts' in the olden days, now new normal, that are seemingly a perk of having gone outside from the office. Persons not unhealthy at that age, but as salaried and the more intelligent sector of American society, the grim role modelling I envisage at/in their household making ostensibly an outlier of olden day fast-til-we-can-eat-thank-god thinnesses now regaled as outliers, even chastised as unforgiving, a not easily solved, if ever, politically at least, pattern of ever-larger waistlines and expenses to be borne by the 'olden days' non-soda non-dessert daily small sector of society that comprises now a small minority more rural and unrepresented in the new normal. Hope this does not sound harsh. [[ why is >> was it a SLIDER btw [ now is not ] ]]
jjt-yn_t 9y ago
What is it tied to? Fun anecdote. Waiting for an x-ray, after strenuous exercise fall, having walked to the medical office, co-workers broke ice with each other by congratulating each other on having eaten large meals I long ago swore off of, or having supplemented such with 'desserts' in the olden days, now new normal, that are seemingly a perk of having gone outside from the office. Persons not unhealthy at that age, but as salaried and the more intelligent sector of American society, the grim role modelling I envisage at/in their household making ostensibly an outlier of olden day fast-til-we-can-eat-thank-god thinnesses now regaled as outliers, even chastised as unforgiving, a not easily solved, if ever, politically at least, pattern of ever-larger waistlines and expenses to be borne by the 'olden days' non-soda non-dessert daily small sector of society that comprises now a small minority more rural and unrepresented in the new normal. Hope this does not sound harsh.

overcast 9y ago

Fat tax, just like Japan. You want to be a fat ass, and drain resources, then you pay for it. Just like car insurance. You want to drive dangerous sports cars, then you pay a higher price to cover liability.

frankc 9y ago
Well, I don't think that is going to "solve" the underlying problem. It might help the government pay for things, but it's not going to solve the obesity epidemic. There are already huge intrinsic and extrinsic negative impacts to your life if you are obese. One more negative impact is not likely to suddenly make you thin. What we need to do is figure out why people are getting fatter despite how much they don't want to be fat.
- NikolaeVarius 9y ago
  Sedentary lifestyle, cheap food (and not just junk food, calories in general are insanely cheap), eating too much of said cheap food.
  - frankc 9y ago
    Those are hypothetical causes but they don't actually line up with all the observations. For instances, poor people are fatter than rich people. Shouldn't rich people be fatter since they 1) don't have to work as much manual labor 2) have more access to food. You can try complicate the explanations to account for this but the fact is that it shows that the 'obvious' reasons most people surmise are not so clear cut and need to be tested like any hypothesis. It's a hard problem to test and there are several other competing hypothesis. The best I can say for my own beliefs is that we need to have more studies that need to be done before I'm convinced of any of them.
    - linkregister 9y ago
      I suspect there is no one-size-fits-all solution for obesity: some people experienced sustained weight loss only after undertaking a vegetarian diet, some only by a ketogenic diet, some only by getting into sustained exercise, and some only by a laproscopic band. For some people, obesity isn't even associated with poor health.
    - antisthenes 9y ago
      What? It makes perfect sense. I explain this here: https://news.ycombinator.com/item?id=14353914 https://news.ycombinator.com/item?id=14353914 It's cheaper to not exercise.
      - overcast 9y ago
        Sorry, but exercise doesn't require a gym membership, that's just nonsense. Look at the guys in prison. Go run around your block, do pushups, and pull-ups in your house. I've never spent a dime in a gym, and I exercise five days a week. Also exercise is not for weight loss, it's for exercise.
    - overcast 9y ago
      There have been poor people throughout the history of time, why is it that obesity rates have been going up? Shouldn't they stay the same, or decrease, as more people move away from the have not, to the have something? Spent a month in India, tons of poor people, very few fat ones. The majority of overweight people were the affluent, that just didn't care, because they were well fed, and had essentially slaves working for them to do all of the hard physical work.
  - humanrebar 9y ago
    I'm not sure this sort of calculus is helpful: Eat less and exercise more, duh! Also works for saving: earn more and spend less, duh! Making friends: be nice more and mean less, duh! Stress: sleep and relax more and worry less, duh! Marriage: communicate and date more and fight less, duh! Fat people want to be thinner. There are plenty of negative incentives to being fat. There's something subtler and more complex going on here.
  - VLM 9y ago
    Hyper levels of advertising with the primary messages being lack of self discipline is the definition of having fun, and sensible time preference judgment, or application of any judgment at all, is for boring low social status people because cool people live for this instant only and never judge anything ever. Not too surprising that being immune or actively avoiding that toxic culture, results in both wealth and fitness. Advertising Kills.
- overcast 9y ago
  You're right, having them pay more, isn't going to make them thin. People are going to do what they want regardless, just like smokers. People will smoke, while they are hooked up to oxygen keeping them alive. However, the cost of that shouldn't be redirected to people who have made an effort to live healthy their entire lives.
samirillian 9y ago
Cold blooded! I don't know if it's more or less efficacious/probable than dinging the corporations, but it certainly seems less moral.
positr0n 9y ago
The problem with that logic is that people with unhealthy behavior actually cost the system less. It's way cheaper to be relatively sickly for a few decades then die of lung cancer or heart disease at 50 than be relatively healthy and die of cancer or alzheimer's at 90. Not saying something like that might not be a good idea from a public health perspective. I'm not educated enough on those issues to have an opinion.
- antisthenes 9y ago
  > I'm not educated enough on those issues to have an opinion. Yet here you are, posting things like this: > The problem with that logic is that people with unhealthy behavior actually cost the system less. Without any data.
  - positr0n 9y ago
    > Yet here you are, posting things like this I posted what I am educated about, and did not post an opinion about what I am not educated about. > Without any data. Apologies. I posted a nytimes story that links to a study in another comment in this thread: https://news.ycombinator.com/item?id=14353347 https://news.ycombinator.com/item?id=14353347
- legulere 9y ago
  I have seen studies go in both ways, depending on which costs they include or not
- overcast 9y ago
  Cancer, and Alzheimer's are generally not preventable. Being fat is. If you want to compare fat people dying of heart disease, and smokers dying of emphysema, fine. But don't compare an avoidable problem, with an unavoidable one.
  - positr0n 9y ago
    Why not? We're talking about average lifetime medical costs, so who cares if one is preventable and one isn't? From a public health perspective yes that absolutely matters, but all I'm saying is this narrow claim: You will not save money on medical costs if you get your population to act healthier and they die of unpreventable diseases instead of preventable ones.
logfromblammo 9y ago
If you want to be fat, please raise your hand. Those who think being fat is fun or desirable, hands up. Nobody? Really? What you're proposing is to pile additional hardship on people who are likely already unhappy with their current situation, and may also feel powerless to fix that part of their lives. On its face, your proposal lacks both compassion and efficacy. It's also horribly authoritarian, and would likely discourage people from seeking preventative health care, just because the nurses weigh you at your office visit. Think about the potential unintended consequences before firing off a glib, "fix it with market incentives" proposal, paired with reasoning by [car] analogy.

mindyourbetters 9y ago

it's interesting that you considering telling people how to live "for their own good" to be politically feasible. Authoritarians abound!

jfaucett 9y ago
When you have a national health care system its no longer the case that each person's health decisions only affect themselves. A person who eats healthy, exercises and takes care of themself ends up paying for those who don't.
- positr0n 9y ago
  That isn't true: On average, healthy people lived 84 years. Smokers lived about 77 years and obese people lived about 80 years. Smokers and obese people tended to have more heart disease than the healthy people. Cancer incidence, except for lung cancer, was the same in all three groups. Obese people had the most diabetes, and healthy people had the most strokes. Ultimately, the thin and healthy group cost the most, about $417,000, from age 20 on. The cost of care for obese people was $371,000, and for smokers, about $326,000. http://www.nytimes.com/2008/02/05/health/05iht-obese.1.9748884.html http://www.nytimes.com/2008/02/05/health/05iht-obese.1.97488... (numbers from 2008)
  - jfaucett 9y ago
    Interesting. I went and read the study which does support what the NYT is saying more or less [1]. The main factor as to why this is the case is important though. The longer you live the more costs you incur on the system because you end up getting another sickness which costs a lot more to treat, they specifically quote Alzheimers, than obesity and lung cancer. One thing they did not take into account though is the lack of productivity i.e. the costs of being disabled (possibly b/c it is a dutch study using dutch data and parameters), in the USA diabetes is a disability and incurs significant other costs on the system which were not taken into account. It would be interesting to see what the comparisons would look like once that is taken into account. But its certainly the case that smoking is much cheaper overall. It doesn't lead to disabilities and people die younger and incur far less costs. [1] http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0050029 http://journals.plos.org/plosmedicine/article?id=10.1371/jou...

robertcorey 9y ago

We could just stop our _massive_ subsidies for these industries instead of taxing them.

utternerd 9y ago
Came here to say the same thing, it's absolutely INSANE how much we subsidize, for example, corn. So it's no wonder there's plentiful cheap corn being stuffed into processed foods (incidentally also increasing the amount of processed food) and overwhelmingly what our cattle are fed with.

RangerScience 9y ago

Popularization of walking...? The only thing (about which I know little) that comes to mind the... Nancy Reagan (?) anti-littering campaigns. But the right fix is definitely the food situation. Everybody already eats.

jay-anderson 9y ago

The most politically feasible solutions to help I can think of are education and better school lunch policies. I'd think the food lobbies would love if we provided free lunch to our students (other political factions maybe not so much). We'd of course need stricter guidelines to ensure the meals are healthy. Another issue is it's expensive to eat healthier foods. Addressing income inequality feels like one aspect that could help as well. It's much harder to come up with a good, politically feasible solution to that.

nradov 9y ago
Expanding free school breakfasts as well would really help some students whose parents tend to give them sugar cereals and too much fruit juice.
- douche 9y ago
  Have you seen what is in the school breakfasts and lunches that are provided to students now? It's sugar cereal, donuts, pastries, and fruit juice. The only thing nutritious is the carton of milk, and three-quarters of them opt for the chocolate milk. Still, as bad as it is, it's better than nothing - I grew up in a pretty depressed, white-trash area where better than 50% of kids were on free-and-reduced lunch subsidies, and for not a few, breakfast and lunch at school might be the only meals they got some days. But for god's sake, we can do much better than we're doing, and it shouldn't cost any more than the sugar-blasted packaged garbage we're shoveling at kids today. Make a big batch of scrambled eggs, give them a piece of toast with peanut butter (although I supposed peanut allergies have ruined that), oatmeal, something with a little protein or complex carbohydrates in it, a piece of fruit. It's not rocket science.

jfaucett 9y ago

Well, we know the following: If people lived active lives and didn't eat too much we wouldn't have this problem. So I guess those are the only two vectors you can attack it on. As far as eating goes, you can't really dictate quantity but I think one thing you can do is subsidize healthy foods and make them cheap and affordable so everyone can have access to them. I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive. As far as physical activity is concerned, we've had unhealthy foods for a long time and people have eaten unhealthily since the 50s. Look at this chart: http://wellandtrue.com/the-world-has-changed-so-have-our-waistlines/ http://wellandtrue.com/the-world-has-changed-so-have-our-wai... and you'll see that we only start getting a big spike after the 1980s when everyone basically started moving to fulltime desk jobs in front of a PC all day. So I think some kind of nationally mandated PE routine kids had to do M-F would be a start even though it'd probably never get support.

Denzel 9y ago
> I know if you grow up poor you just can't afford to buy healthy foods b/c they're too expensive I feel that's a common misconception. Sure, you can't buy fresh, organic foods but I'm able to build muscle on about ~$10/day and stay healthy as a horse. Frozen peas (most frozen veggies) are $1 for 4 servings; canned black beans and chickpeas are $0.89 for 4 servings; whole-wheat bread is $3-4 for 18 pieces; 1 gallon of water is $0.89 (if you faucet water isn't drinkable); etc. You certainly can eat healthy on the cheap. It's just that most people don't want to make the sacrifice.
- cadlin 9y ago
  $10 a day is $300 a month, which is a lot to someone near the poverty line (~$1000 a month). The maximum SNAP (food stamps) benefits for an individual is $194. I know SNAP is supposed to be supplemental, etc., but the government has decided someone who is very poor shouldn't have access to the level of nutrition you're talking about. You can eat on $200 a month without much problem. I received max SNAP benefits for several months and I spent about $120 a month on food, so I had money left over at the end (being a vegetarian helps). This really isn't relevant to the point at hand (or maybe it is, who knows?) but I think poor people would have an easier time if the means testing for food stamps were looser. The benefits fall off steeply. If someone is making a thousand dollars a months and working full-time or close to it, the government can chip in more than $10-20 to give them access to healthier food.

Consultant32452 9y ago

You don't have to tax corn. Removing subsidies would be more than enough. Oh, and the government should STFU about what it thinks is healthy. The last time it tried to interfere with the market it told generations of kids to eat a pound of bread every day. Don't tax anything you think is "bad" and don't subsidize what you think is "good." If you absolutely must do something bring home-ec back to public schools. Teach kids how to cook. Then let them figure out on their own what they want to eat.

wahern 9y ago
> The last time it tried to interfere with the market OTOH, the first few times it interfered with the market they solved widespread nutritional deficiencies that were killing, crippling, and otherwise substantially harming hundreds of thousands of people every year. I'm speaking of the fortification programs: https://www.nal.usda.gov/sites/default/files/fnic_uploads//45-55.pdf On balance I'd prefer they keep at it. Anyhow, the government was simply echoing the advice of the medical establishment. At worse they've merely been a few years behind those recommendation, which is nothing on the scale of a lifetime. If you have a beef, it's with he medical and nutritional sciences, which invested too much confidence in what should have been recognized as problematic research results.
- Consultant32452 9y ago
  >Anyhow, the government was simply echoing the advice of the medical establishment. No it absolutely wasn't. It was echoing the advice of the agriculture lobby. The medical establishment sent its information in and the FDA altered it. And guess what? The food guidelines from this year were manipulated by the agriculture lobby too. http://time.com/4130043/lobbying-politics-dietary-guidelines/ http://time.com/4130043/lobbying-politics-dietary-guidelines... I only skimmed your article, but it appears those instances were almost entirely labeling guidelines. Example: What constitutes "enriched" flour? I can see the value in that, but I hope it's clear that's very different from marketing enriched flour via the government provided education system.
  - 9y ago

afarrell 9y ago

Given that large numbers of obese people don't actually know a way to sustainably and healthily lose weight, focusing on figuring that out would be a good idea. Note that if the solution is "develop the habit of X", we'd also need to figure out how to actually develop that habit alongside raising kids, holding a job, and not alienating your spouse by hangrily shouting at them. (I include myself in the set of people who don't know the solution, though I've never had this problem. My very naive intuition is that http://slatestarcodex.com/2017/04/25/book-review-the-hungry-brain/ http://slatestarcodex.com/2017/04/25/book-review-the-hungry-... is a... reasonable jumping-off point?)

dmurray 9y ago

Why does shaming people not work? If we learnt there had been a secret government policy to reduce obesity by subtly promoting thin musicians and actors at the expense of their fatter competitors, and saw how successfully they promoted this idea of a healthy weight - we'd be in awe of this feat of propaganda/marketing/behavioural economics. That part has been done really well: in the West, fat people aren't beautiful and, with exceptions, successful people are not fat. Gym memberships are at a high. The amount of time and money people invest purely in their fitness is at a high. Yet so is obesity. The behavioural forces making people fat are stronger even than the social, sexual and economic pressures driving people to be thin.

s_ngularity 9y ago
The problem is fitness alone is not a cure for obesity. I think diet is the biggest factor in American obesity, even though lack of exercise is obviously a big problem as well. Portion sizes are inflated compared to other countries, soda is cheaper than water in some places, and high sodium and high fat foods are consumed daily by many people. Not to mention high-calorie "coffee" from places like Starbucks.
- darpa_escapee 9y ago
  People are down voting you but the cold hard truth is you can maintain a healthy weight by diet alone. No amount of excerise is going to offset eating a whole pizza and cheeseburgers everyday unless you're training at Olympic athlete levels. You aren't going to put on weight or maintain an unhealthy weight if you aren't eating excess calories.
- nugget 9y ago
  I'm shocked whenever I find myself in a Starbucks early in the morning - it's essentially a constant line of folks ordering milkshakes for breakfast.

bitwize 9y ago

Public-service advertising campaigns similar to those used for cigarettes. If we can convince the public that sugary/processed foods are icky, deadly, and pushed on an unsuspecting public by Big Evil Corporations, we might have a chance.

humanrebar 9y ago
I'm not sure the propaganda did as much as the heavy tobacco taxes and having friends and relatives who died early and painfully from disease.

nradov 9y ago

The Affordable Care Act (ACA / "Obamacare") allows medical insurers to give premium discounts to members who keep their BMI at a health level. We could expand on that. Some people do respond to financial incentives.

zeroer 9y ago
BMI is a terrible metric for weightlifters.
- nradov 9y ago
  That is a tiny fraction of the population, essentially irrelevant from a public health policy standpoint.
  - zeroer 9y ago
    It's relevant to me.
    - gm-conspiracy 9y ago
      I found the anecdote.
  - douche 9y ago
    It's really not. BMI is wildly outdated, and especially doesn't deal well with anybody who has a larger body frame. At the thinnest I've ever been in my life, when you could see every rib hanging out, I was still forty pounds heavier than what BMI charts calculated my weight ought to be.
    - nradov 9y ago
      That is false. BMI has been shown to be highly correlated with body fat, and remains the only practical method for large scale screening. https://www.theguardian.com/society/2017/may/17/obesity-health-no-such-thing-as-fat-but-fit-major-study https://www.theguardian.com/society/2017/may/17/obesity-heal...

ams6110 9y ago

Probably I'd argue that "politics" should GTFO. The USDA caused the obesity epidemic with their low-fat, high-starch food pyramid. Let people eat what they want to eat. Quit trying to micromanage other people's lives.

humanrebar 9y ago
I'm also wondering why people have the impulse to solve other people's problems whether they asked for help or not (compare this map with a Trump voter map and see how much they tend to like things like the ACA).

antisthenes 9y ago

Obesity/lack of exercise problem is still a poverty problem. Exercise is costly in time, and, therefore, money. As a sort of self-performed experiment, I've exercised regularly for the last 2 years, on average of 3.5 times a week (every other day). This required 1.25 hrs for the workout itself, another .25 hrs for the added commute, $60 for the gym membership per month, an increase in calorie consumption to compensate of about 30%, hence additional food costs of around $100/month. That's a total of 273 hours in a year in opportunity cost and $1920 in various expenses. Assuming a semi-skilled wage of $15/hr, that's $4095 + $1920 ~ $6000 opportunity cost per year to exercise and stay healthy. $6000 is a make or break amount of money for poor people. I can afford it relatively easily, considering how much health benefits I receive from it, but living paycheck to paycheck, most of them likely can't.

humanrebar 9y ago
...you can also factor in the time value of money since the goal, at least in this conversation, is to increase lifespan and health decades in the future.
- VLM 9y ago
  And in a hyper-youth centered culture, "I'll have a lot of fun when I'm 25" counts for a lot more than "I'll be dead at 75" Assuming exercise isn't fun. Physical therapy is supposed to be a brutally painful and exhausting way to repair damage that you'll feel better about in the distant future. Exercise should be fun. If you're not having fun, with fun people, you're probably doing it wrong.
  - antisthenes 9y ago
    Fun was not accounted for because of different preference curves for different people. There are people who genuinely don't enjoy exercise, despite no indication that they would somehow not benefit from the effects.
johnbrodie 9y ago
Your example is just one way of exercising, though. There's no getting around it requiring some time, but you can likely do a decent bodyweight-style workout without a gym membership, without a commute, using only implements you can find in your community. Some space to jog, do pushups, something you can hang from to do pullups, etc. People have been training themselves to have fairly large amounts of muscle and endurance in jail, in 3rd world countries, and plenty of other places besides expensive gyms.

jjt-yn_t 9y ago

[ why is >> was this text in a SCROLL RIGHT to read ?? ... and then not? ]] What is it tied to? Fun anecdote. Waiting for an x-ray, after strenuous exercise fall, having walked to the medical office, co-workers broke ice with each other by congratulating each other on having eaten large meals I long ago swore off of, or having supplemented such with 'desserts' in the olden days, now new normal, that are seemingly a perk of having gone outside from the office. Persons not unhealthy at that age, but as salaried and the more intelligent sector of American society, the grim role modelling I envisage at/in their household making ostensibly an outlier of olden day fast-til-we-can-eat-thank-god thinnesses now regaled as outliers, even chastised as unforgiving, a not easily solved, if ever, politically at least, pattern of ever-larger waistlines and expenses to be borne by the 'olden days' non-soda non-dessert daily small sector of society that comprises now a small minority more rural and unrepresented in the new normal. Hope this does not sound harsh. [[ why is >> was it a SLIDER btw [ now is not ] ]]

jjt-yn_t 9y ago

What is it tied to? Fun anecdote. Waiting for an x-ray, after strenuous exercise fall, having walked to the medical office, co-workers broke ice with each other by congratulating each other on having eaten large meals I long ago swore off of, or having supplemented such with 'desserts' in the olden days, now new normal, that are seemingly a perk of having gone outside from the office. Persons not unhealthy at that age, but as salaried and the more intelligent sector of American society, the grim role modelling I envisage at/in their household making ostensibly an outlier of olden day fast-til-we-can-eat-thank-god thinnesses now regaled as outliers, even chastised as unforgiving, a not easily solved, if ever, politically at least, pattern of ever-larger waistlines and expenses to be borne by the 'olden days' non-soda non-dessert daily small sector of society that comprises now a small minority more rural and unrepresented in the new normal. Hope this does not sound harsh.