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Just the other week I read in a medical textbook: If you are overweight (obese) at age 18, there is only a 15%(!) chance that you will manage to have a more he

Just the other week I read in a medical textbook: If you are overweight (obese) at age 18, there is only a 15%(!) chance that you will manage to have a more healthy weight during your adult life. I found that number utterly depressing and shockingly low.

maccard 5y ago
That lines up with intuition; if you are obede at 18, chances are your parents have not prioritized a healthy relationship with food, meaning it has never been a priority for you or your family, and you are unlikely to change those entrenched habits.
- deleted 5y ago
  [deleted]
- dathinab 5y ago
  That might depend a lot on the country you are in/from. The huge majority of (similar aged) people I had meet between 16-20 which had been obese where so because of "health issues" not directly related to them eating unhealthy being lazy. As such it's not surprising if you have problems changing it because "just" eating healthy and doing sports is far from enough to fix it. And trying to fix it with that is often a task needing far more discipline and self control then the large majority of humans (independent of weight) have. I mean let's be honest the difficulty many of this people face is way higher then the difficulty for a young(1) health male to get a black belt in Judo, Karate or similar. (1): Start training with ~14 or earlier, through not necessary with high commitment, then at some point later (e.g. 16,18,20) added commitment trying to get a black belt.
  - maccard 5y ago
    Are health issues unrelated to obesity the primary cause of obesity in under 18s? Also, I specifically never called anyone out as lazy. The majority of obesity is overeating (a single Starbucks muffin is a 10k run). Yes there are people with imbalances/medication that are outliers but most people aren't outliers. I specifically called out a relationship with food being something that's carried into adulthood as the cause of the relationship between those figures. An obese 14 year old may have some underlying health condition but is more likely to be a victim of socioeconomic problems; lack of access to healthier and more balanced foods, or to have obese parents (which appears to be a good indicator for childhood obesity). Neither of these are easy solves, and the blame doesn't lie with an individual, but it does explain that someone who is obese as a child is more likely to be obese as an adult.
    - amanaplanacanal 5y ago
      There was a recent article discussed here that made the case that our obesity epidemic was primarily caused by something environmental, not by individual eating choices. It seemed pretty convincing.
    - dathinab 5y ago
      > Are health issues unrelated to obesity the primary cause of obesity in under 18s? Idk, I can only speak about people in my environment. Where I can only remember one case which might have been because of overeating and I say might because I simple don't know. Multiple of the obese people I did know had a more controlled and some times far more healthy diet then most people I know. Many cases I know did slowly but continuously got bigger, i.e. something which can totally happen without overeating. I also had meet people the other way around, like needing to consume ~6000+ kcal a day when they don't do sports or they are at risk of becoming severely underweight... > called anyone out as lazy. The main reason I mentioned sport is because I know of a case where the person had a controlled diet and did more sport then most other people in class and still looked quite square, from what I learned this person slowly over multiple years got more and more weight without being able to lose any of it. > . The majority of obesity is overeating (a single Starbucks muffin is a 10k run). I'm not sure if it's the majority. It's definitely a thing, and very often a thing for extreme cases. It also might very well play a big role in countries with unusual many and many unusual extreme cases of obesity. But many of the cases I know did slowly accumulate weight over years without being able to lose weight starting from a very very young age on.
zz865 5y ago
I'm impressed 15% of people can lose weight. I'd expect 99% of people to weigh the same or more at 40 than 18.
- MattGaiser 5y ago
  I want to know the attached caveats to that. Is it 15% lost weight at some point or the much more impressive, 15% lost weight and kept it off?
float4 5y ago
Someone on HN once made the comparison between obesity and the old attitude people had towards depression. When you were depressed, you "just" had to go out and do things. You "just" had to drive out the negative thoughts with positive ones. etc. When you're overweight, you "just" have to get into a caloric deficit. "Just" undereat 7700kcal and you've lost 1kg of bodyweight. It's that simple. Except it's actually hard.
- vitabenes 5y ago
  In principle, it's simple. In reality, it gets complex and hard.
- blfr 5y ago
  Simple and easy are not the same. It is simple if not always easy.
  - RobertKerans 5y ago
    This is the critical point, most sibling comments are conflating the two [when in fact they are completely different]
    - float4 5y ago
      Yeah, I purposefully used the word "simple" when I meant straightforward and "hard" when I meant difficult, but I should've explained why I used those words. Either that, or I myself have gotten the meanings of the words mixed up.
      - RobertKerans 5y ago
        Meaning seems correct afaics? In particular any commenters who build software or engineer products should recognise this, making simple things is often very hard.
      - jmull 5y ago
        Hm. There is a distinction between simple/complex and easy/hard, but it’s a basic semantic one. Simple/complex refers to a system or problem, while easy/hard refers to the difficulty of controlling the system or solving the problem. The problem in this thread with making a distinction between simple/complex and easy/hard is that people are referring to different things. People are even talking past themselves so it’s no wonder others don’t understand what they mean. E.g., the energy model of weight gain/loss — CICO, or calories in, calories out — is simple. But CI depends on interactions between evolution, hormonal systems (a complex balancing feedback system all its own), psychology, age, money, society, culture, family, food supply, etc., which is complex. For a particular person at a particular point in their life, that bundle of factors may happen to be balanced “downward” so that CI is easy to control and weight loss is simple — and easy). In other cases, a person may need to dig in to those factors and find a way to rebalance them, which is complex — and hard. When you’re actually referring to the same thing, simple and easy or complex and hard go together. It is easy to control simple system. It is hard to control complex ones.
andreasha 5y ago
What's the name of the medical textbook?
- yonixw 5y ago
  This research suggest even lower chanches: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539812/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539812/
- ChemSpider 5y ago
  See for example here: https://resident360.nejm.org/from-pages-to-practice/will-overweight-children-be-overweight-adults-2 https://resident360.nejm.org/from-pages-to-practice/will-ove... "Obese 2-year-olds had a 75% chance of still being obese at age 35 and obese 19-year-olds had an 88% risk."
alpaca128 5y ago
It's similarly bad with alcohol. The lower the age of the first super drunken state the higher the chance of alcoholism later in life. It really messes with the young brain.
watwut 5y ago
Through, while long term weight loss have unintuitively low success chances, it is possible to improve health results themselves. Things like moving regularly improve people's health even if they don't result in long term weight loss. The same with diet change - you can eat better and have better health even if you remain fat. You can lower your sugar consumption, stop to drink sweetened drinks and your chance of getting diabetes 2 will go down regardless if whether it moves your weight.
heavenlyblue 5y ago
And if you’re not obese at age 18, what is the chance you are obese when you’re an adult? I have a feeling it’s actually larger than 15%
Buttons840 5y ago
It's worth remembering that only a portion of those people actually make losing weight a goal. It might be a high portion, but still a portion. Simply making the goal increases your chances.
Aerroon 5y ago
Maybe the underlying reason why you're overweight later in life is the same reason you're overweight by age 18? I think a lot of people upon seeing that statistic will assume that being overweight by 18 will lead to being overweight later in life, but that's not necessarily the case. Perhaps the body's self-regulation on food is 'inherently broken' and that's why they end up overweight in both cases?
- mjbeswick 5y ago
  Being overweight for any length of time can ruin you appetite and metabolism. Being overweight usually causes insulin resistance at some point, and develop into metabolic syndrome. Also continuous overeating down regulates the production of leptin which is produced when the stomach is full. Competitive eater have this issue, as when they eat they don't feel full so they are able to eat much more,
Barrin92 5y ago
Relevant to the topic of personality and choice in the article. Robert Plomin in his book Blueprint cites the pretty astonishing finding that the weight of adopted children is pretty much not at all correlated to the weight of the adopted parents, whereas the weight of the birth parents is a strong indicator for weight in adulthood, even if separated at birth. https://imgur.com/XIyvzFz https://imgur.com/XIyvzFz
- darkerside 5y ago
  Is that surprising? Weight is strongly correlated with height, which is absolutely genetic. I'm sure that BMI would be less correlated than pure weight, although I don't know by how much.
DoreenMichele 5y ago
I think all that suggests is that we do poor a job of helping specific individuals pinpoint the root cause of obesity for them. I have lost multiple dress sizes without trying to do so. I finally got the right diagnosis in my thirties, "a better name for my problem than crazy", and changed my diet in accordance with medical recommendations. I was 245 pounds for at least three years. I haven't weighed myself in upwards of a decade but I've likely finally dropped back below 180 pounds this year. I say that based on no longer feeling like "a beached whale" who has trouble getting up out of a chair and past experience with where that point occurs for me in terms of weight. I imagine the minority who do solve it likely don't really talk much about what actually worked for them and why they think it worked. I have gotten insane amounts of ugly pushback for trying to talk about what works for me and my opinions about my own life and body and medical condition. If you have any sense, you find what works for you and keep your trap shut so the "crabs" don't rip your arms off. Unfortunately that means the other 85 percent don't get to hear "calorie counting might just be a broken mental model and seems largely unrelated to what worked for me" and that leaves a whole lot of people stranded behind our current broken mental models because it's not socially acceptable to say "Well, that doesn't fit my experience. Here's what I think about my own life and maybe we can work out better mental models."
strken 5y ago
I was obese[0] 3 months ago, and had been that way for about two years. Now I'm a healthy weight. It was easy to do with minimal lifestyle changes - calorie tracking, minor dietary changes, and couch to 5k running a couple of times a week. The way most studies of weight loss work is by recruiting a pool of obese applicants. This is intrinsically biased: someone who has had a lifelong struggle with obesity can be recruited across 100% of their lifespan, whereas someone who spent two years obese and then lost the weight and kept it off can only be recruited for that 2 year window, or 2.5%. There are probably other factors that come into play that bias the sample even further. The question these studies answer is "given a random obese person, how likely is this person to lose weight?" This is a relevant clinical question, and the answer is usually a pretty low percentage. For an individual who hasn't struggled with obesity their entire life, a more pertinent question is "given that I have just become obese, how likely am I to lose the weight again and keep it off?" The chances of that are much higher. [0] By BMI, which has a pretty big margin for error, but I was visibly overweight.
- graeme 5y ago
  Did you grow up obese though? I think the statistic suggests there is something to having the body grow under those conditions. I was athletic growing up and I’ll always have that experience and know how it feels. Someone obese at 18 has no reference point and neither do any of their body systems.
  - strken 5y ago
    No, but I'm trying to explain the sampling bias, not talking about growing up obese. If you randomly sample obese people at any age, 18 or 81, your sample will still be biased by years-spent-obese. There probably is some effect from growing up obese, but the sampling bias is hugely relevant to interpreting the statistics, and it's not talked about much.
    - graeme 5y ago
      Fair point
  - 5y ago

maccard 5y ago

That lines up with intuition; if you are obede at 18, chances are your parents have not prioritized a healthy relationship with food, meaning it has never been a priority for you or your family, and you are unlikely to change those entrenched habits.

deleted 5y ago
[deleted]
dathinab 5y ago
That might depend a lot on the country you are in/from. The huge majority of (similar aged) people I had meet between 16-20 which had been obese where so because of "health issues" not directly related to them eating unhealthy being lazy. As such it's not surprising if you have problems changing it because "just" eating healthy and doing sports is far from enough to fix it. And trying to fix it with that is often a task needing far more discipline and self control then the large majority of humans (independent of weight) have. I mean let's be honest the difficulty many of this people face is way higher then the difficulty for a young(1) health male to get a black belt in Judo, Karate or similar. (1): Start training with ~14 or earlier, through not necessary with high commitment, then at some point later (e.g. 16,18,20) added commitment trying to get a black belt.
- maccard 5y ago
  Are health issues unrelated to obesity the primary cause of obesity in under 18s? Also, I specifically never called anyone out as lazy. The majority of obesity is overeating (a single Starbucks muffin is a 10k run). Yes there are people with imbalances/medication that are outliers but most people aren't outliers. I specifically called out a relationship with food being something that's carried into adulthood as the cause of the relationship between those figures. An obese 14 year old may have some underlying health condition but is more likely to be a victim of socioeconomic problems; lack of access to healthier and more balanced foods, or to have obese parents (which appears to be a good indicator for childhood obesity). Neither of these are easy solves, and the blame doesn't lie with an individual, but it does explain that someone who is obese as a child is more likely to be obese as an adult.
  - amanaplanacanal 5y ago
    There was a recent article discussed here that made the case that our obesity epidemic was primarily caused by something environmental, not by individual eating choices. It seemed pretty convincing.
  - dathinab 5y ago
    > Are health issues unrelated to obesity the primary cause of obesity in under 18s? Idk, I can only speak about people in my environment. Where I can only remember one case which might have been because of overeating and I say might because I simple don't know. Multiple of the obese people I did know had a more controlled and some times far more healthy diet then most people I know. Many cases I know did slowly but continuously got bigger, i.e. something which can totally happen without overeating. I also had meet people the other way around, like needing to consume ~6000+ kcal a day when they don't do sports or they are at risk of becoming severely underweight... > called anyone out as lazy. The main reason I mentioned sport is because I know of a case where the person had a controlled diet and did more sport then most other people in class and still looked quite square, from what I learned this person slowly over multiple years got more and more weight without being able to lose any of it. > . The majority of obesity is overeating (a single Starbucks muffin is a 10k run). I'm not sure if it's the majority. It's definitely a thing, and very often a thing for extreme cases. It also might very well play a big role in countries with unusual many and many unusual extreme cases of obesity. But many of the cases I know did slowly accumulate weight over years without being able to lose weight starting from a very very young age on.

zz865 5y ago

I'm impressed 15% of people can lose weight. I'd expect 99% of people to weigh the same or more at 40 than 18.

MattGaiser 5y ago
I want to know the attached caveats to that. Is it 15% lost weight at some point or the much more impressive, 15% lost weight and kept it off?

float4 5y ago

Someone on HN once made the comparison between obesity and the old attitude people had towards depression. When you were depressed, you "just" had to go out and do things. You "just" had to drive out the negative thoughts with positive ones. etc. When you're overweight, you "just" have to get into a caloric deficit. "Just" undereat 7700kcal and you've lost 1kg of bodyweight. It's that simple. Except it's actually hard.

vitabenes 5y ago
In principle, it's simple. In reality, it gets complex and hard.
blfr 5y ago
Simple and easy are not the same. It is simple if not always easy.
- RobertKerans 5y ago
  This is the critical point, most sibling comments are conflating the two [when in fact they are completely different]
  - float4 5y ago
    Yeah, I purposefully used the word "simple" when I meant straightforward and "hard" when I meant difficult, but I should've explained why I used those words. Either that, or I myself have gotten the meanings of the words mixed up.
    - RobertKerans 5y ago
      Meaning seems correct afaics? In particular any commenters who build software or engineer products should recognise this, making simple things is often very hard.
    - jmull 5y ago
      Hm. There is a distinction between simple/complex and easy/hard, but it’s a basic semantic one. Simple/complex refers to a system or problem, while easy/hard refers to the difficulty of controlling the system or solving the problem. The problem in this thread with making a distinction between simple/complex and easy/hard is that people are referring to different things. People are even talking past themselves so it’s no wonder others don’t understand what they mean. E.g., the energy model of weight gain/loss — CICO, or calories in, calories out — is simple. But CI depends on interactions between evolution, hormonal systems (a complex balancing feedback system all its own), psychology, age, money, society, culture, family, food supply, etc., which is complex. For a particular person at a particular point in their life, that bundle of factors may happen to be balanced “downward” so that CI is easy to control and weight loss is simple — and easy). In other cases, a person may need to dig in to those factors and find a way to rebalance them, which is complex — and hard. When you’re actually referring to the same thing, simple and easy or complex and hard go together. It is easy to control simple system. It is hard to control complex ones.

andreasha 5y ago

What's the name of the medical textbook?

yonixw 5y ago
This research suggest even lower chanches: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539812/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539812/
ChemSpider 5y ago
See for example here: https://resident360.nejm.org/from-pages-to-practice/will-overweight-children-be-overweight-adults-2 https://resident360.nejm.org/from-pages-to-practice/will-ove... "Obese 2-year-olds had a 75% chance of still being obese at age 35 and obese 19-year-olds had an 88% risk."

alpaca128 5y ago

It's similarly bad with alcohol. The lower the age of the first super drunken state the higher the chance of alcoholism later in life. It really messes with the young brain.

watwut 5y ago

Through, while long term weight loss have unintuitively low success chances, it is possible to improve health results themselves. Things like moving regularly improve people's health even if they don't result in long term weight loss. The same with diet change - you can eat better and have better health even if you remain fat. You can lower your sugar consumption, stop to drink sweetened drinks and your chance of getting diabetes 2 will go down regardless if whether it moves your weight.

heavenlyblue 5y ago

And if you’re not obese at age 18, what is the chance you are obese when you’re an adult? I have a feeling it’s actually larger than 15%

Buttons840 5y ago

It's worth remembering that only a portion of those people actually make losing weight a goal. It might be a high portion, but still a portion. Simply making the goal increases your chances.

Aerroon 5y ago

Maybe the underlying reason why you're overweight later in life is the same reason you're overweight by age 18? I think a lot of people upon seeing that statistic will assume that being overweight by 18 will lead to being overweight later in life, but that's not necessarily the case. Perhaps the body's self-regulation on food is 'inherently broken' and that's why they end up overweight in both cases?

mjbeswick 5y ago
Being overweight for any length of time can ruin you appetite and metabolism. Being overweight usually causes insulin resistance at some point, and develop into metabolic syndrome. Also continuous overeating down regulates the production of leptin which is produced when the stomach is full. Competitive eater have this issue, as when they eat they don't feel full so they are able to eat much more,

Barrin92 5y ago

Relevant to the topic of personality and choice in the article. Robert Plomin in his book Blueprint cites the pretty astonishing finding that the weight of adopted children is pretty much not at all correlated to the weight of the adopted parents, whereas the weight of the birth parents is a strong indicator for weight in adulthood, even if separated at birth. https://imgur.com/XIyvzFz https://imgur.com/XIyvzFz

darkerside 5y ago
Is that surprising? Weight is strongly correlated with height, which is absolutely genetic. I'm sure that BMI would be less correlated than pure weight, although I don't know by how much.

DoreenMichele 5y ago

I think all that suggests is that we do poor a job of helping specific individuals pinpoint the root cause of obesity for them. I have lost multiple dress sizes without trying to do so. I finally got the right diagnosis in my thirties, "a better name for my problem than crazy", and changed my diet in accordance with medical recommendations. I was 245 pounds for at least three years. I haven't weighed myself in upwards of a decade but I've likely finally dropped back below 180 pounds this year. I say that based on no longer feeling like "a beached whale" who has trouble getting up out of a chair and past experience with where that point occurs for me in terms of weight. I imagine the minority who do solve it likely don't really talk much about what actually worked for them and why they think it worked. I have gotten insane amounts of ugly pushback for trying to talk about what works for me and my opinions about my own life and body and medical condition. If you have any sense, you find what works for you and keep your trap shut so the "crabs" don't rip your arms off. Unfortunately that means the other 85 percent don't get to hear "calorie counting might just be a broken mental model and seems largely unrelated to what worked for me" and that leaves a whole lot of people stranded behind our current broken mental models because it's not socially acceptable to say "Well, that doesn't fit my experience. Here's what I think about my own life and maybe we can work out better mental models."

strken 5y ago

I was obese[0] 3 months ago, and had been that way for about two years. Now I'm a healthy weight. It was easy to do with minimal lifestyle changes - calorie tracking, minor dietary changes, and couch to 5k running a couple of times a week. The way most studies of weight loss work is by recruiting a pool of obese applicants. This is intrinsically biased: someone who has had a lifelong struggle with obesity can be recruited across 100% of their lifespan, whereas someone who spent two years obese and then lost the weight and kept it off can only be recruited for that 2 year window, or 2.5%. There are probably other factors that come into play that bias the sample even further. The question these studies answer is "given a random obese person, how likely is this person to lose weight?" This is a relevant clinical question, and the answer is usually a pretty low percentage. For an individual who hasn't struggled with obesity their entire life, a more pertinent question is "given that I have just become obese, how likely am I to lose the weight again and keep it off?" The chances of that are much higher. [0] By BMI, which has a pretty big margin for error, but I was visibly overweight.

graeme 5y ago
Did you grow up obese though? I think the statistic suggests there is something to having the body grow under those conditions. I was athletic growing up and I’ll always have that experience and know how it feels. Someone obese at 18 has no reference point and neither do any of their body systems.
- strken 5y ago
  No, but I'm trying to explain the sampling bias, not talking about growing up obese. If you randomly sample obese people at any age, 18 or 81, your sample will still be biased by years-spent-obese. There probably is some effect from growing up obese, but the sampling bias is hugely relevant to interpreting the statistics, and it's not talked about much.
  - graeme 5y ago
    Fair point
- 5y ago