[nxm]

- 90% of Americans have health insurance - I would say it works for more than half (most) of Americans. Granted, not all health insurance is created equally.

- The obesity and congestive heart failure issues is a function of poor dietary choices most Americans make (choosing fast/process food over cooking/making healthy foods), and not a function of healthcare access

[autoexec]

> 90% of Americans have health insurance

Clearly having health insurance isn't enough to make healthcare affordable or prevent patient outcomes from being worse for Americans than patients in other nations.

> The obesity and congestive heart failure issues is a function of poor dietary choices

I also suspect that obesity and congestive heart failure issues are heavily influenced by diet, although I think that "choices" might be misleading here and that being unable to afford basic and preventative healthcare likely does have a major impact in healthcare outcomes even when the problems come from obesity and heart failure.

It's certainly not as if people in other nations don't also enjoy ultra-processed foods or are any less fond of sugar, fat, and salt. They just often have better access to healthier foods, and more stringent regulations concerning what companies are and aren't allowed to put in foods, what they are allowed to advertise, and how they are sold.

There is a huge difference between the number of people in the US who have little to no access to healthy foods when compared to those in other developed nations. Sometimes it's physical access (food deserts) and sometimes it's a matter of costs, but I don't think there's anything inherent to Americans that forces them to make bad choices. I'm guessing that instead Americans tend to have less choice and fewer opportunities for healthy foods in the first place, while having unhealthy ultra-processed foods that would be banned in other countries readily available, easily affordable, and heavily advertised to them.

[Aerroon]

I call bs on the second part. It's not unhealthy food that makes you gain weight, it's how much food you have.

On top of that, the healthiest foods are among the cheapest foods you can buy. Milk, oatmeal, potatoes, rice, macaroni, chicken are all cheap compared to most foods you can get. This stuff is available almost everywhere.

>but I don't think there's anything inherent to Americans that forces them to make bad choices.

It's partly cultural. But this isn't a uniquely American problem. It's just worse in the US. 72% of Americans are obese or overweight.

On top of that there was a recent study that found that BMR has decreased in the last ~30 years. Among men it was even up to 7%. That's a big enough difference to take someone from barely overweight to obese over a lifetime. But this is only a single study so far.

[autoexec]

> I call bs on the second part. It's not unhealthy food that makes you gain weight, it's how much food you have.

I'd argue that unhealthy food can cause a person to eat more. See for example https://www.cell.com/cell-metabolism/fulltext/S1550-4131(19)...

> On top of that, the healthiest foods are among the cheapest foods you can buy.

The usual argument here calls out "bulk beans and rice" instead of potatoes and chicken, but in both cases you aren't going to find that in a gas station or convince store which for many Americans (some 40+ million) is the only place they can get groceries. If they're getting chicken it's not going to be whole and uncooked. It'll be sold in a plastic bag leaching PFAS into the food and be coated in high fructose corn syrup (most packaged lunch meats have sugar or HFCS added). Those kinds of places tend to have very little fresh fruit and veg as well.

If you're looking at cost per calorie unhealthy food will often win out as less costly, not just in terms of money but also time and effort. Someone who works two jobs and spends hours sitting on or walking to/from the bus isn't always going to have the energy or time to roast a chicken. It's easy to see why they'd choose what's fastest, highly satisfying, requires less preparation and clean up, and is inexpensive.

Not that I'm suggesting that the 72% of Americans who are obese/overweight have those kinds of problems... just that you'll find more Americans who are in that position than you'll find somewhere like the UK.

I found the study on the decrease in BMR. That's pretty wild and if true, I wouldn't be surprised if it was a factor in the obesity problem.

[Aerroon]

>If you're looking at cost per calorie unhealthy food will often win out as less costly

What you should be looking for is cost per gram of protein. That's the only macro nutrient you need large amounts of. Calories per gram of protein are important too - oatmeal and dried pasta are the cheapest protein/$, but their protein/kcal is too low.

I think it comes down to 'not caring enough' to try to get it under control. All the obfuscation and noise around nutrition ("healthy food") doesn't help either, but it's doable.

>I found the study on the decrease in BMR. That's pretty wild and if true, I wouldn't be surprised if it was a factor in the obesity problem.

It might even be the main part, at least for men. If your normal TDEE is 2136 kcal and you eat at maintenance, but then your BMR drops by 7.7% (165 kcal) then you'll gain weight until your TDEE is at 2136 kcal again. During this you would go from ~80 kg to ~95 kg taking you from 24.7 BMI to 29.3.

An argument against the study is that it could be due to different measuring techniques. On the other hand, we have found that the average temperature of humans is slowly decreasing, so maybe it's true.