[lovethevoid]

> The decline in the United States is driven by increasing numbers of deaths because of conditions such as diabetes and heart disease in people aged roughly 40 to 60.

People are asking if we should be surprised by the headline but are missing this. As suggested in the article by the researchers, there is something dragging down the average since the 2010s. Not even hitting the general expectation of ~75 years. We don’t have solid answers yet, only theories.

So yes, generally while going up against the process of aging is going to create barriers (eg can we get to 130 years old), we are also failing to raise the baseline which is the bigger issue that people might not grasp when it comes to “life expectancy rates”.

[hn_throwaway_99]

> We don’t have solid answers yet, only theories.

The exact quote you gave had a pretty solid answer, certainly not just "theories".

[lovethevoid]

That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.

We have research on what can affect heart health, like what things might be linked to it, such as smoking and alcohol. We also know genetics plays a huge role.

So we don't actually have solid answers, actionable answers as to the rise of heart health issues. Look at this analysis[1] regarding how dietary guidelines specifically for fats (saturated, trans) have very little substantial evidence supporting it. Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid. In another study[2] we find that reducing your fat intake still resulted in the same rates of mortality as those who ate more. This is also why more in the space are shifting away from these sort of claims ("only eat x amount of saturated fat per day") and more to general food composition (eg who cares if a fish has saturated fats, eat the fish with vegetables).

It's quite challenging to figure out, everyone has their theories. All I'm saying is we don't actually have the answers yet.

[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9794145/ [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457/

[janalsncm]

Perhaps there are many causes of heart disease and diabetes. It is likely that actionable information would require a case-by-case assessment. That is exactly what doctors do, so getting people time with doctors seems pretty useful.

Regarding other factors, American culture is fairly similar to Canadian culture. However Canadians have free healthcare, meaning more Canadians see doctors than Americans. So I wonder if they have lower levels of obesity, heart disease and diabetes, and if their lifespans have also been decreasing.

[throwaway2037]

    > However Canadians have free healthcare

I don't like this use of "free". It is paid for by taxes. That is no where near free. It is extremely hard in a highly advanced economy to provide quality healthcare at less than 10% of GDP. That is a huge number for any wealthy country.

Also, Canadians are pretty fat. It looks like 65% are overweight, which includes obese. Ref: https://www.statista.com/statistics/1317268/overweight-obesi...

[janalsncm]

Fair point, it isn’t “free” of course. But it is accessible to everyone. No copay/deductible/coinsurance bs.

> It is extremely hard in a highly advanced economy to provide quality healthcare at less than 10% of GDP.

In the US we pay 17% of GDP towards healthcare and tons of people still can’t afford it.

[defrost]

The general view of US healthcare is that not much of the money paid toward better health outcomes reaches the target.

A quote from another comment here is:

     Australia’s health system far outperforms the .. US healthcare system, which spends nearly twice as much per capita as Australia to deliver far worse outcomes — including Americans dying five years younger than us.

[throwaway2037]

    > No copay/deductible/coinsurance bs.

Many highly developed countries have copays in their national health insurance programme.

[BeetleB]

> Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid.

I've been hearing this complaint (that the guidelines claim fat are the worst) for way too long, when in (my) reality, all the guidelines I've seen in the last 25 years has put more emphasis on carbs than on fats (i.e. too many carbs is evil).

I know "low fat" diets were the craze a long time ago. And sure, advertisers still like to slap "low/no fat" labels. But I believe the actual recommendation has been to lower carbs since around the 90's.

This is ultimately a strawman.

[DoughnutHole]

To be fair the framing of “carbs are evil” is also lazy. The root cause of most cardiovascular disease and type 2 diabetes is obesity due to excess calories of any sort (although once you’re diabetic or prediabetic carbs are a HUGE problem no matter what).

The modern lifestyle is incredibly sedentary and every civilisation is built on staple foods that can feed hours of manual labour (with modern snacks thrown on top).

Calling a major food group evil is just a good scapegoat because it’s much more palatable than telling people that they don’t move enough and eat too much food.

[throwaway2037]

One thing I think that we can be very specific about: Diets high in saturated fat surely increase your chances for cardiovascular disease.

Also, I agree with your general sentiment: Framing carbs are evil is lazy. First, calories matter. Second, if your calories are general under control, most people need fewer calories as they age. Many choose to restrict carbs to maintain weight.

[nonameiguess]

All of this shit is stupid. Research has pretty conclusively shown at this point that a high proportion of calories coming from saturated fat specifically will raise LDL cholesterol levels, in people who have neither genetic predisposition toward low or high LDL. If you have one of those, it won't make a difference either way.

Whether that leads to actual heart disease is iffier, but not terribly controversial among cardiologists as far as I can tell. It's only doubted on the Internet where everyone wants to be a galaxy brain with some answer the doctors don't want you to know.

But nobody ever demonized fat in general, and demonizing carbs is just as stupid. Eating enormous amounts of carbs is fine as long as you actually use them. My daily calories right now are around 3,900 with carbs at 650 grams a day, a fair amount being syrups I eat early in the morning while running. If you listened to the Internet, you'd believe I was diabetic already, yet basically every remotely serious endurance athlete eats like this and is fine. Glucose that is continuously and immediately shuttled into muscle cells to power mitochondria and provide energy for movement does no harm whatsoever. It's roughly the entire point of animal metabolism. Glucose that sits around in your blood forever because you're sitting around staring at a screen for 16 hours a day while stuffing your face is what causes problems because of all the oxidizing effects of glucose when it isn't taken apart quickly and turned into ATP.

My BMI is 21.6 for what it's worth. As far as I can tell, the whole "mystery" behind why no diets work is because no diet can magically make people eat less when they spend the overwhelming majority of their time not moving and hunger decouples from energy expenditure. If you're sufficiently active as a lifelong athlete, every diet works. I ate super sized McFlurries, entire boxes of Entenmann's donuts, and Little Debbie's treats as a teenager as staples of my diet. As an adult, I've tried paleo, zone, mediterranean. Right now, I pretty much just eat the standard American food pyramid. None of these has managed to magically poison my brain or destroy my metabolism because metabolic function can be trained just like any other bodily function and it is trained by doing regular athletic activity with a high energy demand. Just like your muscles atrophy if you never do any resistance training, your metabolism atrophies if you never do any aerobic exercise.

I can't claim to know the secret to weight loss but I know how to never get fat in the first place. On every team I was ever on from middle school to college to my time in the Army, whether that be cross country, track, volleyball, basketball, tennis, or general outdoor adventurism and long-haul hiking with a weighted pack, the overweight rate was never 0 but it sure as shit wasn't 70%. And we were all eating the same "poisons" and manufactured foods from evil Nestle that the rest of you were eating.

[hulitu]

> That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.

Nestle ? McDonalds ? Burger King ?

[BeetleB]

Portion sizes. The average plate is larger than it was, say, in the 60's.

[mjevans]

Portion Sizes and the No/Low Fat craze from the 90s mentioned in another post are related.

This is all my THEORY, a speculation that I would like someone to study or to find a study about.

Theory / speculation:

Humans evolved with natural sugars, fats, proteins/meats; primitive cooking, probably some grains (more recently). That's what our bodies know how to process, to react to.

All the fake sugars, modified foods that lack the components our bodies use to regulate internal processes; highly processed foods which also lack those components we need to feel satiated and to produce the messengers to digest correctly: those are likely the causes of obesity (not feeling full, so more eating) and bodies behaving poorly.

'Food Deserts' and corporations that are geared around selling large portions of tasty but unsatisfying food, or only offering huge sizes rather than also offering adults a tasty portion that's not intended for take home leftovers also contribute.

Also: my main vice for this topic. Can I _please_ have lightly caffeinated + carbonated water that isn't outrageously expensive?

[asdff]

Caffeine addiction gets cheap when you stop beating around the bush and start just buying the caffeine pills that are like a cent a pop.

[pessimizer]

Insane prices for insulin?

edit: you really think insulin prices don't have an effect on the lifespans of diabetics?

[ponector]

Are they insane, though? How many hours average man should work to pay for average monthly dose of the average quality insulin? May be even more affordable than in other countries.

[watwut]

Insulin is cheap elsewhere.

> U.S. manufacturer gross prices per 100 international units of insulin were on average 9.71 times those in OECD comparison countries combined.

It is 10 times more expensive in USA.

[Riseed]

I don’t think the average man should have to work any hours to pay for an average monthly dose of average quality anything that they require to stay alive. Perhaps I’m insane.

[doubled112]

People putting off healthcare because it costs money?

[hu3]

I recommend studies about stain medication in increasing life expectancy.

We're talking years of increased life expectancy.

Sadly statin is not without its downsides.

[joe_the_user]

We're talking years of increased life expectancy.

Huh? Statins are a medication type in which increases in life expectancy are extremely hard to point to all. I think they're almost a "poster child" for medications that correct a problem to an extent but whose overall benefit is quite dubious.

(and given that these medications were highly prescribed before any long term studies were finish - creating considerable incentive for people to find benefit - I'd personally wager they are overall harmful but that's me guessing - the main point is they definitely aren't boost-life-expectancy-by-years drugs but probably aren't reduce-life-expectancy-by-years drugs either, given the studies)

Link from google: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531501/

[pessimizer]

Every few years, the lobby inserts op-eds insisting that statins are of such indisputable benefit and zero side effects that they should go into the water supply. I understand this from the companies themselves, but I have no idea which studies are convincing normal people that this is sane.

There is no lobbying like the lobbying for massively selling classes of drugs of dubious effect.

[daveguy]

I think the distinction there is between immediate cause and root cause. Heart disease and diabetes (or complications thereof) is the immediate cause of death, but what is causing an increase in those diseases is theory at this point.

[orionsbelt]

Is it not clearly obesity? Why everyone is obese is perhaps unclear (although portion sizes, ultra processed foods, screen time and sedentary lives, etc, all seem to likely play a clear role), but I’d be surprised if the level of obesity that exists didn’t cause more heart disease and diabetes.

[safety1st]

Yes. Why is everyone tiptoeing around this? The obesity rate has increased by something like 50% since the turn of the century. It is a major risk factor for all the causes of death being discussed here. Sure there are probably many factors but this is clearly a big one.

[lovethevoid]

Go here https://www.cdc.gov/bmi/adult-calculator/index.html and enter your height and weight. If you fall above the healthy category, you are part of the obesity rate and are what most research points to when it comes to increased cardiovascular risk. Also for asians the numbers are slightly lower.

I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.

[JumpCrisscross]

> when I point this out, people often get mad. They feel they aren't obese

We’ve normalised being fat.

[KittenInABox]

I find obesity a weird problem societally because literature to get people to stop being obese on a population level just kind of sucks. All we know is stuff that doesn't really work. Shaming fat people, pointing out their fatness, or other public pressure doesn't do anything. Strict diets like keto or OMAD don't work on a population level (individuals can get great results but I'm talking enough to statistically move the needle as a population). Ozempic and other injectables seem like the best widespread treatment, but that doesn't tell us any causes.

[orionsbelt]

Is it not the case that as BMI increases the risk increases? My BMI is not healthy - and I don’t deny that makes me subject to increased risk - but I would still think morbidly obese is far worse than obese which is worse than overweight, in terms of risk of diabetes, cardiovascular disease, etc.

[cogman10]

I mostly get mad not because obesity isn't a problem, but because BMI is a bad way to measure it. It may work in the general, but it can give bad information in specific cases.

I'm a good example of how it fails. I have long arms and legs which causes my BMI to be fairly low. However, my body fat is fairly high. I need to lose fat but were I to rely solely on BMI I'd think I'm fine.

What I'd want instead of BMI is body fat percentage. I think that gives a much better measure of health problems.

[BeetleB]

> If you fall above the healthy category, you are part of the obesity rate

No. If you fall above healthy, you are "overweight". You need a higher BMI to be classified as obese.

[thaumasiotes]

> I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.

Depends. All cause mortality is notoriously lower for "overweight" people than "normal weight" people.

[hu3]

My result: 18.5 to 24.9. "Healthy Weight".

I tried adding 10kgs and it said "Overweight".

Seems ok to me.

They even warn that BMI should be used along with other indicators.

[ckemere]

Please correct me if I’m wrong, I believe that for aged women, being slightly overweight predicts longevity?

[pessimizer]

> I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.

"Overweight" is longer-lived than "Normal," and "Grade I Obesity" isn't significantly less longer lived than "Normal." So what you're pointing out is misinformation, which is why people are annoyed by it. There is a case that "Normal" includes more sick and dying people because sick people often lose weight, but the difference still can't be as stark as reddit knowledge makes it out to be.

https://pubmed.ncbi.nlm.nih.gov/23280227/

Conclusions and relevance: Relative to normal weight, both obesity (all grades) and grades 2 and 3 obesity were associated with significantly higher all-cause mortality. Grade 1 obesity overall was not associated with higher mortality, and overweight was associated with significantly lower all-cause mortality. The use of predefined standard BMI groupings can facilitate between-study comparisons.

[hu3]

Yeah if I try to handwave obesity impact on diabetes and cardiovascular diseases to the average cardiologist, they are going to tear me a new one within minutes.

I don't know why is this even a question. Do people really think being overweight is a net positive?

[pessimizer]

https://pubmed.ncbi.nlm.nih.gov/23280227/

Association of all-cause mortality with overweight and obesity using standard body mass index categories: a systematic review and meta-analysis

> Conclusions and Relevance: [...]overweight was associated with significantly lower all-cause mortality.

[watwut]

You gotta go higher in BMI for those to kick in. Basically, where you are within normal and slightly overweight bounds is mostly an aesthetic concern with slight lifespan advantage for slightly overweight people.

When you move toward obese or into underweight category, health problems kick in.

[shadowmanifold]

I am on track to lose about 40lbs in 2024 and I suspect the main variable is really as simple as we have mastered the art of making really incredible tasting food.

It is so pervasive though it is hard to tell until you go on a really boring and restrictive diet. It is just hard to not gain weight on average when the food tastes this good with such incredible variety.

That is even if you buy something at the store. With our "foodie" culture, restaurants are an entire other level of choice and taste on top of that.

[cocothem]

1) Taste is very overrated, IMO. Too much gratification in our society. 2) SALTY is a taste. Once you remove salt and give it a few weeks, you will start finding about tastes you didn't know existed. 3) Once you cook your own food from scratch using quality and healthy ingredients , what you find tasty can change. It has in my case.

[zeroonetwothree]

I don’t think the taste itself is an issue, it’s the availability. If I have to cook a delicious steak every time I want to eat I’m not going to randomly snack all day since it’s quite a process. My food consumption will remain at a reasonable amount. Whereas if I just pull out a bag of $chips from the pantry I could eat the whole bag without feeling sated.

[throwaway2037]

I hope this isn't a throwaway account(!). This is a good post. Can you share what/why it is working for you? The best stories always share small experiments that people tried where they learned what didn't work.

[bluedino]

>> we have mastered the art of making really incredible tasting food.

Corporations have intentionally created incredibly addicting food.

[lovethevoid]

Kind of. The tricky thing here is that most people have a rigid view of "obesity" in their minds as it's easier to shift blame to, but the only thing research has shown is that abnormal BMI leads to increased cardiovascular issues. Which includes slightly overweight people.

[derektank]

Higher levels of body fat (which is almost always the cause of a high BMI unless you are an active athlete) is pretty directly tied to inflammation and pre-diabetic insulin resistance. This subsequently results in the liver producing more triglycerides and lipoproteins that clog the circulatory system and the inflammation itself promotes hypertension. All of this together results in more heart attacks and strokes. There's a pretty clear mechanistic link between obesity and cardiovascular disease.

That doesn't mean obese people are "to blame" for any medical complications they might suffer from obesity. It also doesn't mean that obesity is a death sentence; people's bodies function differently and we've all heard stories of pack a day smokers that lived into their 90s. But there is absolutely a connection between the two.

[llamaimperative]

All those things you mention are almost certainly contributors. Another one for you to investigate if you'd like to get pissed off: endocrine-disrupting chemicals. They are everywhere and many of them are strongly tied to metabolic disorders including obesity.

[dyauspitr]

Wow so ozempic is going to cause expectancy to jump by 10 years over the next decade or so.

[briandear]

What has been the role in demographic shifts?