[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.

[sundvor]

Still remember my first time ever setting afoot in USA, Newark airport coming from Norway, in 1999, going to a tech conference.

I saw more grossly obese people at that airport in the first ten minutes than I had back home in probably the previous year. It really stood out to me.

It must be your general dietary makeup and lifestyle. All that corn syrup. Also, I don't see any reason why it would have gotten better since then.

Just calling a spade a spade from an outsider's perspective..

[JumpCrisscross]

> must be your general dietary makeup and lifestyle. All that corn syrup

It’s not just America [1].

Norway’s obesity rate runs at roughly half America’s [2]. But the trend across the world is increasing rates of overweightness, obesity and--most worryingly--child obesity.

[1] https://news.ycombinator.com/item?id=41634611

[2] https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...

[sundvor]

It's been a minute since then, I've been in Australia for the past two decades as well - and yup, the trend is bad almost everywhere.

Having read (well, listened to) Attia's excellent OUTLIVE, I've reversed my own (slowly turned bad) trajectory by switching my diet to the basics - all home made meals, making my own breads, lots of milk and eggs, meats (not in excess), exclusively extra virgin oil and pure butter in my cooking (zero blends/veg oil etc), and not buying any (sugar) snacks - combined with exercise. Oh and no alcohol for the past few years either - sacrifices had to be made. :-)

Luckily my own kids are showing zero signs of obesity, they are very healthy.

[watwut]

People hate fat people. Everywhere I look, everyone is obsessing with diets and weight. People go to unhealthy extremes to try to loose weight, then predictably fail and cycle.

Disordered eating is a norm and being ashamed is a norm.

[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.

[Teever]

We're not making movement on this because we're not calling it what it is -- an addiction.

We dance around it and call it 'obesity' but the real medical cause of obesity is an addiction to unhealthy food.

This is compounded by the fact that it is completely legal for people to make their food more addictive and therefore unhealthy and advertise it to addicted people with underhanded marketing techniques that take advantage of their addiction.

Until we recognize this as an addiction issue that is compounded by dealers being able to operate with impunity we won't make any headway -- short of technological advancements like Ozempic that allow people to side step their addiction.

[fwip]

To the best of my knowledge, there's actually no diet that has been proven to yield long-term weight loss. (There are of course individual success cases.)

[Enginerrrd]

There are tons of diets that have been proven to work. Getting people to adhere to them long-term is the problem.

[watwut]

The issue is that people able to keep doing them long term end up in hospitals diagnozed with eating disorders.

As in, inability to keep them long term is biological defense of organism that does not have genetic predisposition toward anorexia.

[a-french-anon]

> Shaming fat people, pointing out their fatness, or other public pressure doesn't do anything.

Says who? Are you implying that true societal shame is still being enforced right now, without hundreds of refuges in the form of safe spaces and social justice advocacy groups? I'm pretty sure that such shame worked pretty well in the past, and still does in countries like Japan.

In the end, you'll just have to realize that the root issue you're facing is decadence, and that's there's no fighting it.

[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.

[Izkata]

Not strictly. Over the past few decades I've occasionally but regularly seen evidence that "overweight but not obese" (BMI 25-30) might actually be healthier than a normal weight (BMI 18.5-25). In those studies obese did have a worse outcome than both.

IIRC mostly they had to do with seasonal sicknesses like the flu, the theory being that your body can burn the extra fat during periods you aren't able to eat well.

[throwway120385]

That's essentially what "morbidly" means.

[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.

[vundercind]

Really smells like one of those “some alcohol is healthier than none” things where there’s a subset of the otherwise-healthiest group that’s in the otherwise-healthiest group because they’re very sick.

[watwut]

Normal weight and overweight were determined by percentage of population at some point. The boundaries are not about lifespan, they never were.

[thaumasiotes]

Why? "Overweight" and "normal weight" weren't determined by reference to what's better.

[vundercind]

A big 30-year Danish study that seems to be one of the main ones referenced for this purpose sure appears to be doing exactly what I worried it was: measuring the predictive power of BMI for mortality, not the healthiest weight for someone to maintain, which are different things. I see nothing in the abstract & methods about correcting for sick people tending to lose weight, and the healthiest BMI creeping up over time as mean population BMI increased, plus the U-shaped mortality curve, really do look like what you’d expect to see if they’re not accounting for that.

[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.

[pessimizer]

Mechanick, J. (2013). “What If” Being Overweight was Good For You? Endocrine Practice, 19(1), 166–168.

https://doi.org/10.4158/endp.19.1.50042678317gx698

The evidence that being overweight is healthier is a bit dubious, but the evidence that having a "normal" BMI is healthier than "overweight" is nonexistent.

[ckemere]

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

[watwut]

In anyone afaik. The healthiest weight is to be slightly overweight. The worst results are for underweight people and for obese people. The curve makes nosedive in its ends.

[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.