patrick.net

curious2 says

Also a really significant number of kids are overmedicated, including anti-psychotics prescribed to children as young as three, thanks to CHIP and other government programs that have made prescriptions increasingly profitable. (See also here, though it's behind a paywall.) The children of poor families are at worst risk of these "benefits" because the parents tend to lack the education to say no.

The doctors should be using appropriate judgement by not prescribing excessive medication. Many doctors just don't care. :(

Strategist says

curious2 says

Also a really significant number of kids are overmedicated, including anti-psychotics prescribed to children as young as three, thanks to CHIP and other government programs that have made prescriptions increasingly profitable. (See also here, though it's behind a paywall.) The children of poor families are at worst risk of these "benefits" because the parents tend to lack the education to say no.

The doctors should be using appropriate judgement by not prescribing excessive medication. Many doctors....

are under extreme pressure directly and indirectly from drug companies. Doctors complain that patients lie to get permission to buy drugs that are advertised DTC including on TV. Drug companies have also paid doctors and provided other incentives, and research has found that even a "free" lunch and some logo products (e.g. pens) can have a significant effect on prescribing patterns. Drug companies can run politicians too, and the ambitious overachievers that set regulatory policy, resulting in "mandatory continuing education" that tends towards drug company informercials. With the increasingly heavy regulatory and insurance overhead, many doctors find they can't even continue to practice on their own anymore, and must surrender to corporate employment, which can have its own pressures. Many doctors are struggling to cope within a broken system where they get all the blame despite having less and less autonomy.

Thunder lips, if you Google flegal bmi smoking , you will see that the studies she included controlled for smoking in some way, but there is controversy about whether it was done well. When never smokers healthy people (exclude those who did in first four years) are looked at separately lower bmi, the paradox goes away. Another researcher split normal weight people into two groups (stable normal and people who used to be overweight or obese) the stable normals also lived longer than the weight losers. This is because many of the weight losers are already sick and that is why they lost weight.

Strategist says

People weren't so fat 50 years ago. Why are so many kids so overweight today? It's the sodas, burgers, fries, and donuts.

curious2 says

This. I have seen many "greatest generation" lean guys continue working into their 80s and 90s, while fat boomers suffer expensive medical problems and in some instances die younger than their parents did.

Yes, the outliers of that generation were alive and lean. There were plenty of big fat Sicilian guys who dropped dead of a heart attack at 45 in the 1960s, Spaghetti fork in hand. Fortunately in those days, people had kids young so their children were pretty much grown up by then. tPeople born in 1920 didn't live to see 65 on average.

Cheap generic water pills and blood pressure pills, and the widespread use of Heart Bypasses is a big factor in later generations' survival.

curious2 says

Also a really significant number of kids are overmedicated, including anti-psychotics prescribed to children as young as three, thanks to CHIP and other government programs that have made prescriptions increasingly profitable. (See also here, though it's behind a paywall.) The children of poor families are at worst risk of these "benefits" because the parents tend to lack the education to say no. Also the corn subsidies have the effect of reducing the prices of the most unhealthy processed foods. Also the advertising of junk food and fast food shifts demand away from healthy food and towards foods that are engineered specifically to maximize consumption; for example, an apple is better in every way than a bag of Skittles, but kids willingly pay more for the Skittles, "as seen on TV."

Thus "Diet Snacks" which are almost always Corn-Soy based and Insulin Spiking. I've seen people consume 300 Calorie bags of these while on the Treadmill going at an Old Lady's pace, sporting a sizable paunch and no muscle mass and seem to lose not one pound. Day after day. They are convinced they are making super healthy habits.

And the snack food/fitness industry is happy to have them on the low-fat snack endless treadmill hamster wheel. $$$ every month.

The walking probably isn't hurting them any, though they would get more cardio exercise in half the time if they sped up the walking 200%.

I would like to see some comments on the fact of the Obesity Paradox, that being overweight is marginally better for your health against the most common causes of death (and contributing syndromes like diabetes), than being average/lean.

Ironman says

Oh no... looks like you're screwed...

You missed the point about most people who lose weight do it because they are sick, or don't keep it off. I do think that the dangers of being fat are cumulative. You can't be fat all of your life, lose weight, and then be fine. Like smoking or working in a coal mine, quitting helps, but doesn't undo all of the damage.

YesYNot says

You missed the point about most people who lose weight do it because they are sick, or don't keep it off. I do think that the dangers of being fat are cumulative. You can't be fat all of your life, lose weight, and then be fine. Like smoking or working in a coal mine, quitting helps, but doesn't undo all of the damage.

This. Also there is the Loose Skin problem, somebody Class II Obese or even Class I if they have bad genetics, who goes down substantially to a healthy weight, can end up with pounds and pounds of loose skin. And often look better fat than with folds of loose skin dangling from their body.

Ironman says

Are you saying that these babes are hot?

Imagine them if the bellies didn't stick out, but the skin folds hung down like curtains.

This chef lost 150lb via dieting, and he's not an old geezer. Without surgery, his 10lb of loose skin ain't going nowhere.

Here's a link of a guy who also lost 100lb. His loose skin that formerly held his belly fat now folds over his nuts almost down to his knees. I won't put it up as to spoil anybody's lunch.
http://www.sciencephoto.com/media/522413/view

well, the MSM and those shows on television with females hosts all promote girls as being heavy hefty honeys like the one on sports illustrated. then they turn around and skinny shame other females for being too skinny. what a bunch of HIPPO Hippocrits.

I guess since most girls can't be thin anymore just give in and make them fell comfortable being fat pits! like the cuties in the profile just above this. They are GORGEOUS!

oh, and when the four ladies (i think they are human) kids grow up and see this pick they reply will probably be, "you were so thin mommy" oh my lord !!

YesYNot says

So, it's not a yoyo thing.

Ironman says

I don't think yo-yoing up and down from diet to diet is good for you overall. That puts stress on your body and your systems can't stabilize. That's what you've done.

I have no reason to lie. I've spent 95% of my life in the normal weight range and very active. I spent a couple of years working too hard and being 10 lbs overweight. I changed my diet once and returned to my normal weight (bmi between 22 and 24). That's not yoyoing or going from diet to diet. It's a rational person's response to aging and life changes.

thunderlips11 says

Do Obesity Stats control for an aging population? In 1970, most of the population in US/Europe was under 40.

I think thunderlips brought up a key point here. If a chart of mortality=f(BMI) contains only one curve that covers all ages, then clearly part of the excess mortality at higher BMI must in reality be an age effect and not a BMI effect (because BMI tends to increase wih age, the higher-BMI persons in the sample tend also to be older and have higher mortality for that reason, and not just because of more fat on their bodies).

YesYNot says

You keep saying this, but: ( plots of mortality=f(BMI), and healthcarespending=f(BMI) follow ).

Your example of invoking healthcarespending=f(BMI), which is your 2nd plot, is a particularly clear example of not understanding the difference between correlation and causation. Your claim is that high BMI is unhealthy, because, look!, high BMI correlates with higher healthcare spending per person. You are completely ignoring that high BMI also has a positive correlation with age. There is a large statistical causation between age and healthcare spending, There is almost certainly also a causation between high BMI and higher healthcare consumption, but it is completely wrong to attribute the full healthcare consumption rise just to the BMI. This is what thunderlips has been trying to tell you.

By other applications of the same flawed logic, higher BMI also causes forgetfullness, thinning hair, glaucoma, Alzheimer's, racism, xenophobia, favorable views of torture, and (you guessed it) voting Republican.

thunderlips11 says

I gave three photos of 5'10" guys who are well into the "Overweight" range, and aren't bodybuilding or Olympic Weightlifting contestants by a long shot, just fit.

Average Joe at 5'10" or 5'9" and 190lb has a little pudge, you could pinch an inch. But healthwise, Joe presents negligible cost or mortality risk to society or himself even if he wasn't built.

Agree. Also, BMI is a very bad predictor of body fat percentage, which is the much more interesting indicator of overweight. If a male has a half-decent amount of muscle, the BMI quickly gets quite high even for persons with moderate body fat. Myself, I can easily get classified into the "obese" BMI range unless I insist on taking off my shoes and most of my clothes when weighing in at the doctor's office. While I'm hardly a sylph and should lose 20 lbs, I'm not "obese" either.

This whole weighing/BMI thing is a bit of peeve of mine, because if Obamacare ever gets repealed I will have to watch like a hawk on the weigh-ins or else my insurance cost would double.

justme says

Your interpretation of healthcarespending=f(BMI), which is your 2nd plot, is a particularly clear example of not understanding the difference between correlation and causation. ...

Health care costs are higher for overweight people within age brackets. It is true that overall, middle age people are fatter and sicker than younger people, and it is also true that both age and weight influence cost. However, it is also true that overweight middle age people are more expensive than normal weight middle age people. If you follow the link, you will see that the health is better and cost is lower within each age group for normal weight people.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637212/

Excess body weight increases the burden of age-associated chronic diseases and their associated health care expenditures
Vincenzo Atella,1,2 Joanna Kopinska,1 Gerardo Medea,3 Federico Belotti,1 Valeria Tosti,4 Andrea Piano Mortari,1 Claudio Cricelli, MD,3 and Luigi Fontana4,5,6
Author information â–º Article notes â–º Copyright and License information â–º
Go to:
Abstract
Aging and excessive adiposity are both associated with an increased risk of developing multiple chronic diseases, which drive ever increasing health costs. The main aim of this study was to determine the net (non‐estimated) health costs of excessive adiposity and associated age‐related chronic diseases. We used a prevalence‐based approach that combines accurate data from the Health Search CSD‐LPD, an observational dataset with patient records collected by Italian general practitioners and up‐to‐date health care expenditures data from the SiSSI Project. In this very large study, 557,145 men and women older than 18 years were observed at different points in time between 2004 and 2010. The proportion of younger and older adults reporting no chronic disease decreased with increasing BMI. After adjustment for age, sex, geographic residence, and GPs heterogeneity, a strong J‐shaped association was found between BMI and total health care costs, more pronounced in middle‐aged and older adults. Relative to normal weight, in the 45‐64 age group, the per‐capita total cost was 10% higher in overweight individuals, and 27 to 68% greater in patients with obesity and very severe obesity, respectively. The association between BMI and diabetes, hypertension and cardiovascular disease largely explained these elevated costs.

justme says

thunderlips11 says

Do Obesity Stats control for an aging population? In 1970, most of the population in US/Europe was under 40.

I think thunderlips brought up a key point here. If a chart of mortality=f(BMI) contains only one curve that covers all ages, then clearly part of the excess mortality at higher BMI must in reality be an age effect and not a BMI effect (because BMI tends to increase wih age, the higher-BMI persons in the sample tend also to be older and have higher mortality for that reason, and not just because of more fat on their bodies).

This is not how any of the research works. There are loads of studies that correct for age, physical activity, alcohol intake, smoking, etc. Nobody is holding up correlations that do not adjust for age. The issue is that with enough data, it is easy to correct for things that don't correlate strongly, but it is hard to adjust for things that do correlate strongly (like smoking and weight). So, people get different results when they regress all data and correct for smoking (Flegal) than when they just regress data after excluding everyone who smoked or was sick when the study began.

What is not correlated with age is the percent of the country that is obese. But it has grown so much that it doesn't really matter. You don't go from 10% obese to 30% obese just because the baby boom is at peak fat years (late middle age).

www.youtube.com/embed/RBKM3b7phJc

Ironman says

Yep, it's actually the majority of the Gen Xers that are the most obese, not the baby boomers:

While your chart is helpful, your analysis is off as usual. Boomers are 50-70 at the moment. They represent more than 1/3 of the 40-60 group. Plus, the 60+ group is thinner in part b/c the fatter oldsters have died off and the surviving ones are shrinking with age.

Ironman says

When you have a population of teenagers (who should be in the best condition of their lives), and just about 20% of them are considered OBESE (not just overweight), tell me what does that do for the future of healthcare in the country.

Health care and the military. What's a bigger long term threat to US military power, ISIS or running out of fit people to serve in the military?

YesYNot says

Health care costs are higher for overweight people within age brackets. It is true that overall, middle age people are fatter and sicker than younger people, and it is also true that both age and weight influence cost. However, it is also true that overweight middle age people are more expensive than normal weight middle age people. If you follow the link, you will see that the health is better and cost is lower within each age group for normal weight people.

Overweight or Obese? Again, the Obesity Paradox shows that Overweight (25-30BMI) is healthier than average, with better health outcomes from the major causes of death like heart disease and cancer.

YesYNot says

This is not how any of the research works. There are loads of studies that correct for age, physical activity, alcohol intake, smoking, etc. Nobody is holding up correlations that do not adjust for age. The issue is that with enough data, it is easy to correct for things that don't correlate strongly, but it is hard to adjust for things that do correlate strongly (like smoking and weight). So, people get different results when they regress all data and correct for smoking (Flegal) than when they just regress data after excluding everyone who smoked or was sick when the study began.

Which ones do and which don't? Did the EU study correct for Age?

Even in Europe it's not at all unusual to see Overweight-Obesity Class I people over 55.

thunderlips11 says

Which ones do and which don't? Did the EU study correct for Age?

If you read through some of the abstracts and summaries I pasted in this post http://patrick.net/?p=1290424&c=1277827#comment-1277827, you will see that many do correct for age. I believe the rest do too, but I didn't look for that when copying results.

As far as the EU study goes, I assume you are talking about the cost study. This article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4637212/) was written by the same person who wrote the article with the cost/bmi chart. If you follow the link, you will see that overweight is more expensive and has more disease than normal bmi in each of the age groups.

thunderlips11 says

Overweight or Obese?

Overweight is more expensive than normal bmi. Just look at the link in my last post.

YesYNot says

Overweight is more expensive than normal bmi. Just look at the link in my last post.

Maybe - but chart is from Europe and it doesn't look like it's adjusted for age.

But overweight is healthier. Scientists and Mathematicians have spent more than a decade trying to debunk the research and have conducted hundreds of studies and many metastudies, and almost all of them confirms it, and those that don't generally find no difference in health outcomes.

thunderlips11 says

Again, the Obesity Paradox shows that Overweight (25-30BMI) is healthier than average, with better health outcomes from the major causes of death like heart disease and cancer.

Only if you include smokers and sick people.

YesYNot says

Only if you include smokers and sick people.

So average weight smokers are healthier than non-smoking overweight people?

Source controlled for age and addictions?

Obesity is out of control; why?

This is an easy one

Carbohydrates

Next

Wish they had a chart for Sugary Drinks like Lattes, and Diet Snacks made from Soy-Corn.

thunderlips11 says

So average weight smokers are healthier than non-smoking overweight people?

Source controlled for age and addictions?

Smokers are thinner than nonsmokers. The normal weight category is burdened with a higher percentage of smokers than the overweight category. People who are already dying (e.g. cancer patients) are also thinner due to their battle with disease (e.g. chemotherapy). Flegal used articles that controlled for smoking in some way, but there is disagreement over how accurate the control methods were. If you just get rid of the people who used to smoke, and look at people who have never smoked, there is no obesity or overweight paradox. Look up Flegal and Willet. It's an interesting debate.

I happen to agree with Willet that the balance of evidence is that normal bmi is healthier in general. But it is only one of many risk factors. Waist circumference to height is probably better. Diet and exercise and bloodwork are important as well. On top of probably being less healthy, for the young / middle age, being overweight is often a stepping stone to being obese.

Ironman says

Portion Distortion

Definitely a factor.

thunderlips11 says

Sugary Drinks

"Calories don't count if I drink it!"

When my mom was a kid in the 40s and 50s, Soda was a desert item after Sunday Dinner or maybe on a Summer Outing. Other than that it was never served.

YesYNot says

I happen to agree with Willet that the balance of evidence is that normal bmi is healthier in general. But it is only one of many risk factors. Waist circumference to height is probably better. Diet and exercise and bloodwork are important as well. On top of probably being less healthy, for the young / middle age, being overweight is often a stepping stone to being obese.

Perhaps - we'll certainly get more clarity in the next 20 years as my generation consists of far fewer smokers.

Speaking of Wiley, came across this graphic which is tied to some of his research, just as you mentioned it:

It's funny how low carbers throw out all observational studies that they disagree with even when the studies are well done, repeatedly state that correlation is not causation, then throw out a plot of obesity with a point when the low fat guidelines came out. When the plot is in their favor, correlation = causation regardless of how thin the evidence is.

Nobody is on a low fat diet. As your graphic points out. They just drink more sugar and have more sugar added to things like pasta sauce.

http://wholehealthsource.blogspot.com/2012/09/more-thoughts-on-macronutrient-trends.html

YesYNot says

It's funny how low carbers throw out all observational studies that they disagree with even when the studies are well done, repeatedly state that correlation is not causation, then throw out a plot of obesity with a point when the low fat guidelines came out. When the plot is in their favor, correlation = causation regardless of how thin the evidence is.

It's funny how high carbers refuse to consider that the people with some of the worst health outcomes in the world are huge carb eaters who lather on the ghee and vegetable oil, and the healthiest are largely pescatarians, including several (France, Norway) that consume large quantities of diary. Almost all (Greece, France, Norway, Japan) use conspicuous amounts of salt, either by pickling vegetables, in soy sauce, etc.

thunderlips11 says

People born in 1920 didn't live to see 65 on average.

PatNet has had some excellent tables on the history of life expectancy, I will try to find them. Bottom line though, most of the change occurred in childhood mortality, due mainly to vaccines and potable water, and reducing childhood mortality has a dramatic impact on life expectancy at birth. In contrast, 50 years of Medicare, spending trillions of USD, has had only a modest effect on life expectancy at 65, around three years. Even to the extent that people in that cohort are living longer today, it's mainly due to fewer people smoking. I used to listen to a lot of old radio, and I lost count how many ads claimed that doctors recommended a particular brand of cigarettes for my "T Zone." (I knew a doctor who started his practice in those years, but he smoked a different brand, until around the time the Surgeon General told everybody to quit.) In terms of life expectancy, the Surgeon General's warning in 1955 did about as much as Medicare in 1965, and at far lower cost. Government can be really useful when it supports research and evidence-based decision-making guidelines, but it can swiftly become a double-edged sword when it enables chronic revenue models and gets captured by the resulting industrial complexes, e.g. military-industrial complex and medical-industrial complex.

Hmm, the very website you posted has this chart:

It seems to me that if ~2/3 of the macronutrient calorie increase in coming from Carbs, that is primarily what we should be worried about vis-a-vis the Obesity Epidemic.

We should be spending 2/3 of our efforts getting people to consume less (refined) Carbs, and only 1/4 of our energy/funds on reducing fat.

thunderlips11 says

It's funny how high carbers refuse to consider that the people with some of the worst health outcomes in the world are huge carb eaters who lather on the ghee and vegetable oil,

I don't know of anybody who advocates lathering on ghee and vegetable oil, but those wouldn't be classified as high carbers. They're just vegetarians.

Ironman says

I stopped drinking soda long time ago, just because of the sugar content.

I betcha a Big Mac that the majority of the massive increase in Carb Calories is coming from sugary drinks and 'diet' low-fat snacks packed with corn syrup, corn, and soy.

thunderlips11 says

It seems to me that if ~2/3 of the macronutrient calorie increase in coming from Carbs, that is primarily what we should be worried about vis-a-vis the Obesity Epidemic.

If that were the only piece of information we had to go by, I would agree with you.

YesYNot says

I don't know of anybody who advocates lathering on ghee and vegetable oil, but those wouldn't be classified as high carbers. They're just vegetarians.

Indians have some of the highest rates of heart disease in the world, even when they live in the US, even versus Blacks. US Indians are far more likely to be Vegetarians than any other ethnic group, probably at least half of US Indians are vegetarians.
http://www.thehindu.com/news/cities/Coimbatore/coronary-artery-disease-on-the-rise-in-coimbatore/article8379180.ece

http://blogs.wsj.com/indiarealtime/2016/01/26/researchers-seek-clues-to-heart-disease-in-indians-south-asians/

YesYNot says

If that were the only piece of information we had to go by, I would agree with you.

Well, the own charts above either show a slight decrease or no change in fat consumption. Yet obesity has exploded (age?) and carb consumption is on a strong uptrend since the 1970s-1980s

Of course, the problem with looking at fat and carbs is, how much is from healthy fat like butter and red meat, and how much is from unhealthy fat like margarine or vegetable oil. Most Diet Snacks, French Fries, etc. are also saturated with Vegetable Oil. And carbs, how much is from refined carbs and sugar.