Number of States with High Rates of Adult Obesity More Than Doubles | Hacker News Reader

Number of States with High Rates of Adult Obesity More Than Doubles

cdc.gov

57 pointsDowwie103 comments

To be clear, it is estimated that >98% of Americans can afford a recommended diet.

The issues are access, culture, education, and time constraints. Innovation in these areas are how we can reduce non-communicable disease and the trillion dollar externality of poor diets.

https://www.nature.com/articles/s43016-022-00588-7

>"The issues are access, culture, education, and time constraints."

I respectfully disagree, because I believe the root issue is physiological/chemical rather than mental. Most obese people know they are living an unhealthy lifestyle and that what they eat is bad for them. Education can only do so much to counteract cravings. I believe the mind over matter approach works for some, but not for the majority of the population.

Beyond the fact that modern prepared and prepackaged food is often engineered to be as desirable as possible, I believe some of us are just naturally more prone to seeking calorie dense foods. This was probably a positive adaptation in past living conditions, but it is now maladaptive in a world of cheap and virtually unlimited calories.

> but it is now maladaptive in a world of cheap and virtually unlimited calories.

I think that's the nice way to put it.

I think it's maladaptive in a world where brand food companies have developed rigorous approaches maximally exploit our normal systems for acquiring and consuming food, and are free to deploy them to increase sales.

In addition, reasonably strong evidence points towards shifts in microbial communities that can induce cravings. Thus, your microbiome can be "addicted" to certain foods and pass that on to you. Intervention at the microbial level may be helpful for some people, including microbiome transplants. However, my impression is that we're still largely stumbling in the dark in this area.

I recall having this theory quite a while ago. Let's say your diet includes eating powdered sugar donuts in the morning. The gut microbes that feed on it become plentiful. Then when you switch out diets, that particular microbe starts to die out. Then as they die, they release a hormone that causes the gut to signal the brain to crave that particular food type, and this is an evolved behavior for that microbe. And after a while of switching up the diet, those microbes finally get purged, and you don't have as bad of cravings anymore.

At least this is the sequence of events that really makes sense (to me), but I haven't read this in any research yet.

I wonder if it is also the case that some feedback mechanism in our digestive tract exists in order to try and preserve those bacterial populations. Perhaps it works in tandem with the signalling you mentioned. The idea seems plausible, but this is just speculation on my part.

Our minds haven't changed. What has changed are external factors (e.g. culture and economic forces). So a causal sociological analysis would see those as the crucial factors here.

It's best, if possible, to attack causes or mechanisms behind problems.

I mean if we assume that we are impotent to change society (e.g. to regulate food companies and advertising companies from encouraging worse diets), then what you say is true. But we are only impotent if we make ourselves impotent, or fail to organize against such external forces.

Looking back on my comment, I feel like I should have clarified that I primarily disagree with the education aspect. Mainly because "education" is thrown around as a nebulous deficiency that implies other regulation/intervention will become unnecessary once people are taught how to eat properly. I agree with you that the causes need to be addressed, and it looks like the way to do that is through regulation of ingredients, additives, and advertising. But truth be told, I do not know what specifically those regulations should be.

From a regulatory standpoint, removal of tax policy which incentivizes corn production would be a start.

Well, I listed multiple factors because they work in conjunction with one another. I never said it was only education. But is education a huge factor? Yes. I can provide literature but a quick Google scholar search is probably faster.

To a degree, I can agree that there are likely a group of people more disposed to seeking calorie dense food do to some chemical balance, mental state.

That being said, the fact that there is such a large obesity disparity between various countries with equal enough access to food suggest to me that this may not be what is causing the population level obesity issues. Do these countries with lower obesity rates, but equal access to food, just have most of their population going around feeling hungry at all times? Or is the idea that the high obesity countries' populations have a genetic markup different from the low obesity countries'?

A lot of comments blaming this on high-carb, sugary foods, but it has to be more than that. Carbs and sugar intake started falling in 2000 and has fallen every year since[1]; this is not happening because people can't control themselves around delicious foods. Obesity continues to stubbornly rise despite the fact that we, as a nation, have all started to eat in ways that are supposed to be healthier. Something else is going on.

[1] https://slimemoldtimemold.com/2021/07/11/a-chemical-hunger-p...

Part 3 of that link is more interesting, seriously looking into the possibility of chemical contamination in the environment: https://slimemoldtimemold.com/2021/07/13/a-chemical-hunger-p...

It’s because we are super sedentary.

During the pandemic, I got my mom walking 10k steps a day with no diet change, she lost a pound a week for a year. Once she stopped, gained it all back.

>It’s because we are super sedentary.

I think about that too. Sitting in front of screens for most of the day, people don't need as much energy as they used to when the tradition of 2 to 3 meals a day was established. I chose to eat just once a day, and still think some more fasting wouldn't hurt.

This is the cheat code. If you have a sedentary white collar job, only eat one meal.

Depending on your weight, walking for 1 hour burns about 300 calories, which is 1 pound ever 12 days. So that is definitely a big factor (on hour walking is about 7200 steps).

It’s quantity first and foremost, of calories and of gas carrying us around rather than our own bodies.

Put in the bigger picture of our capitalist consumer economy, which has been unstoppably growing since the neoliberal policies of the 1970s, it seems like the quite logical result. (As is the fact that there is more information still trying to convince us these are not problems—-e.g. big is beautiful! or coke == happiness—-than who are trying to point us towards solutions, i.e. halting and/or at least slowing the liberal regime.)

I was trying to find data to confirm my belief that people walked less due to the pandemic.

At least in the UK, people took less trips but when they did they walked more (probably less public transit) https://www.gov.uk/government/statistics/walking-and-cycling...

The average London commuter does 10k steps without even thinking about it, and used to do that 5 days a week. I can see total walked miles decreasing across the board during the pandemic, even if walking did become our national sport for a short while (mostly due to being the only time and place you could get drunk with your friends)

At CVS and Walgreens the pharmacy is at the back of the store. To pick up your obesity, sugar intake related prescription you have to walk through aisles filled with Milky Ways, Cokes, Lays Chips and Oreos. Viva La Freedom!

A while back, CVS stopped selling tabaco products because of the health concerns, even though it was very profitable for them. I wonder why they haven't made the same decision for the candy and snacks yet.

Side effects of smoking on non-smokers are more obvious. Candy and snacks can also be defended as "CICO bro", even though sugar is ridiculously addictive and makes proper calorie intake far more difficult.

It looks bad, but since the checkout is in the back, there’s little incentive to go through the line again on the retail side just to get snacks. And they are totally unavailable via drive-through.

No doubt one of the many knock-on effects from a lack of affordable, community-based access to cocaine. Thanks, Reagan!

The Homer Simpson barometer always puts this into perspective. There’s an episode of The Simpsons from the early 90’s where Homer steps on a scale, and it reads 240lbs. It was meant to be a comically absurd number at the time, but the joke falls completely flat now.

In the well meaning and fun spirit of HN pedantry it was 239lbs in Season 1 Episode 10[0] which aired March 25, 1990. By Season 7 (1995) he was trying to get to 300lbs to be classified as "obese" and get on disability[1].

But, to your point, his quote of "239 pounds! Awwww, I'm a whale. Why was I cursed with this weakness for snack treats?" would be nearly insulting to much of an American audience today and the grotesquely obese Homer portrayed from "King-Size Homer" (at 300lbs) would likely need to be used for that joke today.

[0] - http://www.simpsonsforever.com/episodes/quotes/quote.php?id=...

[1] - https://en.wikipedia.org/wiki/King-Size_Homer

https://www.cdc.gov/obesity/data/prevalence-maps.html

Anyone have a link to that report a few years ago that the Midwest is more obese than the South but just not as honest?

https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20451

I'm one of these people. I'm quite fat and got fatter in the pandemic.

I'm looking for a way for me and my family to lose weight. And it looks like we have to look seriously at a workout regiment and cutting out many foods... I don't know if we will succeed.

Does anyone have advice? Thank you.

semaglutide has FDA approval as a weight loss drug and is quite effective

Find an activity you like, and get started. Walk, moderate bike, SUP on lake, snowshoe. Mix it up so it is not a chore and it gets you outside.

I have read that 2/3rds of weight issues is food intake, 1/3 is exercise. I can believe it, because if you look up how many calories are burned walking 30 minutes, it's 80-100 calories. By contrast, there are 150 calories in a can of soda.

If I was overweight, I'd concentrate on the food aspect and forget about exercise, because that's 2 difficult things to change at once. Cut out grains (bread, rice, pasta), sugar, high fructose corn syrup, starchy vegetables (limas, peas, corn, beans, potatoes). Losing weight requires putting the body in calorie deficit so that it has to use fat already stored rather than relying on incoming food calories.

Cut down drastically on carbs and sugar. Take a walk every day building it up to an hour a day.

I wonder if anyone has input on the methodology / presentation of data here. What actually happened is a number of states passed the "35%" threshold they chose. The timeframe is surprisingly short (2018-now), but the actual increase in obesity could be relatively low, and it just so happens that a significant number of states passed that threshold.

To be sure, it's not trending in the right direction. And it's true that the number of states did double in a short time. But the absolute increase could be incredibly small.

To summarize the data about race and ethnicity:

Blacks are the fattest group, followed by hispanics, American indians or Alaska natives, whites, and finally, Asians.

This is easily explainable: blacks and hispanics have the lowest incomes and least healthy diets. Whites and Asians are the opposite.

It's sad that everything at cheap stores like Dollar General is in a package with more preservatives than a Goodyear tire.

I was homeless for three years in Saint Louis (also lived in West/South Chicago for some time) and was the healthiest I ever had been in terms of weight. You don’t have to patronize these places, even in so-called food deserts.

I think the working poor, who do not have any time to pick and choose what they eat, are worse off than let's say me when i was a homeless student with enough time to cook myself salads.

Wasn't in a food desert though, i don't think those exist in my country.

I mean there's still enough time to pick and choose the food that is making people fat...

In my experience, most large grocery stores funnel customers past the produce section first. So, if people simply grabbed the first edible things that they saw. . . However, I have lived primarily in rural and suburban areas of the US, so I don't know if that is generally the case.

That’s the case in nearly every proper supermarket I’ve ever visited on pretty much every continent. The only exception seems to be bodega-like corner stores.

It's the same way in urban grocery stores in the US. Produce is at the front, next to the entrance. Junk food is furthest from the entrance, in the back row of aisles.

I assume the grocer logic is something like "make them walk past and consider all the other stuff before they get to what they really want (junk food)"

I was able to eat mostly fruit and veg for free from food banks that took maybe 15 min a day to visit. I also was not slovenly not working, I just didn’t have good habits to get out of my situation thanks to extreme mental illness and addiction. (Both of which are thankfully well under control now.)

How did you cook a salad.

A cheap diet can be healthy. Rice, beans, eggs, apples are some of the cheapest items in the store.

Apples aren't cheap. Fruit in general isn't cheap for the macros, arguably not even for the micros (competes with vegetables there).

A pound of apples costs about $2, usually less. For that you get around 10 grams of dietary fiber, or nearly half of the daily recommended intake, plus substantial amounts of vitamin C and potassium. Not the cheapest thing on the shelf (vs cabbage/beans), but with convenience and taste factored in it can be a very practical choice.

And how expensive are, say, carrots? Apples here are 2 eu per kilogram. Carrots are the same price out of season, and carrot season is coming. From what I can tell, carrots beat apples on most benchmarks, except for having to prepare the things.

If dietary fiber is your concern, switch to brown rice and eat some more.

I have no clue what typical vegetable or fruit prices are in the US, but both here and in most Asian cultures known for low obesity rates, fruit is more expensive than alternatives. I don't expect mass produced fruit to break the bank, but realistically it's one of the larger costs.

> Apples aren't cheap.

A $2 bag of apples gives me snacks for a week. A $2 bag of chips gives me snacks for a day.

Nice strawman. Compare with raw vegetables please. Not salted, deep fried, prepackaged ones.

Fruit are snacks, so I compare them with snacks. But sure, a bag of carrots is cheap snack too.

https://www.smithsfoodanddrug.com/search?query=apples&search...

> Access denied

Why are grocery store websites like this?

Anyway I just got back from the store. I bought: 2 pounds of pears ($3.50), 1 pound of carrots ($0.90), 1 pound of celery ($2.00), 1 pound bag of chips ($3.50)

What does that prove? Not much, except that fruit seems to be in the price range of vegetables, and I wouldn't characterize either of them as expensive. The celery was a bit more expensive than the pears, and the carrots were 50% cheaper. Both fruit and vegetables are cheaper than junk food, so if you can afford junk food you can afford fresh food too.

Especially if you change up which fruit you are eating depending on the store’s sales. My local store almost always has some berry or grape for $2 a pound.

Assuming you don’t live in a food desert.

Only 8% of the American population live in what could be qualified as a food desert.

So _only_ ~29 million people.

Edit:

What is your 8% source? 12.8% according to the USDA.

https://www.aecf.org/blog/exploring-americas-food-deserts

The statistics here are saying anywhere from 30-50% of each American state's population is obese so yeah I'm gonna venture to say food deserts are not the culprit here

Edit: Looks like the AECF link might've been edited as the Google preview said 8% - indeed is 12% on the same link. USDA says 10%: https://www.usda.gov/media/blog/2011/05/03/interactive-web-t...

The start of this thread was about unhealthy diets specific to poor minorities.

And still vast amounts more of poor minorities are obese than live in food deserts.

Sorta. Half of "Rice, beans, eggs, apples" have a 6+-month shelf life, and the other half will keep for a month in the fridge. Getting to a "real" grocery store ~12 times a year is much lower a bar than getting to one weekly or more.

But then requires the time to cook them

If you account for travel you save a ton of time by cooking at home.

And rice in an instapot is perhaps the easiest thing ever.

But not quite as quick as the microwave or McDonald’s.

More importantly, unhealthy food is more expensive than people think. Walmart sells the "party size" Doritos, 14.5 oz, for about $5. For that you could get two pounds of rice and two cans of beans. Meanwhile, McDonald's is now charging $6 for a breakfast meal, and more than that for dinner.

Unfortunately, people often try to cook healthy, but they impulse eat unhealthy. Bulk sugar and oil are indeed some of the cheapest foods on the shelf. It does nobody any good to buy them at a substantial markup inside processed foods.

This may have as much to do with cultural staples as available food options. What constitutes a typical meal in a Black family is quite distinct from what constitutes a typical meal in an Asian family. As an example, soup (from a variety of bases), is a staple meal for the latter and quite a rarity for the former.

Or that the cultures in each racial group have different diets of wildly different nutritional value. No one is making anyone overeat.

It's not so simple. Asians for example are genetically predisposed to being lean (https://www.nature.com/articles/s41598-019-46960-9), so we "seem" healthier. However, that can be deceptive because Asians tend to have less fat and more muscle than other ethnicities and are predisposed to higher rates of type 2 diabetes at lower body weight (https://www.cdc.gov/diabetes/library/spotlights/diabetes-asi...).

So even though Asians might "look" healthier, it doesn't all come from a difference in diet and even BMI ratios can be a deceptive measure of health.

It's a multi-variable analysis and can have confounding factors.

That’s a reasonable explanation for the spread across racial groups. But that spread has existed for a long time. There are other even more important phenomena to explain, like (1) why is it going up across all (or most) groups and (2) why are there geographic disparities?

Wouldn't geographic disparities be easily the result of the accessibility of food and government assistance programs in that region?

It could also easily be the historic cultural dietary trends of that geographic region (e.g., I suspect moonshine is still predominantly consumed in Appalachia, although that is primarily due to past government policies, and cheese curds near the Great Lakes).

I believe the effect of race persists even controlling for income?

Perhaps relevant:

"Consistent with our results, it has been shown that FADS genetic variants have a stronger effect on PUFA metabolism in African Americans than in Americans of European descent as a result of differences in genotype frequencies." - Genetic Adaptation of Fatty-Acid Metabolism: A Human-Specific Haplotype Increasing the Biosynthesis of Long-Chain Omega-3 and Omega-6 Fatty Acids https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3376635/

Darker skin also needs way more sunlight UV in northern climates to stimulate vit-D (lack of which helps ‘cause’ obesity). It’s a tragedy that sunscreen is being marketed to these folks now.

I wonder how the field would split if you divided "Asians" into subgroups.

I haven't yet seen an obese Vietnamese person, but Indians seem to be exploding out of their pants faster than anyone else.

Obesity is also correlated with much lower rates of fertility due to downstream health impacts.

In the long term Darwin would suggest it’s self correcting assuming our environment of unlimited food and low cost sugar remains intact.

So more states have more people with more fat on them?

Or perhaps more scientifically put: the prevalence of states with a high prevalence of inhabitants with a high prevalence of fat cells is increasing.

what is the end outcome of this. We have known about adult obesity rate for decades now, yet the wrong numbers keep getting higher. At what point does this become unsustainable?

I'd bet on a small-molecule GLP-1 agonist being the most likely path out. Certainly more likely than a nation wide overhaul of diet/lifestyle.

All we can hope the side effects won't be too bad.

Yeah in the US we’d never curtail industrial food profit to overhaul the state of store shelves being full of easily consumed crap packaged in plastic waste of enormous energy and material cost.

The health side effects are not the only outcome of concern with our eating habits.

Why are we not already using them? Because they're subQ injections? Supply issues? Side effects? They are already proven effective, why is every obese/overweight person not given a script? We could solve the crisis within a year

Before recently most GLP-1 agonists only gave a small amount of weight loss, and they've typically only been approved for type 2 management.

Mounjaro from Eli Lilly though shows great promise with an average weight loss of 50 pounds per participant. It's been approved for type 2 management, but they've also submitted it to the FDA as a weight loss drug.

On the first month on the lowest dose (no exercise), I lost 15 pounds.

The good side is the injection is mostly pain-free, and easy to administer. You will feel a little prick, but it feels mostly like getting a burr stuck to your skin.

The downside is it's $1000/month. Most insurance won't cover it yet. It also makes maybe more sense when insulin costs $5000/year or more. Right now there's a coupon which makes the co-pay $25 but that lasts for only 3 months.

Side effects for me were decreased appetite (which is a good thing), low level nausea, and constipation. All of which were not deal breakers for me.

They're injections, which reduces patient compliance, and they're peptides, which are costly to produce.

Unsustainable? Probably never. It’ll have noticeable effects but it’s hard to imagine this becoming a hard upper bound on things

> what is the end outcome of this.

Rising revenue for healthcare treatment of symptoms. Reduced entrance requirements for military recruits. Shorter lifespan so less pension payments.

Solutions: Food security. Taking processed foods out of the American diet as much as possible. Permaculture. Basic income, basic food, basic housing, basic medical.

"The future is here it's just not evenly distributed yet." -William Gibson

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