Eastern societies have different ways of dealing with things than Western, and that’s ok. A person should not feel humiliated, but that’s a relative feeling by culture - the law seems to be working for them.
I am obese myself - whenever I visit Asia (China, Japan, Vietnam, India etc.), the difference in diet and daily walking lingers on for a bit back here in the US but I regress to the ‘cultural mean’ here very soon. At least I know I can change my habits when the right support system is around me.
I’m older, less stressed and (hopefully) wiser than I used to be but still: I stop, but keep coming back to it for a couple of months after a longer break, because this behaviour is so deeply ingrained in my upbringing and in the culture of my new home. And there are so many socially accepted triggers. I am aware that ultimately this is my own responsibility but it’s hard.
I know that I can’t fully compare obesity to nicotine addiction, these are all complex states/behaviours but I feel like the social and cultural aspect is similar in some ways.
Familiarity with the environment matters so much. An example would be the percentage of Vietnam war veterans who suffered from heroin addiction during deployment but ceased using after coming back home (it was ridiculously low compared to people who lived and used in the same country.
[1]https://www.express.co.uk/life-style/health/1733624/obesity-...
As someone with a couple doctors in my family, that's BS if talking about any competent doctor. No, doctors may not say "You're super fat and better eat less", but that's because they're generally not assholes, not because they're "tip-toeing" around obesity. On the contrary, for many decades most doctors would say the same thing: "You're overweight. You have bad lab numbers (e.g. high A1C, high cholesterol, etc.) You need to diet and exercise."
Of course, that advice obviously made no difference at a societal level (Americans only got more obese) largely because of things pointed out in this article: cultural impacts of things like standard portion sizes, favored cuisines, ease of walking instead of needing to take a car everywhere, etc. swamped any once or twice a year advice of "you're overweight and need to diet and exercise more".
This would be reasonable advice for most people, but falls flat when a doctor completely ignores a patients circumstances.
This kind of lazy advice is commonly given to women, and more so to women of color. As a result, I’m very leery of describing all cases of disgruntled patients “sensitivity”.
The thing that you are misunderstanding is that people don’t want to be humiliated about their weight. It isn’t that they want to be fat, but that they don’t want to be thought of as disgusting or “less than human” for being fat.
In fact, most people who struggle with their weight have worked harder to try to lose it than you can imagine. If you think “just eat less and move more” is something they’ve never heard before, you’re living in an alternate universe. It’s not always quite that simple; people have baggage, trauma, genetics, and so on.
It’s not that they’re proud of being fat. It’s that they’re proud of who they are despite their weight, not because of it.
The issue with doctors isn’t that they can’t tell patients they are obese and need to make dietary changes or lose weight; it’s that people will come in with unrelated issues and doctors will refuse to look past their weight to diagnose what the underlying issue might be, using weight as an easy answer to blame it on. Sometimes it’s weight; but sometimes it isn’t.
The goal of those ads (which I agree there are too many of today) is to help people hate themselves a little bit less. There’s a reason obesity is often comorbid with suicide.
But shaming is effective. There are of course fat Japanese people, but for the average person, shame is an effective deterrent against weight gain. That makes sense. Food doesn’t act on people’s rational senses. It targets pleasure centers. The cold logic of non-judgmental medical advice is powerless to do anything against that. Medical professionals, after all, are nearly as likely to be overweight or obese as the general population. Shaming, by contrast, targets a different, more primitive part of the brain. People will change their behavior in an effort to avoid shame in a way they won’t for abstract good advice.
So you’re right, shame works. But, for the sake of argument, if it leads people to suicide, eating disorders, or depression, while obesity is no longer technically the problem, you’ve just created another problem.
Shame works for Japan (for now, at least) because they are a wholly different society than ours, based on a wholly different set of morals and upbringing.
But is a Japanese salaryman happier than an obese American? Most are miserable, for most of their lives, and simply don’t talk about it to anyone outside their close circle, if at all. Remember that mental health in Japan isn’t really a thing that gets discussed very much, by doctors or anyone else.
It’s just trading one thing for another.
We’ve learned a lot about reinforcement learning from training animals, and specifically that positive feedback tends to lead to better results long-term, even if negative reinforcement may lead to quicker changes in the short-term.
I’m not convinced the same ideas don’t apply to mammals like us.
Moreover, what gets lost in the shame / blame game is the concept that people can work really hard at changing themselves and still have a long way to go. That is, if someone is 200 lbs overweight and has spent the last two years losing 100 of those lbs… someone who sees them in a “shame” society would still shame them, with zero context given to the fact that they’ve had a massive success over the last twelve months that should be celebrated even if they’re not where they want to be yet.
Without positive feedback, it’s exceptionally difficult to “stay the course,” and that is the point. Shame only gets you so far.
Supporting someone on their journey to a healthy weight gets them much further, and if you genuinely care about someone, that should generally extend to their mental health as much as their weight, imho.
Part of the problem with discussions in many societies now is this false equivalency. Yes, some people might be driven to suicide due to shaming, but this is not the vast majority of people. However, NOT shaming people about their weight leads to a much larger portion of the population being fat and unhealthy, which has incredible downstream health and societal impacts.
So I disagree with your equivalency here - shame is a good social tool for the majority, and while we should certainly be on the lookout for the extreme minority who have mental health issues, we should not be throwing out good general social tools just because of a few edge cases.
What you're calling "thought police society" is basically another way of saying that "there are social norms in a particular society". This is true anywhere.
You may not like the social norms of a particular place and time, or think your rival political tribe is from the dark ages (I recommend going outside to touch grass if you're in a Western country and believe this), but the base point is that any group of people that has any sort of group cohesion has preferred social behaviours and disliked antisocial behaviours.
But do those hurt the median person, or does that social policy just increase those problems at the margin? If the median person is made better off overall then it’s worth the trade off.
And is the Japanese salaryman more or less happy than the obese American service worker?
This also ignores a very basic premise in medicine: nobody will willingly go to a doctor they do not believe has their best interests in mind. It’s one of the reasons the Hippocratic oath exists.
Being fat was considered appealing in ye olde times, because it indicated to your peers that you had more access to food. Being lean became popular (again) in more recent times, especially with advances in entertainment like cinema and fashion magazines.
Now that entertainment is lambasted for seeding unrealistic (and in some cases even harmful) expectations, so too has popularity for leanness waned.
The pendulum will swing back again, of course. Before being fat became appealing, the ancient Greeks and Romans certainly preferred lean figures, judging by all their marble statues and other cultural artifacts.
This is basically my point. A lot of the policies the writer points to arent transferrable to the west imo because they rely on eastern values that wouldnt fly here. In some ways the estern values are better, in some ways the western ones are, nothing wrong with that.
(I know that these are complex and wicked problems, and using the word “translating” might sound like an oversimplification, but humans are incredibly adaptable)
That's almost bordering on orientalism. The fact that everything you do has a social dimension, that the way you live impacts the people around you is a true fact, not an eastern value. It's simply that we in the West ignore this at our own peril because we ideologically pretend that every man and woman is an island. That what any individual does has no impact on their surroundings, and for that reason that society cannot impose on our "private decisions". You can actually map out obesity spreading within families and communities like a viral disease.
That's why they have a 4% obesity rate spending almost nothing, why over here half the nations are obese despite spending hundreds of billions on individual livestyle fixes. They have a correct understanding of how societies work in this regard at least, we've given up on it. This is not about subjective cultural values.
[0] https://www.niddk.nih.gov/health-information/health-statisti...
What about dumb people? Or people with Down syndrome? Or people who use a wheelchair? Or people who were born with a missing limb? Or spina bifida?
Why limit it to “fat people,” other than because society says it’s simply okay to shame them more than others?
And before you say it’s a choice: it isn’t always. Kids don’t get to pick what their parents feed them, and while you can make changes in adulthood, if you don’t have the tools or skills, good parents (or any at all), and so on, you’re in for a rough time.
So the costs are ones we as a society are putting on individuals are coming back to bite everyone in the ass.
> one-unit decrease in BMI showed gains in life expectancy ranging from 0.65 to 0.68 year and changes in total health care costs varying from -€1563 to +€4832.
https://pubmed.ncbi.nlm.nih.gov/37222003/
You should at least consider the possibility that you’ve unfairly jumped to assertions about “cost” out of another layer of paternalism that is not warranted by the facts. Like the whole “muh tax/healthcare dollars” may actually be backwards and having them live longer might well end up costing you more.
That is the essence of the CBO paper that was discussed yesterday too: curing the obese doesn’t really reduce lifetime healthcare spending, because the US healthcare system barely spends anything on anyone who isn’t an AARP member anyway, and reducing obesity is going to lead to a lot more AARP members in 10-20 years. Which is a good thing, but also not going to be a net financial benefit, especially when you only are paying for seniors to begin with and don’t see any of the healthy-population benefits.
This is the problem with all these discussions around obesity, everyone treats it as a moral failing and automatically assumes every other factor falls into line backing their ideal moral stance etc. And money doesn’t really care about morality, it’s quite cheap to have people die early before they get the third knee replacement and the second round of chemo.
People have been doing the “ugly people = worse/morally inferior/less deserving” since the dawn of time and people today have somehow convinced themselves they’re immune. But morality doesn’t necessarily line up with practical reality, in this case finances.
That is my interpretation of why the semaglutide budget effects are dire etc - well, Medicare doesn't spend anything on the fatty who dies at 50, and if they live to 80 and get cancer it's a lot more expensive for Medicare in the long-run actually. The proximal cost of the drug almost doesn't matter itself ($700/mo is w/e in terms of what we spend on seniors, and obesity is expensive both short-term and long, right?) it's more the long-run budget effects.
It's already generally a shift upwards in Euro societies with more egalitarian age distribution of spending. Then you consider the US's favoritism for seniors... and the fact that ultimately Medicare foots a lot of it (minus the substantial amounts they can claw back ofc). They are the ultimate "sick pool"/adverse selection, right? Yeah, the USG's budget numbers probably look really bad if we cure obesity actually, even if it wasn't expensive.
Thanks for your disarming attitude.
> I've been in Japan for 15 years (visiting for 20) and for most of this time, doctors had no problems calling patients "fat" right to their faces. Now things have changed, though, and doctors are coming up with a bunch of diff. euphemisms. Last week, one hit me w/ "You're... blessed with size."
https://bsky.app/profile/ostrichson.bsky.social/post/3ksqebx...
For what it's worth. I've worked at a Japanese company since the program was introduced in 2008 and don't recall that happening. I'll have to ask some of my former co-workers about it next time I see them.
upon further investigation I might not have experienced it because I was under the ago of 40 when I worked in Japan https://en.wikipedia.org/wiki/Fat_tax
Other countries who clung on to "old ways" longer had the benefit of seeing the outcome of US approach in this respect and there is little resistance/pushback to both cultural trends and policies meant to deter obesity.
All of which to say I don't think Japan's relatively better health outcomes has to do with exceptional peer pressure. Many European countries are more culturally individualist (though less than the US) and still come out better than the US.
The other point I would argue is that there are social pressures everywhere, the expectations are merely different. You can also distinguish some by political divide.
Why?
> sugar.
By way of junk food (sweetened drinks are junk, boxed cookies are junk). Added sugar is one way to facilitate consumption of excess calories, the other is flour + added fat + salt, absent fiber and protein. (and also deep frying).
Because I run a lot, and was steadily gaining weight. Stopping eating all desserts, pies, boxes of cookies, candy, soda, etc. resulted in slowly losing weight. I still eat high fat foods, chips, cheese, etc.