Obesity Epidemic

[Seshat]

Okay. Let's assume that the 'obesity epidemic' is real. The stats seem to imply it, and there is a certain fraction of both Australian and American populations that are visibly carrying a significant excess of fatty tissue.

So let's pretend we're all public health officials with actual, genuine authority, and a reasonable budget. (Don't laugh, it's my fantasy world, I can decide what I like. So there.)

What would you do?

I'll start with mine.

Ascertain which foods are genuinely healthy. Such as grains with the germ and bran, but not grains with only the endosperm. Fruit and vegetables that have been snap frozen as near to picking as possible. Etcetera, etcetera. Reduce or remove taxes that get those foods to the retail level.

Ascertain foods which are particularly unhealthy. Anything with a fat level above (whatever) percent. Anything with added sugars. Certain foods with especially high natural sugars and little or no compensating nutritional value. Tax those to a level that compensates for the reduced taxes for the other foods, and perhaps a little higher so you can add a 'food benefit' welfare payment for people on incomes that make healthy foods less affordable.

(IE: if you can't afford to eat carrots with your ramen, you qualify for the food benefit. If you're trying to decide between lobster and t-bone steak, you don't.)

Second stage: Ensure footpaths/sidewalks are built in all new construction, and where possible, create them where they don't exist. Create pleasant walking paths, cycling paths and/or shared use paths within or near housing areas.
Encourage the development of small local shopping areas within a reasonable walking distance of housing areas, rather than mega-complexes you have to drive to. (Megacomplexes have their place, but for specialty shops: for everyday needs, small shopping areas you can walk to foster community and enable people to - well - walk.)
Encourage the availability of personal shopping carts people can keep at home, which they can take with them when they walk to the shops.

Supplemental to the second stage:
Encourage community houses, libraries, and other such facilities near the small local shopping areas. Encourage a police station there whose sole responsibility is keeping that community safe. Provide wheelchair/scooter ramps. Provide scooter parking, for those who can't travel long distances on foot but could walk around the shopping centre.

Add a local pool, local gymnasium, sporting fields, children's playgrounds. Provide dance classes at the community house. Etc etc.

Third stage:
Bully employers' groups to change their systems enough that people get enough time off to actually use these facilities, without becoming so impoverished that they can't afford them.


So.... there's a bit of a pipe dream to my plan. But what do other folks think?

[Gravekeeper]

Okay. Let's assume that the 'obesity epidemic' is real. The stats seem to imply it, and there is a certain fraction of both Australian and American populations that are visibly carrying a significant excess of fatty tissue.

Its quite a bit more than a fraction. 63.1% in America as of 2010. I don't think you need to assume anything for this particular exercise. >.>

The underlying causes, however, are lack of education, poverty and access to decent food. People don't know how to be healthy, can't afford to be healthy, don't have the time prepare healthy food and live in some shit hole where the only thing around is McDonalds and crappy little corner stores that can't get in fresh produce with any sort of regularity.

Combine that with relentless corporate advertising of cheap, totally shit food from fast food places and you have a recipe for, well, an obesity epidemic.

So the problem is vastly deeper than "Well just eat better" or "Exercise more", unfortunately.

[Rapscallion]

Denmark just slapped a tax on unhealthy food. Be interesting to see how it works.

Rapscallion

[Gravekeeper]

Denmark just slapped a tax on unhealthy food. Be interesting to see how it works.

Interesting, yes. Not sure it would work in the US though. Part of the problem is simply access to decent food. I'm not sure if Denmark has much in the way of inner city ghettos or not. But there are places in the US where the best homecooked meal you could hope to put together is Hamburger Helper. -.-

[Panacea]

One of the problems in the US is the lack of community grocery stores were the poor CAN buy healthy food. Because grocery shopping is so difficult, and buy fast food so easy and cheap, there's not much incentive to eat healthy. Some communities are offering incentives for developers to build such stores in poor communities.q1

Surveys have been done that say that the poor would eat healthy if they a) had access to healthy foods, and b) could afford them.

I think part of the solution would be to change how SNAP works: disallow all processed foods. Allow fresh ingredients only. Increase the allotment to account for the difference in pricing. The savings from lowering cardiovascular disease rates and diabetes rates would offset the costs of the food.

It can be done: WIC operates on a similar model.

Of course, education is a huge part of the problem. Most people don't understand the roles carbs, protein, and fats play in our diet. One of my students had a patient whose weight loss plan consisted of, "Don't eat any fat." The problem isn't the eating of fat, it's how much and what kind. We actually need some kinds of fats in our diet to be healthy.

And its really hard to educate some folks because they can barely read.

I do like Seshat's idea of building healthy communities, but those changes won't come from a public health official but from the planning department. It would take a local government that values public health and is willing to address public health issues.

[Seshat]

I disagree with 'disallow all processed foods'. There's a certain advantage to be had in creating healthy processed foods on a bulk scale. (She says while gnawing on a raw carrot.)

I have a friend who buys a pre-prepared meals in bulk. Over the course of a day, these meals follow the food pyramid fairly well. He doesn't know how to cook, and it's FAR too expensive for someone like me, but it's a hell of a lot better for him than fast food or most restaurant meals.

Anyway: I'd go with 'allow healthy processed foods'. Particularly ones which are either a food plan, or which label themselves to indicate which eating role they're intended for: breakfast/lunch/dinner/snack, for example. Or if we break from that model, some equally clear model.

[Andara Bledin]

The first thing I'd do is stop paying farmers to not grow shit. I don't care if the price on vegetables drops through the floor because they're so plentiful; their prices don't need to be artificially inflated.

We've gone from an industrial society to an information society, but our bodies and the vast majority of our support structure have yet to adapt to the changes that entails.

Couple that with the fact that processed foods provide more calories more efficiently than unprocessed foods, and you end up with people eating far more than they require to maintain what is promoted as a healthy weight.

^-.-^

[Panacea]

I disagree with 'disallow all processed foods'. There's a certain advantage to be had in creating healthy processed foods on a bulk scale. (She says while gnawing on a raw carrot.)

I have a friend who buys a pre-prepared meals in bulk. Over the course of a day, these meals follow the food pyramid fairly well. He doesn't know how to cook, and it's FAR too expensive for someone like me, but it's a hell of a lot better for him than fast food or most restaurant meals.

Anyway: I'd go with 'allow healthy processed foods'. Particularly ones which are either a food plan, or which label themselves to indicate which eating role they're intended for: breakfast/lunch/dinner/snack, for example. Or if we break from that model, some equally clear model.

I don't know there are any processed foods that are really healthy. It would be a short list if so.

[Fashion Lad!]

I don't know how I would determine obesity, because even the BMI scale doesn't take into account some people's over all muscle mass.

However, I would put people on high fat, adequate protein and low carbohydrate cyclically until they reach healthy weight.

I am a firm believer in the keto diet. I'm 5'11" 170lbs, and I eat eggs, bacon, steak, cheeseburgers (no bun), cheese (love cheese) every day. My blood pressure every time I go to the doctor is 90/60, my cholesterol is low. Triglycerides are low. Glucose is perfect. I had my body fat percentage last measured at 14%.

I use fat to fuel my body, my body burns fat. I maintain my muscle. I am healthy.

[AdminAssistant]

I'm really happy that works for you, FashionLad, but fat and protein are expensive. Grains are cheap. Economically, a low-grain diet doesn't work on a nation-wide scale.

[Fashion Lad!]

I'm really happy that works for you, FashionLad, but fat and protein are expensive. Grains are cheap. Economically, a low-grain diet doesn't work on a nation-wide scale.

Eat more fat and more protein, you'll eat less overall. The problem with carbohydrates is that the body turns those into simple sugars in the intestines. The sugar is absorbed into the blood, raising your blood glucose which increases the production of insulin. Insulin is the fat storing hormone. When insulin decreases, fat reserves get "let loose" for the body to use as fuel.

So it's either going low-carb, or everyone is going on one hell of a workout plan. I'm talking P90X. Maybe Insanity.

Our bodies are not designed to handle a high carbohydrate diet.

[Seshat]

I don't know there are any processed foods that are really healthy. It would be a short list if so.

By 'processed foods' I include 'pre-cooked foods' and 'pre-cooked meals'. So a vegetable lasagne made with wholegrain pasta is a 'processed food' to me.

We may not be meaning the same thing.

I don't know how I would determine obesity, because even the BMI scale doesn't take into account some people's over all muscle mass.

The BMI is a very lazy way to determine fat/other tissue ratio. Pinch tests are more accurate, but depend on the training of the tester. There are scales which use a body electrical resistance, those are more accurate than the BMI but still of relatively low accuracy.

The most accurate that I know of is body density, which is done in a float tank and measures the density of the person's body.

However, my personal vote would be to use a human version of the body condition scale. The one I linked to is for dogs and cats.

You can easily see how to come up with an equivalent for humans. Especially since there's also body condition scales for cattle, horses, sheep, and other such mammals on the 'net as well.

However, I would put people on high fat, adequate protein and low carbohydrate cyclically until they reach healthy weight.

Different people have different digestive systems. Part of this is variation in gut flora, part is hormonal variation. A dietary system which works well as a reduction diet for one person will not necessarily work well as a reduction diet for another.

For people who are insulin sensitive, a low glycaemic load diet - which your recommended diet is one form of - is effective. But not everyone is insulin sensitive. Not even every overweight person.

This is one of a range of potential weight reduction diet strategies. For the people with the correct digestive systems, it works well.

[Nyoibo]

I don't know how I would determine obesity,

Body fat percentage, the easiest way to determine obesity however is visually, it's pretty easy to tell an obese person, if you're 5'10" and 250 lbs, unless you're a body builder, you're obese.

Our bodies are not designed to handle a high carbohydrate diet.

Rubbish, the majority of the population of the planet exists on a high carbohydrate diet, the problem is the quality and quantity of high carbohydrate foods being eaten.

[Lace Neil Singer]

I disagree with the idea that taxing unhealthy foods will make people cut down. Over here, they tax cigarettes to hell, yet people still smoke. All a tax would do is penalise people who want to treat themselves.

I think that education is the key; if people were taught from school how to manage a budget and cook healthy meals, it would make more of a difference than just whacking a tax on unhealthy food. Home economics used to be part of the curriculum when I was at school; now tho, it's not.

I used to buy ready meals rather than cook; now I cook everything, and actually save money cuz it costs less to cook than it does to buy ready meals. A lot of people say, "Well, I don't have time to cook" when it would take as much time to cook as it would to order a pizza delivery. With a lot of people it's just ignorance and/or laziness.

[AdminAssistant]

A lot of people say, "Well, I don't have time to cook" when it would take as much time to cook as it would to order a pizza delivery.

Okay, that's bull. It takes me less than 5 minutes to order a pizza online, which will then be at my home in 30-40 minutes that I can spend doing something other than cooking. Most meals I cook take 20-45 minutes, no doing anything else, and then there are dishes to do and a kitchen to clean.

A low-carb diet sounds like a special level of hell to me.

The other problem is that no roasted vegetable, quinoa salad, or tofu anything tastes as good as a pizza or chicken strips or *insert junk food here*.