Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
9 Jul

Is the Obesity Epidemic Exaggerated?

obesitycrisisObesity has reached epidemic proportions. People are fat and getting fatter, with no end in sight. Even kids are fat these days. Right? We’ve all seen the picture of the McDonald’s-eating toddler and heard the dire nightly news reports about growing obesity narrating back shots of anonymous overweight families trudging along with wedgies and short shorts. But just as the public at large bemoans the pervasiveness of the obesity epidemic, many critics are claiming the opposite: that the obesity epidemic is exaggerated and overinflated; that the “overweight” and “obese” categories are ploys by insurance companies to get more money from policy holders; that obesity in and of itself isn’t actually a health hazard. Some, like Paul Campos, are even arguing that America’s weight problem is “imaginary.”

Could this be? Am I tilting at windmills when I decry our collective weight problem?

Let’s look at the claims being made.

First, there’s the claim that the definition of obesity is arbitrary and the obesity epidemic only arose because our definition of obesity changed to include more people. According to this argument, people aren’t necessarily any heavier, but what was previously assumed to be a healthy weight has now been deemed an unhealthy weight by statistical trickery. In his 2005 book, Fat Politics, J. Eric Oliver (PDF) tells the story of Louis Dublin, a statistician for MetLife insurance in the 1940s who analyzed the connection between age, bodyweight, and death rate among MetLife subscribers. Dublin found that thinner people generally lived longer and those who maintained close to the bodyweight of an average 25 year-old lived the longest. He published a new weight chart that shifted the healthy weight threshold back, effectively making millions of Americans obese or overweight overnight. And even though he did this to predict who would die earliest and determine who should pay the most for insurance policies, not to uncover a public health threat, it caught on and formed the basis for government policy regarding obesity and health that continues today.

The controversy is in determining whether the current weight charts are based on medical observances and biological truths about the effect of certain BMIs on disease and death risk, or on corporate interests. Is a BMI greater than 25 officially overweight because research shows that people with BMIs over 25 are more likely to die or develop diabetes, heart disease, cancer, and other degenerative diseases?

This leads to the second main argument – that obesity in and of itself has never been causally linked to health problems or increased mortality.

It’s not a new one. In both Oliver’s book and The Obesity Myth, by Paul Campos, the authors try to debunk the causal connections between obesity and poor health outcomes. According to Campos, Oliver, and others like the Health at Every Size (HAES) movement, the negative health effects associated with obesity aren’t caused by the excess body weight itself, but by the inactivity, poor eating, and other metabolic factors that cause the weight gain. Obesity is just an indicator of the root metabolic dysfunctions. And it’s not even a reliable indicator, they say, since many obese people remain “metabolically healthy.” They often cite the studies that find slightly overweight BMIs to be protective against early mortality as proof.

Some of their messages resonate. Fixating solely on what the scale says while excluding how you look, feel, perform (in the gym, bedroom, and bathroom), and sleep doesn’t really work, and I have always maintained that body weight is not the ultimate determinant or even indicator of health. BMI is good at identifying obesity in large populations, but it’s less accurate on the individual level, almost to the point of uselessness. People who strength train will often have overweight BMIs but low body fat. Are they overweight? Technically, yes. But are they unhealthily overweight? Absolutely not.

But I’m not convinced the obesity epidemic is a figment of our imagination, nor do I think obesity in and of itself is harmless.

Evidence shows that body fat is an endocrine organ – it produces hormones that help control body weight and energy metabolism, as well as inflammatory cytokines. It’s not inert insulation that just sits there. It does stuff and if you have too much of it, it does bad stuff. Like:

  • Body fat secretes leptin, the “I’m full” hormone. Leptin indicates “plenty” to the body, and it scales up with body fat. The more body fat you have, the more leptin you secrete, the less you eat. It’s one way our body keeps itself in energy balance, and it works pretty well – up to a point. Unfortunately, excessive amounts of body fat secrete more leptin than the body can handle, the leptin receptors become resistant to the effect of leptin, the “I’m full” message cannot be received, and hunger grows unabated. Thus, obesity often perpetuates itself by blunting the appetite-suppressing effect of leptin.
  • Body fat also secretes adiponectin, an anti-inflammatory hormone involved in glucose regulation, fatty acid oxidation, triglyceride clearance, and insulin sensitivity. More adiponectin means better fat burning, favorable blood lipids, improved glucose tolerance, and lower insulin levels. Unfortunately, the relationship between body fat and adiponectin secretion isn’t like the one between body fat and leptin. The more body fat you have, the less adiponectin you secrete. That’s why the obese and overweight tend to have lower levels of the beneficial hormone.
  • Body fat secretes resistin, a hormone that increases insulin resistance. Both genetic and diet-related obesity increase resistin levels, suggesting that resistin is a function of obesity and excessive body fat rather than the lifestyle factors that lead to obesity. If a bad diet and poor exercise habits increase resistin, it’s only because they also increase body fat.
  • Body fat secretes inflammatory cytokines, also known as adipokines. Adipokine-derived inflammation may be causing or exacerbating the insulin resistance and other conditions often associated with obesity. Thus, obesity is inherently inflammatory.

There are also different kinds of body fat. You’ve got subcutaneous fat, visceral fat, and brown fat. Visceral fat (the fat that surrounds organs and concentrates in the abdominal area) contains more inflammatory cells that secrete inflammatory cytokines. It’s more metabolically active, more insulin resistant, more dangerous than subcutaneous fat, which is more stable and less inflammatory (but still not harmless!). Meanwhile, brown fat actually promotes the oxidation of other kinds of body fat. It’s how babies keep warm without the ability to shiver, and new evidence reveals that it plays a large role in adult metabolism, too; adults with the most brown fat have lower fasting glucose and weigh less. If you’re going to say that obesity is healthy or imaginary, you have to account for the functional differences between subcutaneous, visceral, and brown fat.

As to the arbitrariness of BMI interpretation, okay. That’s true. It wasn’t based on the most rigorous of data analysis. Even so: how we interpret BMI has changed, but how we measure BMI has not. Say there’s a guy with a BMI of 26 in 1985. You put him in a DeLorean DMC-12, tell him to hit 88 MPH until he catapults into the year 2014, and then recalculate his BMI. It’s still going to be 26. The rate of people with high BMIs indicative of overweight/obesity/whatever you want to call it has not remained static. Unless you’re positing that corporate interests corrupt the calculation of BMI, bodyweight has increased. The data is clear (PDF). Value judgments about those BMIs are another thing entirely, but that doesn’t negate the fact of the matter: people are getting larger.

Besides, BMI isn’t the only way to measure obesity. It’s not even a particularly effective way. If we look at every other measurement of obesity available, it’s increasing. Waist circumference (an arguably better marker than BMI for predicting heart disease mortality) has been going up. Abdominal obesity – the most dangerous kind (or the kind that’s most strongly associated with poor health outcomes, if you’re Paul Campos) - is increasing and has tripled since the 1960s. And although this is anecdotal and thus inadmissible in the court of Science Based Medicine, just taking a look around next time you’re out at a mall or an amusement park will tell you that obesity remains an issue.

And the common co-morbidities of obesity and overweight have been increasing in incidence, too. Non-alcoholic fatty liver (even in teens), type 2 diabetes, obstructive sleep apnea (which is strongly correlated with body fat percentage, especially abdominal body fat), most cancers, and many other conditions associated with obesity are all rising.

So there you go. People are getting bigger. They’re gaining belly fat. Common obesity co-morbidities are skyrocketing; even if people are living longer, they’re feeling worse. Maybe those morbidities are just associated with obesity, not caused or exacerbated by it. That’s fine. Call it what you want, as long as you acknowledge that a problem exists.

Because in the end, losing excess body fat just works. Whether it’s the inherent healthiness of the steps you take to lose the weight, the normalization of leptin, resistin, and adiponectin levels and the reduction in fat-derived inflammatory cytokines that comes from shedding excess body fat, or both, you’re healthier. And a bit leaner.

Let’s imagine for a moment that the excessive accumulation of adipose tissue (obesity) is completely innocuous. Maybe obesity and its related maladies merely have common causes, like inactivity or a bad diet, and don’t interact with each other at all. Maybe body fat is the body’s way of dealing with the true offender and obesity is just a reliable indicator of poor health, diet, and exercise habits (I suspect this is partially the case). Assuming all that is true, what changes? What are you doing differently to improve your health? You’re losing body fat. If getting rid of the obesity (through changing your diet and modifying your activity patterns and getting better sleep and reducing stress) makes you healthier, the primary cause doesn’t matter. Only results do. You don’t ignore the smoke alarm just because it’s not the cause of the fire.

That’s my take on the situation, folks. What about you? Let’s hear yours in the comment section.

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You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I believe that there is a problem: many Americans eat in an unhealthy manner and do not participate in any form of physical activity. I take this as fact in the people I see around me; the people in the fast food lanes, the people piling on sugar coated grain cereals and breads and eating pastries at Starbucks or candy or a carton of ice cream in a single sitting. Some people eat two helpings of birthday cake for EVERY birthday party held in their office. Worse, many people, stuck in their office, don’t even get up except to go to the bathroom or maybe grab that next snack.

    It’s clear that many (but certainly not all) of the people doing this are carrying extra fat on their bodies, belly fat is commonly a portion of this additional fat. As you made clear, Mark, the production of several different hormones and / or the body’s sensitivity to them is altered by the extra fat.

    Heck yeah! It seems that people who have unhealthy diet and exercise lifestyles frequently have large body sizes, which signals a pretty obvious problem. For those who have unclear causes of “obesity” that are unrelated to diet and exercise lifestyles, I sympathize and encourage anyone in this category not to give up and to do as much research and self-experimentation as you can get away with! The more experimentation you can do, the better your chances of finding other related symptoms that may lead you or a doctor well-versed in nutrition to the answer you seek (truly: good luck!)

    Kevin Grokman wrote on July 9th, 2014
  2. Pull up a random crowd picture from the 1960s and then one from today. To say we are not getting fatter is to be blind. And frankly I don’t care if people are obese just as long as I don’t have to pay for their poor choices. But since our nanny government says I must, then I say it’s time to loose weight.

    Green Deane wrote on July 9th, 2014
    • Fat people even get a ‘discount’ while the healthy and thin pay more….true.

      I just don’t know how menopausal women are supposed to remain thin when it’s the bodies natural defense against bone loss to create slightly higher body fat to help produce estrogen.

      Women once again will be punished throughout this debate, while doctors and policy makers completely ignore the 2 different biologies between men and women.

      To all the fat men out there: You’re just lazy. No other excuse.

      Al wrote on July 11th, 2014
  3. Maybe I’m on a different wavelength here, but although I understand, & by & large agree with many of the comments, what came to my mind when I read the article was a bit different. I read quite a bit, & am always looking out for ways to improve myself (which is why I’m tied into the Daily Apple!). I’m working through a book now on Brain Rules. Much of what I’m finding there rings harmoniously with this article. I wonder if there is any research being done to see how our brains are developing with the current dietary fiasco? It seems to me that I got a better education out of HS (Class of 1964) than most are getting out of college today. I was taught to think, today kids seem to be being taught to pass a test & many schools are cutting recess time so kids can study more….which seems to be working in reverse!

    Waya wrote on July 9th, 2014
  4. Just look at newsreels or newspapers from the 1960s. Most people look downright thin, compared to the way people look now.

    I’m glad to read this take-down of the anti-fat-shamers’ campaign. Some of my friends have been posting rationalizations of their obesity on FB, saying that it’s not really a problem, and that they’re not really fat, or if they are, it doesn’t matter.

    It may be true that it’s nobody else’s business if you are fat. However, we all pay for the health crises that obesity produces, either through insurance premiums or through taxes that pay for Medicare and Medicaid. It’s similar in a way to the tobacco-related illnesses that smoking caused in so many people.

    I find it odd that it’s almost impossible to discuss the obesity epidemic and the problems it is causing for society as a whole and for individuals, without being attacked and labeled a “fat-shamer.” Were people who talked about the dangers of smoking “smoke-shamers”?

    shannon wrote on July 9th, 2014
  5. I wonder a lot about WHY the obesity epidemic is so prevalent. Of course it is partly due to larger portions, fast food, addictive food, people sitting still in front of computers and TVs, people working long hours sitting down and then driving long hours to get home, people eating out more b/c they don’t have time to cook, people having to eat cheap food b/c real wages have fallen. But there’s another possible cause that is related: the increasing use of anti-depressants and anti-psychotics. These drugs often cause enormous weight gain. And they weren’t around in the 1960s.

    I think there are an awful lot of unhappy people in America, people who are terribly bored by their jobs but see no escape from them, people who are trapped in unhappy relationships, people living in ugly, violent cities. The United States has a mental health crisis as well as an obesity epidemic, and it’s possible that the two are related.

    shannon wrote on July 9th, 2014
    • “people sitting still in front of computers and TVs”

      So, does this mean that all those accountants and (male) secretaries and log-book maintainers back in the late 19th century were all fat? THEY spent all day every day sitting at a desk and not moving — but they weren’t fat!

      “people working long hours sitting down”
      Back then, they worked 10, 12, and 14 hour days, not like today’s 9-to-5…

      I’m not picking on you Shannon — but we all tend to slide into ‘easy descriptions’ that don’t actually seem to apply, if you try to equate them to ‘pre-obesity epidemic’ folks. Besides, I’ve read of studies that it’s NOT that “kids sit and get fat”; it’s that “kids get fat, and only then cease moving as much”!

      Elenor wrote on July 9th, 2014
      • I just read an article in the New YOrk Times “Well” section about the fact that kids today are in fact much more aerobically unfit than they were even ten years ago. The culprit seemed to be…screens. Sitting and staring at them.

        As for the 19th century scribes and clerks: they walked to work. Bob Cratchitt did, anyway. In A Christmas Carol, Dickens describes his walks to and from work and what he saw…

        Clearly sitting still isn’t the ONLY factor in the obesity epidemic, but it’s one of them. I probably sit still more than I used to before I had my computer. I’ve never had a TV.

        shannon wrote on July 10th, 2014
  6. I went to a wedding recently and I was astounded at how much people could eat during that weekend. The portions were huge, and yet people cleaned their plates. I was one of the few that could not. Also I was surprised that many people did not dance. I wonder if they are afraid of “looking silly” or something. Dancing is great exercise as well as great fun. Some of the people who didn’t dance were healthy, fit people, so it couldn’t be because they didn’t want people judging their bodies on the dance floor.

    It occurred to me during this weekend that food is one of the few pleasures in modern life that people allow themselves to indulge in. That and drinking. We don’t dance; we don’t sing with each other; most people hardly ever go outside and look at nature; we don’t have time to play; we don’t sleep and dream very much; people don’t even have time to have sex! But eating is allowed, so we over-eat to make up for all the other things we don’t get to do.

    shannon wrote on July 9th, 2014
    • OMG. Best comment EVER.

      Meagan wrote on July 9th, 2014
    • I agree and I’ve definitely noticed this with the people in my life. We all have to eat and so many fun (stress releasing) activities are surrounded by food. It’s one thing everyone can indulge in.

      Nikki wrote on July 10th, 2014
    • +1

      Steve wrote on July 10th, 2014
  7. I know one thing for sure – I feel a hell of alot better since switching to Primal & I have not even come close to losing the amount of weight I want to (perhaps my ideal weight is a bit skewed, too??). I do believe that extra weight contributes to all kinds of issues, namely the feelings of fatigue & depression (probably just a byproduct of fatigue), but I also believe WHAT we eat contributes to all of those issues even more so. I find it hopeful that the topic of low-carb, exercise, & general health topics are argued so passionately, it means that people are beginning to wake up! In the mean time, I think some posters above said it best, always be kind to others b/c we don’t know what others’ stories are and just be helpful in a constructive manner. It also helps to just lead by example:) My hope is that as I progress with my Primal lifestyle that my husband & others in my life follow suite, too.

    Cheers to another great article to make us think!

    IslandSeeker wrote on July 9th, 2014
  8. Hello from MD. We’re fat here! I couldn’t help but notice, however, that when the Warren Jeffs group was broken up in 2006, they were ALL as fit as a fiddle. It’s lifestyle, lifestyle, lifestyle ….

    Karen wrote on July 9th, 2014
  9. I’m sorry. Just come sit outside a Winn-Dixie anywhere in the South. The evidence is irrefutable. In fact, you don’t even have to be at a grocery store. It’s shocking!

    Chris wrote on July 9th, 2014
  10. It a bell shaped curve. Many are overweight and do just fine. Elders even have a few pounds in storage to help survive illness. The problem is the increase of the super obese. The ones we need to get super large beds, wheel chairs and bedside commodes for care. These folks are often very strong. Think how much strength it takes to carry all that extra weight. Often they cannot even cate for themselves. These outliers are increasing. Our conventional method of weight loss to restrict calories and increase “good carbs.” just leaves these people misirable and sets up failure. Thus increases overeating the processed foods made to encourage overeating. “no one can eat just one.” i work in a hospital that serves fired potatos, a blueberry muffin and fruit juice on a ADA diabetic tray. I kid you not! Our medical community reminds me of what i see on many magazines. The cover screams “lose 20lbs in 20 days just like the celbs do!” it will be placed by a photo of an eight layered cake food porn cover spread. Yes, we are accountable for our actions, but our society does not do enough to educate or patients. We just write them of as non compliant.

    Georgina wrote on July 9th, 2014
  11. BMI may work for the diet and medical industries but it does nothing for me.

    I lost over 80 lbs in one year; slimming down from a plus size 16 to a trim 2. Yet, I’m overweight. I’m told to lose another 12 to 15 pounds to be “healthy”. I’m strong for a girl ( in my opinion). Pushups and the occasional pull up is no longer a problem. But despite my genetics and my improved musculature, I need to lose more weight. At 160, ,I wear smaller sizes than
    others at my height (5,5) and weight.

    Are people getting “bigger”? Sure.. but if active folks like me are factored in “America’s obesity crisis” then how can it be accurate or a measurable standard of good health?

    And like in 1997 when the bmi standards were changed, one could simply go to sleep “normal” one day, wake up as ” overweight” the next. Thus worsening the “epidemic”

    like in 1997, then those who claim that the bmi is ok well be reclassified as overweight and

    Rene wrote on July 9th, 2014
  12. I don’t think humans can add billions of pounds of endocrine-disrupting chemicals to the environment every year and not eventually experience some kind of effect. I imagine that this is one part of what we’re seeing here. Not the only thing of course, but it could explain how some of us can be very active and eat very healthy and all the rest but still not look like people did 75 years ago.

    Diane wrote on July 9th, 2014
  13. Rattle off all the statistics and studies you can find. It doesn’t matter. All you need to do is go to any public place or group gathering anywhere in America, and you will see all you need to know about the very real obesity epidemic. I am 45 years old, and, growing up, we had like maybe two “fat kids” in our entire elementary school. A few years back when my own kids were in grade school and I’d attend events there, it was the lean kids who stood out in the crowd of double chins and inflated cheeks. Last summer we went to Disney and the pool was crowded with 4th grade girls who looked five months pregnant, and 11 year old boys sporting jiggly B-cup breasts. I work in a community hospital where 2/3 of the nurses literally WADDLE and are out of breath walking the distance of a unit hallway. Trips to the beach are a parade of back rolls, beer bellies, butt cheeks eating up bikini bottoms, chafed thighs, and overflowing bikini tops…all decorated with stretch marks, rashes, and cellulite…there was NO SUCH SCENERY when I was growing up in the 70s and 80s.

    Michele wrote on July 9th, 2014
    • I had a similar thought. I was in high school in the 60s. There was one (1) overweight student in the entire school. One (and none before high school.) None of the teachers had any weight problems. Not long ago I went to a “vegetarian fair” where local vendors of vegetarian foods and related products showed off their wares. I rode my bike. The only person to do so. Meat-eating me was the skinniest person there. I felt like a gazelle amongst hippos. Everyone was very fat, the sellers and the buyers. But ask those carb-stuffing vegetarians if they are healthy and they will tell you their diet is superior… what delusional nonsense.

      Green Deane wrote on July 10th, 2014
  14. People are throwing out wild assumptions about what causes obesity, so here’s one for you. Maybe children would not be so overweight if we cared for them the way we used to (back when people were thin) with a parent at home to nuture them and bond with them. We stick them in child care before school and child care after school and then they finally get to go home (if they are not shuttled off to dance or soccer or fill in the blank activity) to very tired out parents from working so much. I think emotionally their needs are not being met. Maybe the highlight of their day is eating. Parents work hard too without little down time. It’s probably their highlight too. I think people/Americans live way above their means and have forgotten about what is important.

    CodeRed wrote on July 9th, 2014
  15. I came across that show, “Say yes to the dress” the other day, on my way up the channels to watch the world cup. OMG! Every one of those brides was enormous! They try on wedding gowns and then stand in front of there equally-enormous friends and relatives, who ooh and ahh over how beautiful they look. Ugh. Just another example of how easy it is to see that the obesity “epidemic” is not overblown.

    k-del wrote on July 9th, 2014
  16. BMI is a tool used to evaluate risk. When taken out of context, and not looked at as a ‘risk’ indicator, then people get offended and antsy b/c their BMI is high or low. It also doesn’t take into account many other factors, like muscle mass and bone density. It’s important to look at the whole person when evaluating healthy weights and considering overall weight management, whether you’re large or small.

    Meagan wrote on July 9th, 2014
  17. It’s all well and good to say things like “BMI isn’t the only way to measure obesity. It’s not even a particularly effective way.” However, it’s not true. Obesity is now a disease, and the definition of that disease is a BMI of 30 or over.

    Now, one might say that certain interests benefit from this definition, and that this definition will have predictable effects. However, I’m not that one. He’s a freaking conspiracy theorist. I’m just reminding y’all of the fact.

    Ion Freeman wrote on July 9th, 2014
    • BMI measures weight. DEXA scans (or similar methods) measure body fat percentage. Wikipedia defines Obesity as “excess body fat.” BMI is a very indirect and inaccurate way of measuring body fat.

      I’m not sure continuing to use BMI is a conspiracy; It’s more likely a tragedy caused by cheapness and habit. Weight and height are slightly easier to measure than body fat, and that’s what they taught the docs to measure back in medical school before scans were easy and cheap.

      Karl Kelman wrote on July 9th, 2014
      • I generally agree with you, but sincerely doubt that the majority of people with a BMI of 30 or over are in the stratospheric range due to all the muscle they carry; I was into natural bodybuilding for a while, and in my experience, most of the competitors are in the “overweight” BMI range even in the offseason; the ones who solidly fall into the “obesity” range as defined by BMI are few and far between.

        Karl wrote on July 9th, 2014
        • I generally agree with your response. The significant problem is the number of “skinny fat” (normal weight obesity) people: They have a BMI under 25, but high body fat percentage. I’m forgetting the exact numbers, but that’s a very significant percentage of the population (something like 30% of all people with a BMI under 25).

          People with normal weight obesity are that substantially greater risk for many illnesses, but they may believe there’s no need to improve their fitness, since their BMI is under 25.

          In addition to risking their personal health, the skinny fat problem skews scientific data gathered from populations. Studies that assess things like heart disease risk generally compare people by BMI groups. But, if there are large percent of people with high body fat in the “normal weight” group, it’s hard to know what the results mean. Is weight the risk factor or body fat percentage, or other variables (exercise, diet, lean body mass) linked to weight/fat%?

          In Japan, people tend to control their weight (being perceived as “fat” is far more stigmatized there), but exercise is less common than in the US. As one might expect, lean body mass is lower, and the risks of obesity-related disease starts to climb at lower BMI levels in that population.

          Karl Kelman wrote on July 10th, 2014
  18. One way to stop the problem is through education, which is what this site does, so thank you for that, but quite frankly we don’t want to change our diets. That is the real problem at hand. There’s pushback wherever you go! Way over 50% of the standard grocery store the world over is made up of foods not conducive to any sustainable diet and we know this. We know this from childhood. Seriously, are we worried at all if California’s lack of water will have an effect on Walnut production OR were we sick about weather Twinkies were not going to be produced for at least as long as it takes one to oxidate which we all know is something like a thousand years!? Personnaly I was sick about the fact that those yellow buddies might get the ax! That is the true issue here: We simply do don’t want to change!
    The thought of getting into bed with carrots and cabbage is unimaginable compared to a juicy hamburger, followed by pizza, rounded out by something with the name nugget in it! We have been trained to ignore what is good for us for things that give us the short term zing!
    What is that word, Mark, that sounds so good when you say it? Indulgence! Yes that’s it.
    Tomorrow you can get hit by a car, slip on a banana, a safe can hit you on the head and with that kind of danger lurking out there it’s no wonder that daily massive Indulgence rules our stomachs!

    William Perrigo wrote on July 9th, 2014
  19. Specifically on the obesity epidemic: I don’t think it’s necessarily ‘exaggerated’ in terms of its actuality. That said, I do think that mainstream media likes to grab onto the concept and use it as clickbait- in which case it winds up becoming exaggerated as the discourse becomes less of a legitimate part of discourse around health and more of an exercise in shaming particular sections of society.

    Speaking more broadly, what I’d like to see is a more systemic discussion: on health, on economics, on marketing, on food justice, on organics, on the environment and how all of these things are connected. I’ve been poor for most of my life, and I think that I can safely say- from personal experience- that a heck of a whole lot of marketing gets directed at folks who don’t have a lot of money to spare: cheap burgers, 2-for-1 deals etc*. Now that I’m financially middle class, most marketing directed at me/my demographic isn’t focused on cheapness- it’s telling me that I want to spend more money (on highly processed foods) so that I can be thin without the effort of moving. A systemic discussion would (hopefully) set aside the hyperbole, posturing, blame and excuses and focus instead on genuine, holistic health. I’ve been overweight (as a kid) and underweight (as a teenager) and I don’t think either are what we’re talking about when we talk about health and fitness- yet most of the current discussion centres around obesity (it centred around anorexia when I was growing up).

    *Note: I don’t necessarily think that ‘junk food’ in the broad sense of the term is always cheaper than eating ‘real food’, That said, I was only able to work this out when I had the privilege of access, time and level of education to read widely and consider the issue properly. While I think there are plenty of people who fall back on excuses to avoid addressing problematic habits, I also think it’s worth considering and respecting- in good faith- the realities of people living below the poverty line or acting as full time carers.

    SisterCaveman wrote on July 10th, 2014
    • +1

      Wendy wrote on July 10th, 2014
  20. Is obesity a symptom?

    http://www.ted.com/talks/peter_attia_what_if_we_re_wrong_about_diabetes

    Also, why is there no mention of Japanese sumo wrestlers in this dialogue? Technical very obese, high body fat, and still athletically far superior to the typically obese person. AND the results are repeatable.

    Jamie Fehr wrote on July 10th, 2014
  21. This is so concerning on so many levels. On a recent trip to South Africa, I noticed something immediately different from the USA. The serving sizes are drastically different, as are the offerings of pre-packaged foods like chips. What the USA would typically consider a lunch size bag, and take two of for lunch, the people of that country only have one of. Their pizza size is typically the size of a small USA pizza, but they consider that a large. Cappuccinos and other coffee drinks do not come in glasses the size of pounder glasses for beer, rather, they are served in tiny tea cups on saucers. People all over the world just don’t eat that way, but they’re also not marketed to the same way either.

    For many in the USA, it is not cost effective to eat healthier, the poorest people there cannot afford the healthier foods, they are marked up by as much as 50% in some cases, more in others. Without access to a local farmer’s market, or the ability to pay less for the better foods, society in the USA dooms it’s citizens to obesity by cutting out their ability to pay for their health. When a bag of chips that is 6x the size offered and marketed to other countries is cheaper than a single bag of carrots, we have a problem.

    More needs to be done to make the healthy options available to more people.

    Caroline Combs wrote on July 10th, 2014
    • Agree 100% see my post below…

      Yes, the obesity epidemic is real and no, it is not the “fault” of “fat” people: Rather, it is the direct result of capitalism run wild (economic policy) manifested in colonial, agricultural, industrial, medical, political, and, ultimately, social practices. Make no mistake: we are generations of victims–perhaps willing, but victims none the less.

      Is the decline of the middle class in the US be correlated with the increase of population BMI? Absolutely. Are the “rich” really “thinner?” Of course! Can I prove causation? Foment a political revolt? Er, probably not.

      However, thanks largely to Mark Sisson, I can continue to pursue my own, personal, revolution: the Primal revolution that has enabled me to reject blood sugar medication, blood pressure medication, and cholesterol medication. A revolution that has allowed me to pause and reevaluate my life in a kinder, gentler, more spiritual direction; to breathe and move easier at 60 years than I did at 30!…oh, yeah, and forced me to shop for (smaller) clothing…which I can pretty much afford because real food actually costs less!

      Corey B. (Long Beach, CA) wrote on July 11th, 2014
      • “Yes, the obesity epidemic is real and no, it is not the fault of fat people.”

        Nonsense. Nobody holds a gun to anyone’s head and forces them to overeat, or to eat a steady diet of junk. It’s purely a matter of choice, never mind the million or so excuses fat people manage to come up with. Sorry if that sounds cold, but it’s an unavoidable fact.

        Shary wrote on July 11th, 2014
        • Step on over to the nearest charity food pantry and check out the choices. How much is “junk,” let alone paleo-compatible? Ask just about any doc involved in public health about “healthy” grains. What patently false dogma do you hear? View some “food” adverts. Inventory 90% of the items for sale in a grocery store. Have your emotional angst temporarily assuaged several times by using the drug, sugar, and see how easy it is to quit “cold turkey.”

          Yes, the information required to make food choices enabling healthy gene expression possible is out there–but not so much. Google, “healthy food choices,” and see what I’m talking about.

          You are correct, “nobody holds a gun to anyone’s head and forces them to overeat, or eat a steady diet of junk.” So what? Where is your empathy? Your compassion? Yes, you do sound cold to me. But behind your insensitivity lies fear, I suspect. Try coming from faith instead. Just a suggestion…

          But the he point of this debate is causation. The very real obesity epidemic is absolutely NOT the choice of the victims, although people like Mark are enabling them to loosen their shackles, via information and education. Blanket condemnation of the “fat people” does nothing to help, save perhaps shock a few into action.

          Corey B. (Long Beach, CA) wrote on July 11th, 2014
        • Fear of what, Corey?

          For many if not most obese people, food is an addiction. I don’t believe in enabling them by portraying them as victims of external situations that are supposedly beyond their control. You, however, come across as part of the problem, not part of the solution. Try offering any addict faith and warm fuzzies and see how far you get. Facing the cold, hard facts can be painful in any self-created situation, but it’s the absolutely necessary first step toward making positive changes.

          Shary wrote on July 11th, 2014
        • Shary~I guess I must agree to disagree. I am an addict in recovery (via the 12 steps) and my recovery is based on Faith. I’m sorry if I sound like “part of the problem” to you–that wasn’t my intention. I know so many who are recovering from addictions and obsessions far worse than poor eating habits I habitually try to visualize the best in people and tend to ignore more common failings, I suppose. Maybe if I were financially rich instead of spiritually wealthy I could afford to be more critical of the 99%. But, I’m glad I’m not. Please forgive my vision of society as a helpless child, bullied and oppressed. In the end, you are correct, we get exactly what we sow.

          Corey B. (Long Beach, CA) wrote on July 16th, 2014
        • Thanks for your comment, Corey. Best wishes to you for your recovery.

          Shary wrote on July 17th, 2014
  22. what was previously assumed to be a healthy weight has now been deemed an unhealthy weight by statistical trickery.

    Sounds like the whole Ancel Keys/lipid hypothesis/statin thing to me.

    Wenchypoo wrote on July 10th, 2014
  23. It is hard to classify America as a whole since each region varies so much and even each part of your town varies due to the family income and culture. Lower income has more of a problem with obesity. Easy access to junk food is prevalent. Portion control is another issue. Currently, I’m getting tired of my office having junk food offered at parties and co-workers expecting you to eat that crap. If they are upset, so be it.

    Michael Alber wrote on July 10th, 2014
  24. If you were a single guy and lived where I live, I’m not sure you would ask this question. Seriously. The size of people here is surreal. I have lived in LA county so I can do a reasonable anecdotal comparison. It’s easy to believe the obesity epidemic is exaggerated living there. Not here. Not even close.

    Barry wrote on July 10th, 2014
  25. Try going on Google Images and typing in “class of 1920″ or any year thereabout and it’s pretty obvious that people were quite a bit thinner back then. I also think it’s pretty obvious that people generally feel better and are healthier when they’re thinner. Have you ever met anyone who wanted to put on an extra 20 or 30 pounds of fat so that they could feel better? There’s a lot of interesting science and implications mixed into all of this, but the bottom line is that we’d all be better off if we were on the thinner side, and that may mean reasonably different things to different people.

    *LB wrote on July 10th, 2014
    • Class of 1970 or 80 even. It doesn’t go back that far that things were more “normal” than they are now.

      But us elders remember. Young people and children only know that this is the way it has been all their lives. To change this new normal is an even more monumental task in light of this.

      Pure Hapa wrote on July 10th, 2014
  26. Yes, the obesity epidemic is real and no, it is not the “fault” of “fat” people: Rather, it is the direct result of capitalism run wild (economic policy) manifested in colonial, agricultural, industrial, medical, political, and, ultimately, social practices. Make no mistake: we are generations of victims–perhaps willing, but victims none the less.

    Is the decline of the middle class in the US be correlated with the increase of population BMI? Absolutely. Are the “rich” really “thinner?” Of course! Can I prove causation? Foment a political revolt? Er, probably not.

    However, thanks largely to Mark Sisson, I can continue to pursue my own, personal, revolution: the Primal revolution that has enabled me to reject blood sugar medication, blood pressure medication, and cholesterol medication. A revolution that has allowed me to pause and reevaluate my life in a kinder, gentler, more spiritual direction; to breathe and move easier at 60 years than I did at 30!…oh, yeah, and forced me to shop for (smaller) clothing…which I can pretty much afford because real food actually costs less!

    Corey B. (Long Beach, CA) wrote on July 11th, 2014
  27. We are definately getting larger, not just in America, but here in the UK. Back in the 50′s when I was at school, I only remember one girl who was overweight in my year which had about 60 girls. But you can’t always tell by looking at someone if they are overweight. My grandfather who was of a very stocky build but short, he was the same height as me,and also smoked all his life, lived until he was 92. By today’s standards he would probally be labelled as fat. He worked until he was 70 and then did gardening when he retired and walked everywhere, he didn’t have a car.
    As to the sizes of clothes, they have changed here. When I was in my teens & 20′s I bought size 12, I then put on some weight and needed size 14. Before I went paleo I had to buy size 12 even though I hadn’t changed size. I now need size 10 trousers and sometimes the waist is too large. A pattern I bought last year to make a dress, I needed size 14 verging on size 16!! I have gone down to my teen/20′s weight but I think I am still a bit fat round the middle. Going paleo has reduced my waistline several inches. I’m a skinny build with small bones, not like my grandfather.
    I don’t think we have the right to lecture people about their eating habits, but need to be a role model. If people notice how good you look or how much weight you have lost, and ask you how you did it, then you can plug our diet. I’m still getting good comments about how well I look from people I haven’t seen for a while, I had one today in the supermarket. this really encourages me to continue.

    Diana wrote on July 11th, 2014
  28. I’m 20 lbs overweight because I drink too much raw milk.

    I also consume too much fruit in combination of a high fat diet.

    I totally OWN my reasons…unlike so many here that come up with excuses such as:
    Medication ruined my metabolism or my parents fed me crap and I’m stuck this way.

    On the other hand, I don’t think some extra pounds have ever hurt anyone, I had more health problems than I could count on 2 hands before going primal.
    I actually weigh more now than before and the chub on my belly wiggles when I laugh but do I care?!

    Health and feeling great is what matters.

    Al wrote on July 11th, 2014
  29. I chose fat acceptance over low-fat dieting (the only form of dieting that I had read about/been told about in a positive light) for 10 years. (During that time, my weight varied between about 200 and 250 lbs. I’m a 5’8″ tall woman, so I was decidedly obese.) The up side of this choice was that I saved loads of money over buying books, paying for weight watchers, buying new clothes as my weight yo-yo’ed, etc. I also exercised more than many of the other fat people I know because I found it made me feel good regardless of my weight.

    I read Good Calories, Bad Calories and Why We Get Fat and What To Do About It a year and a half ago after a friend recommended them. Since then, I’ve been slowly losing weight on a low carb diet. I feel great, and I plan to eat low carb for the rest of my life.

    I hope that the message that a low fat diet is a terrible way to lose weight gets out (I have several friends trying low-carb after seeing my success), but until then I think that Paul Campos’s message is less destructive than telling people that obesity will kill them while giving them terrible advice about how to fix it.

    Kay wrote on July 11th, 2014
  30. I agree that the obesity epidemic is greatly exaggerated. Fitness and weight control are the new religion, fueled more by faith than science.

    That said, our modern diet does encourage an unhealthy body. One of the common effects of overindulgence in carbs is sending the appetite out of control. And a side effect is craving more carbs. So kids growing up eating cereal for breakfast and dinner, super-sized portions, sodas everwhere — the list is too numerous to ennumerate — yes! kids are too fat and parents too.

    And, as you say, the health effects of obesity are actually the product of our normal everyday diet. Obesity itself is a symptom of a bad diet and inactive lifestyle.

    Sue Swafford wrote on July 16th, 2014
  31. I have been moving to different continents & countries for 12 years now. I am from Ireland originally. I lived in Norway first where people are in general very fit & healthy. I then moved to Indonesia where obesity in not seen in the general population, quite the opposite due to intense poverty. I then moved to Texas! I was actually shocked I had never seen so many obese people, seeing overweight young children was unbelivable to me how much & what kinds of food were these kids given to counteract all that growth hormone! I recently traveled to Ireland since I was last there people are bigger, I saw overweight kids too, nothing like the volume in Texas, but a definitive shift, I’ve just settled back in Norway and can’t believe the amount of young overweight people I have seen,in my experience the generation below me (I’m 36) is most definitely suffering from weight gain. I truely believe the obesity epidemic us alive and well especially in places like Texas. It’s those poor children I feel for, I’ve seen children just over a year be given coke to drink, surely this can be made illegal, do people realise that this stuff is caffeinated?

    Lean Garland wrote on July 23rd, 2014

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