Krugman: FREE TO CHOOSE OBESITY?

[HuckleB]

Free to Choose Obesity?

http://www.nytimes.com/2005/07/08/opinion/08krugman.html?hp

"...

In public, the industry's companies proclaim themselves good guys, committed to healthier eating. Meanwhile, they outsource the campaigns against medical researchers and the dissemination of crude anti-anti-obesity propaganda to industry-financed advocacy groups like the Center for Consumer Freedom.

More broadly, the ideological landscape has changed drastically since the 1960's. (That change in the landscape also has a lot to do with corporate financing of advocacy groups, but that's a tale for another article.) In today's America, proposals to do something about rising obesity rates must contend with a public predisposed to believe that the market is always right and that the government always screws things up.

You can see these predispositions at work in an article printed last month in Amber Waves, a magazine published by the Department of Agriculture. The article is titled "Obesity Policy and the Law of Unintended Consequences," suggesting that government efforts to combat obesity are likely to be counterproductive. But the authors don't actually provide any examples of how that might happen.

And the authors suggest, without quite asserting it, that because people freely choose obesity in a free market, it must be a good thing.

..."



----------

More on the topic:

The Food Industry Empire Strikes Back:

http://www.nytimes.com/2005/07/07/business/07food.html


--and--

Obesity Epidemic’s Heavy Costs

http://www.townhall.com/columnists/GuestColumns/Fumento20050707.shtml

"How times change! Wasn’t it just in April that the media and food and beverage lobby ran riot over a single study claiming that being overweight is actually good for you? I was among the few who pointed out that this utterly contradicted a mass of previous research, along with what’s known of human biology. Now a new study shows that the burden excess fat exacts on insurance costs comes from the burden it exacts on our bodies.

That study in the July Health Affairs classified people as obese (Body Mass Index above 30), overweight (above 25), and normal (below 25). Granted that “normal” is something of misnomer in a country where only a third of adults are below that 25 BMI level. It then compared medical expenditures for these three categories in 1987 and 2002.

To do so it looked at nine physical conditions aggravated by extra poundage, plus “mental disorders.” For all nine of the physical conditions in 2002, “overweight” persons fared WORSE than “normal” ones. They were almost three times likelier to have type 2 diabetes and well over twice as likely to have high cholesterol and high blood pressure.

But the obese suffer far more. They were more than twice as likely to suffer arthritis, asthma, heart disease, and upper gastrointestinal problems compared to “normal” persons. They were more than six times likelier to suffer diabetes and more than four times likelier to have hypertension.

..."

[SteppingRazor]

1. I see both sides...

Yes, you should be free to be as cartoonishly bloated as you wish.

Yes, the government should weigh in on the health effects of your blimp-sized body.

[indigo32]

2. You might want to find a different way

of describing the very large number of overweight people all around you (Yes I do believe it's a serious problem), and not make assumptions about how all of them got that way (though surely we know how alot of us got there).

Just a hint.

[Eloriel]

6. And what if that cartoonish bloat isn't actually what you choose,

but something that happens TO you because our food supply is riddled with all sorts of sugar, which after eating enough of it often enough results in a metablic disorder called insulin resistance, which disorder results in a host of other problems, including high blood pressure, high triglycerides, high bad cholestorl / low good chlesterol, clogged arteries, and obesity. And eventually diabetes, and heart disease. All of this is also being referred to lately as Syndrome X, I understand.

I no longer see obesity as the CAUSE of all those other problems (diabetes, hypertension, cholesterol, heart disease, etc.), but rather just another symptom.

If anyone wants to conduct an experiment to get a flavor for how absolutely saturated our food is with sugar (and refined carbohydrate -- white flour, white rice, cornmeal, all of which are converted to sugar almost instantly upon hitting the stomach), and how difficult it is to avoid it, just TRY to eat for a week getting absolutely no sugar. No refined carbohydrates, no sugars in any other foods purchased at the grocery story or a restaurant, no fruit or fruit products. It's not impossible, but it's (a) one helluva lot of trouble and (b) not exactly cheap. You're left with virtually NOTHING that comes in a box or bag -- and only those foods which are basically fresh produce (or certain canned and frozen) and meat/other protein (eggs, tofu, legumes). You'll be amazed to find sugar in the most amazing places -- some lunchmeants, and not just the "honey baked" ham! Peanut butter (which has actually had sugar in it since at least the early 70s -- WHY?).

Almost everything processed in any way (that is, not fresh, or very simply canned or frozen) contains added sugar in one form or another: glucose, sucrose, dextrose, maltose, high fructose corn syrup, corn syrup solids, the list goes on and on and on.

If you need a snack from a convenience store, just about the only things that you can eat are the peanuts (or cashews), or cheese sticks if they carry them, and few do. No chips, twinkies or other baked goods, no candy of course, and not even trail mix. Very, very few choices if you find yourself in a pinch.

Some of our bodies can't handle this constant onslaught, which elevates blood sugar, and in turn insulin, so that eventually our cells get insulin resistant, which means more insulin gets pumped into our system until there's TOO much, and then our blood sugar crashes and we end up craving the very things that got us in trouble in the first place: quick energy in the form of foods with high sugar content or which are quickly turned into sugar upon ingestion. And the cycle continues. And because our bodies aren't meant to handle that much sugar in our blood, it gets converted to fat.

BTW, when I say craveings, I MEAN cravings. For some (or sometimes) it's just the seemingly insatiable munchies, but for some it's "I'd chew thru table legs to get to that candy," and that's NOT an exaggeration.

There are ways to break the sugar habit, get over the cravings, but mere willpower alone isn't likely to do it -- certainly not for everyone.

I'm very interested to watch how the food industry is already engaged in distraction and deflection so that no one (hopefully) ever gets a REAL clue as to why they're obese, and who the real cause is.

[Vinca]

7. I think you've nailed the exact cause.

When you try to eat healthy - buy canned kidney beans, say - what's in the list of ingredients? Sugar! Canned tomatoes? More sugar! Tomato sauce? Sugar! What started out as a nutritious pot of chili turns into a vat of sugar. I try not to use canned anything, but tomatoes don't grow well in New Hampshire in February. Goods from the natural foods store, which are definitely better for you, are much more expensive and often lacking in flavor. The whole industry has to change.

[Skittles]

10. it can be very difficult eating healthy

I'm on a business trip and so many places I go to eat offer NO healthy alternatives - it is sometimes such a struggle.

[Serial Mom]

22. Exactly!

I know my body increased in size not only because of how many "calories" came in, but what type of calories - useless! It came in the form of processed foods and restaurant foods that use a lot of additives in the forms of sugars AND salts (MSG is another one). I believe you when you say these cause cravings, and more than just cravings, I believe some are addictive.

I also don't know have any idea why the food industry began adding this stuff but when you mention the year they began adding sugars to peanut butter (I will only buy natural now) is the year this country began it's rise to increase weight on adults, then kids!

I consider them as bad as the tobacco industry ... I know we all have a choice whether to smoke or not, but the food industry doesn't leave us much choice.

[rinsd]

3. Sorry Paul....

...you can stuff the nanny state bullshit.

[HuckleB]

8. Thanks for the cliche.

The funny thing about your offering is that the "nanny state" currently works to protect the fast foodies, which means it's actually working to help produce obesity, if anything.

[Inland]

42. Because he was pointing out that the sales are directed to children

I'm not sure what's so wrong with a nanny.

Particularly since one of the places kids get their food is schools and near schools, out of parental supervision.

If we can be sufficiently a nanny state to hold the children for six hours a day, we can also feed them decently.

[eridani]

4. My letter to Krugman

krugman nytimes.com
http://www.nytimes.com/2005/07/04/opinion/04krugman.html

But it's also, alas, a partisan issue.

First, let's talk about what isn't in dispute: around 1980, Americans started getting rapidly fatter.

Some pundits still dismiss American pudge as a benign "affliction of affluence," a sign that people can afford to eat tasty foods, drive cars and avoid hard physical labor. But all of that was already true by 1980, which is roughly when Americans really started losing the battle of the bulge.


1980 is a key year in several respects—the onslaught against the American working class went into full swing then, greatly exacerbating the time crunch, and Americans also went into high gear on fetishizing thinness and demonizing fat people. Concurrently there was a serious backlash against feminism.

Seems to me that obsession with thinness got really bad right around the time when feminism re-emerged, a very convenient excuse to deny economic advancement to women, particularly Black, Latina and Native American women.

Note that even for many women within the normal weight range, the extensive time devoted to maintaining average weight is time that can't be spent on coursework for professional advancement.

See the following study--the fact that weight discrimination does not apply to men definitely shoots down the "health" excuse.

http://www.sciencedaily.com/releases/2005/06/050620010100.htm

The study's authors also found that a women's body mass is associated with a reduction in a woman's likelihood of marriage, her spouse's occupational prestige, and her spouse's earnings. In addition, the researchers found that the association between body mass and occupational outcomes was more pronounced among younger women, suggesting that it is body mass that affects occupational prestige rather than the reverse. By contrast, and consistent with past research, men experience no negative effects of body mass on their economic situation.

The researchers found no association between height and economic outcomes. The paper is available at http://papers.nber.org/papers/w11343.pdf.

Through sibling comparisons, Conley and Glauber found that a 1 percent increase in a woman's body mass results in a .6 percentage point decrease in her family income and a .4 percentage point decrease in her occupational prestige as measured 13 to 15 years later. There were no such associations found for the men in the sample.


There actually is no evidence that obesity, independent of other factors, is a health risk. That is, no evidence which distinguishes between two possible models for the mild correlation between weight gain and poor health.

--Poor nutrition + lack of exercise --> obesity --> poor health or

--Poor nutrition + lack of exercise --> obesity AND ALSO
Poor nutrition + lack of exercise --> poor health

All evidence so far points to the second explanation, which makes invoking the first explanation merely piling on to the really nasty discrimination that fat people, particularly low-income women, deal with already. To appreciate the class snobbery involved here, recall that 100 years ago, being pale and plump made the social statement “I sit around all day in the shade and drink mint juleps, unlike you average slobs who dig potatoes and chop cotton all day in the hot sun.” These days, being lean and tan makes the social statement “I play tennis in the summer, ski in the winter, and can afford a personal chef and trainer, unlike you average slobs sitting and standing around all day in convenience stores, offices, and factories.”

The flogging of poor nutrition by corporations that benefit from the time crunch that employers have imposed on working people is, of course, not justified. The best way to deal with it is to fight the growing wealth and income gaps, give working people real bargaining power for a change (which would result in more free time to pay attention to exercise and better nutrition), and take a stand against the class-related anti-fat bigotry that is so prevalent. Dieting (particularly starving and bingeing, is in and of itself a very likely contributor toward increasing average weight. And poor nutrition and no exercise are bad for you no matter what you weigh.

[depakid]

5. Not his best column- but

I think he had way too much to say for the limited space he was allowed- although it did shed a little light on some of the libertarian types who defend the likes of McDonalds around here without any regard to their blatant effort TO HARM CHILDREN and externalize their costs on society.

I say to those types- try for a moment to think about the big picture. Get out of your narrow minded framework (and your petty little cliches) and do some honest analysis for a change. It might actually do you and our children some good.

[Logansquare]

9. Peddling of sugar-laden products to children has reached obscene levels

When I was a kid, milk was the beverage you were most likely to drink at a meal. Soda pop was a treat, usually purchased for parties or out of a machine at the gas station. Now you can't even buy juice for your children without having to check it and see if it's really juice or a "juice drink" full of corn syrup. A number of products which are high sugar spin-offs of once healthy treats, such as fruit leather and granola, have started to dominate the market. In some cases, parents don't realize that they are actually poisoning their kids by feeding them this crap.

All I know is that 1 out three little boys in my neighborhood have *breasts* and fat rolls on their backs. I can't imagine what will happen to these kids when they grow up.

[ikojo]

11. Why when talking about obesity and its causes, don't we

talk about our extremely car dependent society? Most people will get in their gas hog of an SUV to go on an errand that is less than a mile or two. Back in the day, when our grandparents freaking cooked with LARD and such, people were much leaner. Why? Because if they lived in an urban area they WALKED to most of their destinations. WALKED to the store. WALKED to shul or church. WALKED to visit their friends. WALKED to work or to the bus stop to take the bus that took them to work.

Now we are happy if the pedometer tells us we took 10,000 steps in one day. Most suburbs don't have sidewalks, so walking is discouraged by virtue of a lack of safe places to walk.

Also, obesity isn't new to the 21st century..just look at the old Hollywood movies. Marilyn Monroe would be called obese by today's standards, as would Elizabeth Taylor and most of the Hollywood goddesses of yore.

[HuckleB]

12. Huh?

Marilyn Monroe would be called obese?

No.

Just because today's actresses often have BMI's below 20, which means they may be endangering their health in another way, does not mean that Marilyn, or even Elizabeth in her younger days, were anywhere near obese.

Yes, automobile culture is a big part of the equation, and it is discussed ad nauseum in research circles. But the power to change that doesn't lie with researchers.

[ikojo]

13. A co-worker who is 60 years old and

much smaller than Marilyn Monroe was at the height of her popularity, was told she is pre-obese. Oh yes, Marilyn Monroe would be told to go on a diet. I believe she was a size 12 and that is not tolerated in today's Hollywood.

[HuckleB]

14. Hollywood recommendations and doctor's recommendations...

are two very distinct things. In her movie days, Monroe likely had a BMI around 23 or 24, and that's hardly "pre-obese."

[calico1]

24. Marilyn Monroe may have been a size 12

but a size 12 in her day was not what a size 12 is today. At the height of her career her weight hovered around 135 lbs. on a 5'4" frame. Today she'd probably be wearing a size 6 because we have what is known as "vanity sizing." That didn't exist in her day because we did not have the obesity problems of today. A size 12 was very common. Take a look sometime at a vintage clothing store and check out the size 12's of 50's and 60's clothing. I helped my aunt clean out a closet one day. She also had lots of size 12 clothing from back in the 50's and 60's and they were tiny. A lot of women like to feel they are a size 6 or 8 or whatever, or at least most clothing designers think this. So the sizes keep getting smaller as the clothing keeps getting bigger.

[Inland]

43. Somebody put a pedometer on an Amish man

and it read thirty miles a day.

And in the opposite direction, city dwellers end up walking more than suburbanites--you can't take your car to the corner grocerty in the city, and in the suburbs, there IS no corner grocery.

[eridani]

15. When will these stupid jackasses get it?

Obesity does not cause diabetes--being genetically prone to diabetes causes obesity, and also heart disease. The genotype occurs most frequently in parts of the world where periodic starvation is the norm. The only conceivable way for the diabetically prone to be of average weight as adults is a lifelong commitment to semistarvation, artificially replicating the lives of their ancestors.

Harrasment, psychological and physical abuse of the obese aggravates the trend toward diabetes, mainly because adrenalin is one of the most effective insulin antagonists that there is. Also, starvation (or as middle class folks call it, "dieting") followed by stuffing dramatically increases risk for diabetes.

Asthma and arthritis? YOU GODDAM FUCKING STUPID SHITS!! Has it ever occured to you that being asthmatic or arthritic hinders mobility, therefore leading to being much less active and gaining weight?

[depakid]

16. You might want to think again

There is more than a correllation between diet, obesity and diabetes...

and all the rationalization in the world isn't going to change that hard clinical fact.

[eridani]

17. When you learn some science--

--then you will be able to understand the difference between correlation and causation.

If you think being fat aggravates athsma, you probably think that getting older increases gasoline prices. After all, there's a really good positive correlation between your age and the price of gas. Here's a clue for you--committing suicide will not have any effect whatsover on the price of gas.

[depakid]

18. I get so tired

of having to try to teach people who are on agenda driven crusades.

Try Pub Med- or Try Google Scholar-

[eridani]

19. An example of an agenda-driven crusade, and a very profitable one,

--is the multibillion dollar diet industry.

You might want to do some crusading against this silly notion that metabolic diseases have anything to do with genetics. Start by eliminating PKU tests for infants. That this disease is treated 100% environmentally, namely lowering phenylalanine in the diet, is clear proof that genetics is irrelevant.

And you should also work to outlaw sunscreen. It's clearly been proven that the darker your skin is, the less likely you are to get skin cancer. Therefore everybody should get out in the sun to make their skin as dark as possible.

Also, get into the toupee business. Male pattern baldness is positively correlated with incidence of heart disease, so you could make a big contribution to preventative medicine that way.

http://www.findarticles.com/p/articles/mi_m0922/is_1_54/ai_n9772637

Impaired insulin secretion, insulin resistance, and increased hepatic glucose production (HGP) are the three major pathophysiological players involved in the development of type 2 diabetes (7). However, it is currently debated which of the defects are primary and perhaps genetically determined and which are secondary to other abnormalities of glucose and lipid metabolism. Patients with overt type 2 diabetes display multiple abnormalities of cellular glucose metabolism, the most important being defective glucose oxidation, glycolytic flux, and nonoxidative glucose metabolism (NOGM) (8). Studies have shown that the genetic component of insulin resistance, as seen in first-degree relatives of type 2 diabetic patients, is almost exclusively explained by defective NOGM (9). Additionally, it is well established that all of the cellular defects of insulin-stimulated glucose metabolism, including nonoxidative glucose uptake in type 2 diabetes, have quantitatively important secondary (nongenetic) components (10).

http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=15546003

Genetic and environmental factors contribute to age-dependent susceptibility to type 2 diabetes. Recent studies have reported reduced expression of PPARã coactivator 1á (PGC-1á) and PGC-1â genes in skeletal muscle from type 2 diabetic patients, but it is not known whether this is an inherited or acquired defect. To address this question we studied expression of these genes in muscle biopsies obtained from young and elderly dizygotic and monozygotic twins without known diabetes before and after insulin stimulation and related the expression to a Gly482Ser variant in the PGC-1á gene. Insulin increased and aging reduced skeletal muscle PGC-1á and PGC-1â mRNA levels. This age-dependent decrease in muscle gene expression was partially heritable and influenced by the PGC-1á Gly482Ser polymorphism. In addition, sex, birth weight, and aerobic capacity influenced expression of PGC-1á in a complex fashion. Whereas expression of PGC-1á in muscle was positively related to insulin-stimulated glucose uptake and oxidation, PGC-1â expression was positively related to fat oxidation and nonoxidative glucose metabolism. We conclude that skeletal muscle PGC-1á and PGC-1â expression are stimulated by insulin and reduced by aging. The data also suggest different regulatory functions for PGC-1á and PGC-1â on glucose and fat oxidation in muscle cells. The finding that the age-dependent decrease in the expression of these key genes regulating oxidative phosphorylation is under genetic control could provide an explanation by which an environmental trigger (age) modifies genetic susceptibility to type 2 diabetes.



Results: VLCD induced rapid weight loss, but all the lost weight was regained during refeeding. Blood pressure fell during caloric restriction, but rose above baseline during refeeding. Urinary excretion of norepinephrine, epinephrine and dopamine changed several fold during weight cycling. Urinary catecholamines paralleled the changes in blood pressure, falling during caloric restriction and rebounding during refeeding. Dopamine showed the greatest decreases during weight loss and rises during weight regain, whereas epinephrine changed the least and norepinephrine was intermediate. Weight cycling elevated blood pressure above the initial baseline throughout the rapid weight gain phase of refeeding. The density of 2-adrenergic receptors was decreased in both the renal medulla and cortex of weight cycled SHROB, consistent with receptor down-regulation owing to overstimulation.


http://www.findarticles.com/p/articles/mi_m0817/is_n9_v42/ai_7895885

The weight-cycling wrestlers were compared to the non-dieting wrestlers. Those who were constantly dieting had metabolic rates that were 14 percent lower than the nondieters. The dieters tended to gain weight faster on less food.

With yo-yo dieting, the body also distributes body fat--shifting it from the thighs and hips to the waist--in a way that is dangerous to the health. Research shows that fat gained around the waist raises the risk of heart disease and diabetes.

In a study with obese rats, it took the rats 21 days to drop down to normal weight--the first time. The second time it took the rats 46 days for the same weight loss, even though they ate exactly as many calories as they had the first time. It also became easier for the rats to regain the weight.

After the first diet, it took 45 days for the rats to again become obese. After the second diet, it took only 14 days. * Losing and regaining weight increases food efficiency, or the ease with which the body can maintain its weight on a given number of calories.

To top it off, reported cycles of losing and gaining weight may also raise the risk of developing heart problems.

Researchers at Northwestern University tracked 1,701 men over a period of 25 years. The researchers reported that men who showed the greatest weight swings also had the highest risk of sudden death from coronary heart disease.

[northzax]

26. Do your studies explain the correlation

between increased levels of early adult obesity and early-onset type 2 diabetes? Find a doctor over the age of 50. Ask her if she ever saw type 2 diabetes in people before 55-60 before 15-20 years ago. Now you see it in 30-40 year olds, and even teenagers. Either we've completely screwed up our genetic code, or something else is coming into play.

As for the connection to obesity, recent studies have shown that walking 15 minutes twice a day can reduce the progression of pre-diabetes into type 2 diabetes by 5 years, and even reverse the condition. for most patients, losing 15 pounds halts the progression of the disease.

to your dieting studies: obviously weight swings are unhealthy, anything that puts that type of stress on your body is unhealthy. My weight fluctuates between about a five pound range, I walk 20 minutes to work, 20 minutes home, play random sports, do active things on the weekend, go out dancing every now nad then, don't drive anywhere less than 5 miles, I take the stairs whenever possible. that's all it takes.

Are there some people who are genetically predisposed to be fat? of course. is two thirds of the US population genetically predisposed to be fat? seems unlikely, doesn't it?

[Name removed]

37. Deleted message

Message removed by moderator. Click here to review the message board rules.

[northzax]

40. for about 80 percent of people, yes, that's all it takes

there are those who are outlying on the metabolic scale for whom the regular routines don't work, this it true. But for most people, it does work.

so your arguement, basically, is that there is no correlation between exercise, diet and weight, for most people? that's really what you're saying? The two largest risk factors for type 2 diabetes are obesity and age, one is solvable in most people. I'm really sorry to have to tell you that (I might note, here I am citing those quacks at the American Diabetes Association and the similar quacks up at the Canadian Diabetes Association) Surely you have some peer reviewed studies to cite on your own to counter that?

Weight gain before the onset of type 2 diabetes is a different matter than weight gain after the onset of the disease. One is a risk factor for the disease, another a side effect. There's a difference, see?

As for the correlation between weight loss and reversal of pre-diabetes, I can again only cite the statistics from the ADA, (http://www.diabetes.ca/Section_About/type2.asp) "a 5-10% reduction in body weight, coupled with 30 minutes a day of moderate exercise, can reduce your chances for developing type 2 diabetes by 58%"

Again, every human body is different. that's why we have doctors, not machines, to tell us what's wrong with us and how to help it. You have one situation, I have another (and still others never exercise at all, while some people spend 2 hours a day in the gym to get the same results) for the average person moderate exercise and a reasonable diet will control weight, energy and insulin levels, staving off a huge number of adult onset diseases, including type 2 diabetes. You simply cannot argue with that, without citing something in the medical or scientific literature to back it up.

How do I know we're all different? some people can smoke a pack of cigarettes a day, weight 300 pounds and be perfectly healthy. For others, the optimum weight is 200 pounds, or 150. your claiming that weight and diabetes are not linked is dangerous to other people. You have one situation, your body may be built for 200 pounds, you eat well and exercise, that's the weight your body is meant to be. good for you. If you weighed 200 pounds, ate fried food and ice cream all day long and your version of exercise was pressing the button on the elevator, I'd tell you were probably unhealthy, but that's obviously not the case. If you were personally insulted by me calling your regimin an acceptable one, I apologize. But I do think, that if you re-read my post, you'll see that I was, in every case, referring to people with either pre-diabetes (which can be halted) or risk factors for diabetes (which, in most people can be reversed) not to people who actually have the symptoms. they, like everyone else, should consult their doctor.

[eridani]

44. Correlation IS NOT CAUSATION!

What part of that don't you understand? Obesity is statistically linked to diabetes because the genetics of insulin resistance promotes weight gain in the people with those genes who are living in societies where there is enough to eat. People are born diabetic in the same sense that they are born with PKU. In the latter case, a diet low in phenylalanine will insure that you don't suffer brain damage. In the former case, being active and eating reasonably will typically postpone diabetic symptoms until you get old enough to die of something else. In neither case can you do anything about the genetics.

As for the correlation between weight loss and reversal of pre-diabetes, I can again only cite the statistics from the ADA, (http://www.diabetes.ca/Section_About/type2.asp ) "a 5-10% reduction in body weight, coupled with 30 minutes a day of moderate exercise, can reduce your chances for developing type 2 diabetes by 58%"

The statement is flat out wrong. There is no evidence whatsoever that reduction in body weight is a relevant factor INDEPENDENT OF exercise and dietary change. If you think there is, post the mulitvariate analysis. (And even if it were a valid independent variable, that could also mean that the weight loss reflects a genetic variant of diabetes that is easier to control.) Does mentioning the magic word "fat" cause instant obliteration of the capacity to understand the post hoc ergo propter hoc fallacy?

Also, the fact that a comparatively insignificant amount of weight loss is involved conclusively establishes that obesity does not cause diabetes. If you get better sugar control going from 250 lbs to 230 lbs, guess what? You are still obese! If simply being obese is causative, why is it even possible for there to be improved sugar control in cases like that?

for the average person moderate exercise and a reasonable diet will control weight, energy and insulin levels

This is irrelevant. What is relevant is that moderate exercise and reasonable diet are two factors that everyone has some control over. Now, given that someone chooses those two options, what control do they then have over what specific results their new program yields for them? NONE! NADA! ZIP! ZILCH! Claiming otherwise is not medical advice--it is simply abuse.

(Speaking of abuse, sorry for going off on you personally.)

[northzax]

47. you really need a citation

in my opinion, if you are going to challenge the statements of the Surgeon General, the ADA and the CDA. It seems strange that 1 in 5 humans is predisposed to diabetes, you'd think it would have killed more people in the days before insulin injections and diet control, wouldn't you?

there is certainly a genetic component, there is a genetic component to everything that happens in our bodies. the thing is, there are people with such a weak genetic predisposition that they would never actually develop the symptoms, except for the stress applied to the system, including from obesity. I have met a 17 year old with type 2 diabetes. no one else in his family has ever developed the symptoms. Genetic? or envrionmental? who knows?

You may be right that there is a predisposition to weight gain tied to the genetic component of diabetes, but it's never been proven, unless you can provide an analysis for us?

the best part of all this is that we are splitting hairs here, we're both saying the same thing, regular exercise and a good diet can stave off the onset of type 2 diabetes. does it matter if there is a correlation or a causation? you get the same result, right?

[eridani]

50. Yes, the difference between correlation and causation matters

The reason that diabetes killed fewer people 100 years ago is that infectitious disease killed off huge numbers before they got old enough to develop symptoms.

I mean, jeezus--are there still people around who don't realize that high insulin levels biologically cause weight gain?

http://www.mercola.com/2000/oct/1/insulin_appetite.htm

Diet cycling and age alter weight gain and insulin levels in rats
http://ajpregu.physiology.org/cgi/content/abstract/267/2/R527

Re your 17 year old--how do you know how many of his current and deceased relatives are or are not diabetic?

There is no evidence that obesity is a stress to the system, independent of diet and exercise factors. Focussing on weight rather than factors directly subject to individual control, like changes in diet and exercise, is stupid and abusive. So even though we are recommending the same lifestyle changes, you retain the attitude that it's OK to publicly abuse people if those changes don't result in significant weight loss. You might just as well holler "Make more insulin, dammit!" at them.

The best possible reason for ignoring weight when you are treating people with diabetes or heart disease is that you get better health outcomes.

http://dukemednews.duke.edu/news/article.php?id=236

"We now have the data for physicians who can tell their patients that they shouldn't focus so much on the scale," said Kraus, who led the study. "These patients should not become discouraged and give up exercising, because our study shows that these patients are getting healthier even if they don't lose any weight."

Specifically, patients saw an average decline in the so-called "bad" LDL cholesterol from 122 to 104, and an average increase in the so-called "good" HDL cholesterol from 32 to 37. These changes were deemed to be statistically significant. In addition, patients saw a 4.3 percent decrease in body fat, which researchers say likely turned into muscle.

The weight of all patients remained the same during the three-month study. In fact, if patients started losing weight, researchers altered their diets to maintain a constant weight.


http://www.thinkmuscle.com/articles/gaesser/obesity.htm

All of these improvements in health profile while on the Pritikin program were observed within three weeks. Although participants do lose weight (typically about 7-11 pounds, or about 5% of their initial body weight), statistical analysis indicates that less than 5% of the improvements in health can be attributed to changes in body weight. Most important to the question at hand is the fact that most men and women who enter the program obese leave the program obese--but with one major difference: They no longer have the health problems thought to be caused by excess body fat.

Just as risk factors for heart disease can be affected by changes in lifestyle independent of changes in body weight, the actual disease itself can be influenced by lifestyle modification--without changes in body weight.

http://www.radiancemagazine.com/issues/1995/diabetes.html

http://www.healthyweight.net/editor.htm#98-1

[HuckleB]

48. .

.

[HuckleB]

20. Here's the deal.

Genetic propensities didn't suddenly jump in frequency overnight. Further, what we know about genetic propensities is that they are propensities, and don't determine ends for everyone. Thus, for many, there are environmental factors that can enhance genetic propensities, regardless of where one's propensity to develop said disease lies on the spectrum in regard to likelihood.

[eridani]

38. Cheap glucose meters, however, did jump in frequency overnight n/t

[HuckleB]

41. And your point?

Technology changed? Someone noted the increase in obesity and diabetes and chose to develop something that should have been developed long ago?

:shrug:

[eridani]

45. What does the word "increase" mean?

It means that at point A there is a baseline incidence of diabetes, and at point B, 10 or 15 years later, the incidence is much greater. In order to say whether there has been an increase, you need to know the correct value for the incidence at point A and the correct value for the incidence at point B.

Now, given the incidence of cheap glucose meters, and the standardization and wide availability of A1C testing (which as recently as 1985 was considered much too expensive to use routinely), we have a reasonably good estimate of the current point B incidence of diabetes.

All we need now is a good number for point A. Given that our measurement capacity back then seriously sucked in a comparative sense, how do you know what in fucking hell that number really was? And if you don't know, how can you say that A is a smaller number than B?

[HuckleB]

46. You assume far too much.

Cheap glucose meters are a tool. They are the only tool for studying the matter. Or did you forget that? Why are you stretching the bounds of logic at every turn? What is your emotional tie to this? What keeps you from being able to step back and look at the whole picture?

[eridani]

49. You didn't answer the question

How do you know about prior incidence of diabetes in the American population? If glucose meters are the only study tool available, how is it that people were ever diagnosed as diabetics before they were invented?

You are the one with the intellectual problem here. I have posted straightforward logical questions, and somehow your refusal to answer them becomes my emotional problem.

[HuckleB]

21. Diabetes 2 risk determined mainly by your adult lifestyle

http://www.medicalnewstoday.com/medicalnews.php?newsid=27225

[eridani]

23. Body fat and waist: hip ratios are physical traits, not "lifestyles"

Men and women with more body fat and larger waist and hip measurements were more likely to have insulin resistance which significantly increased the likelihood of diabetes at the age of 50.

This is bullshit. It assumes what it is supposed to prove. Fat distribution is almost entirely determined by genetics.

And the single biggest "lifestyle" determinant of type II diabetes is living in an industrialized society with enough to eat and work that takes up most of our time with non-aerobic activity. And that is something you have no control whatsoever over, unless you think that moving to Rwanda is a reasonable alternative.

Eating a diet low in phenylalanine has not the slightest effect on the defective metabolic gene responsible for PKU, though it will prevent the brain damage that would otherwise occur. Exercise and not overdoing foods with high glycemic index have not the slightest effect on the genetic determinants of diabetes, though it will postpone symptoms and make them far less severe when they occur. This is completely unavoidable, unless you consider dying of some infectitious disease before that gets a chance to happen desirable, which was what used to happen 100 years ago. Thanks but no thanks on that one.

[HuckleB]

25. Nice try.

Yeah, where the body fat goes is due to genetics, but how much body fat one has is not just about genetics.

As for the learned helplessness bit, having enough to eat does not equate to eating too much, and work type is not the only issue in regard to lack of activity in industrialized nations. Not by a long shot.

Again, genetic propensities are not determinants for everyone, and environmental factors play a big part. It's interesting that you note environmental factors and then pretend they don't exist in the next paragraph. Sorry, but that doesn't make any sense at all.

[eridani]

27. Wrong. Having enough to eat IS eating "too much"

for quite a few people, if "too much" is defined as any amount of food more than that required to maintain a statistically average weight. Why should 20-30% of the population be required to voluntarily starve on 1000 calories a day and spend most of their free time on treadmills in order to qualify for basic human respect?

Newsflash: Eating better and exercising almost never brings fat people anywhere near average weight. All that happens is that they become fat people who are healthier and weigh somewhat less.

[HuckleB]

28. Thanks for the spin.

Alas, hyperbole, especially the meaningless kind, doesn't promote understanding. But, hey, thanks for the hyperbole. It did make me giggle, and I can always use one of those.

[eridani]

31. Whatever made you think that your spin was superior? n/t

[HuckleB]

32. My mind did.

:)

Though I suspect that any healthy, skeptical mind would be in agreement, after reading the claims you've offered.

:hi:

[Name removed]

33. Deleted message

Message removed by moderator. Click here to review the message board rules.

[HuckleB]

36. Interesting.

Since I'm the only one who has offered an argument that can be backed up in this little exchange, I'd suggest that you find a mirror.

Thanks.

[depakid]

29. Welp- that argument pretty much flies in the face

of the laws of thermodynamics....

For the vast majority of people, eating a proper diet (which may require types of foods specifically tailored to their cultures) and getting an adequate mount of exercise WILL result in losing weight. To argue otherwise is to argue against basic laws of physics.

[eridani]

30. I didn't say that it wouldn't

What I said was that weight loss will almost never result in turning fat people into people of average weight. Here's a clue for you--the testosterone poisoned pustules who see fit to comment on my weight when I do my bike commute don't give a flying fuck about the difference between 230 and 200 pounds, although the latter weight is obviously healthier.

[Stray Roots]

34. If these people really favor the free market

why are the opposed to giving people information about the health effects of eating this way, so they can make better consumer choices?

[HuckleB]

35. I'm confused.

Who are "these people"?

[Stray Roots]

39. The food industry groups Krugman was talking about

They seem to be objecting to giving people information on healthier eating.