Post No.: 0963
Fluffystealthkitten says:
Obesity rates fluctuate from year to year but the overall trend over the past 5 decades is a clear increase. Human genetics haven’t notably changed since after WWII yet lifestyles have i.e. it’s primarily the environment in which modern humans find themselves in that has evolved dramatically. Some countries consider obesity as a disease itself, like they do with addiction. At the very least it increases the risk of diseases like diabetes, osteoarthritis and some cancers.
Just because something naturally exists in the body, it doesn’t mean you can’t have too much of it, like blood sugar levels or saturated fat. Too much of anything is harmful – even exercise or water. Too little of something that’s necessary for us is also bad of course – girls with under-eating disorders especially need fats, proteins, carbohydrates and vital minerals like calcium.
Apart from the increased availability of relatively cheap calorie-dense ‘obesogenic’ foods and drinks – modern conveniences, sedentary pastimes, more sit-down office jobs and less manual labour, contribute to the rising obesity rates. Women delaying having children is both biologically and behaviourally associated with a higher risk of raising overweight children too. Sleep deprivation, whether from work or all-night play, can alter one’s metabolism and increase appetites. Climate-controlled buildings mean that the body doesn’t need to expend as much energy to regulate heat than without climate control, although this isn’t a significant driver of obesity. Weight gain is a side-effect of some medications. Smokers (nicotine), meanwhile, tend to have a lower bodyweight than non-smokers, but this doesn’t explain the increased rates of obesity in preschoolers and there are indubitably health risks with smoking too. (‘Adult-onset diabetes’ was renamed ‘type 2 diabetes’ in the last couple of decades because many children started developing it.) And some pollutants are endocrine disruptors, although again it’s difficult to make a case for this being a key driver.
Having a lower socio-economic status (SES) correlates with eating less healthily and in turn higher rates of obesity and heart disease, fatty-liver disease and stroke. Low SES groups have higher rates of chronic diseases and lower health outcomes overall, not just in ‘developing’ countries but in ‘developed’ countries – indicating health inequities related to different levels of SES. (One study however suggested that higher-income groups are now catching up with lower-income groups in terms of obesity rates in some OECD countries.)
Factors influencing food choices aren’t only based on individual preferences but are constrained by circumstances that are cultural, social and economic. Diet no doubt has a financial aspect. In general, more healthful foods like fruits and vegetables are more expensive than more calorie-dense, ultra-processed foods when we look at their price-per-calorie. Yet, although choice will be restricted, there are enough healthful yet affordable foods available to sustain a healthy diet if one can otherwise afford an ultra-processed-food diet (e.g. choosing canned tomatoes if one cannot afford fresh organic tomatoes, or tap water is cheaper than soda). Plus, logically, although one cannot consume more if one cannot afford more, one can always consume less if one is consuming too much.
However – poverty tends to increase stress, which can lead to more emotional eating (please read Post No.: 0947). And the biological mechanism that might be deeply rooted within all of us is that if we live in poverty or unstable environments, our bodies may instinctively make us seek to store more fat precisely because we perceive that we could be soon facing food insecurity. (Fruit and vegetable consumption dropped whilst high-fat and added-sugar item consumption rose across all households on average after the 2007/2008 Financial Crisis.) This occurs in ‘developed’ as well as ‘developing’ countries. This instinct is adaptive in environments where food is indeed scarce but is maladaptive where food is actually plentiful. Our instincts evolved for way before food was relatively consistently plentiful like in this modern food-rich environment i.e. they’re not optimal for today’s world. People with low SES are therefore eating as if constantly preparing for a potential upcoming famine that doesn’t quite come. Meow.
Most chronic stresses for our ancestors were probably related to food insecurity thus any stresses for us today are crudely generalised with a response to seek to store calories in case of impending lean times. Most people, regardless of their SES, comfort eat when stressed, which is okay if the stress is transient. But poverty or any ongoing (perception of) insecurity is a chronic stressor.
This is why mere information campaigns (evidently) haven’t worked – education is vital but it’s not always sufficient since most people with low SES know what’s healthy and unhealthy but they’re not biologically driven to choose healthful choices when they experience insecurity. Physical accessibility to, and affordability of, healthful options are still crucial too.
What could also help protect from this behaviour is to be brought up with the attitude of ‘what am I going to cook today?’ rather than merely ‘what am I going to eat today?’ and cooking large batches (which increases the cost efficiency) of homemade preserved foods to store in order to combat the feeling of food insecurity. If one has the space, one could also grow one’s own fruits, vegetables and herbs.
Home-cooked meals are typically cheaper than eating out or ordering takeout. But if people don’t have the facilities to cook, or energy prices are high (although eating out or takeouts would still be more expensive if so), then this will affect food choices too. And experimenting with cooking feels risky for those who are unconfident in the kitchen in case they waste food.
…A nation is made up of its people, and thus the health of its people. A healthy workforce and economic productivity go paw-in-paw. It was thought that higher GDP levels automatically led to higher levels of health for a nation, and indeed this correlates up to a certain point (e.g. having enough clean water, food, medicines). But beyond this level of reliably providing the necessities, this correlation breaks down (e.g. USA has ~5x the GDP/capita of Costa Rica yet citizens of the former have a life expectancy of ~2 years less according to World Bank figures from 2020). Well hospital visits increase GDP hence an unhealthy nation can be seen as beneficial for economic growth(!) So it’s far more complicated than just measuring GDP, and it’s not just about what we do more of (e.g. consuming more oily fish or vegetables) but what we do less of (e.g. sitting in offices or inhaling air pollution) too.
The purpose of economics is ultimately about trying to promote and enhance a society’s well-being. But since ‘well-being’ is difficult to measure – money becomes its proxy because it’s easy to measure.
Although we can compare with other populations indirectly, it’s difficult to directly know how many lives have been saved from an intervention unless people were clearly about to die. It’s easier to tell how many people have been saved when a drug saves them from a life-threatening disease they had, but it’s not so easy to tell how many people have been saved when we successfully encourage people who aren’t (yet) ill to eat healthily and exercise regularly i.e. would they have needed saving at all? Likewise, it can be hard to know precisely how many lives have been harmed when something has a cumulative and delayed harmful effect. So causes with delayed harmful effects will get under-blamed for the harms they cause (e.g. too much junk food advertising) and causes with delayed healthful effects will get under-credited for the benefits they create (e.g. instilling healthy habits in children).
Yet we know that prevention is always better than (attempted) cure in terms of overall costs and effectiveness. Some outcomes are irreversible no matter how much money you have, like a diabetes-related limb amputation! We must therefore be aware of these factors and appreciate the full value of actions that prevent harms especially the earlier they intervene in the potential chain of events that can lead to a harm, even though we cannot see the threat they’re trying to prevent being an immediate one. We’ve got to get away from short-term thinking along the lines of ‘I’m not sick so why do I need to eat healthily?’ or ‘me consuming so much ultra-processed food must be fine because it hasn’t made me sick yet’.
We can reduce strain on public health services by throwing more resources at treating the ill and/or by reducing the number of ill in the first place. But a problem with democracy is that it discourages upfront investments that the incumbent government allocates for future savings/benefits that a future government may take the credit for. And it encourages short-term gains for future costs that a future government may take the blame for or need to deal with.
Nations can therefore parallel individuals in the way they prioritise short-term gains while pushing problems for their future selves to deal with. And even when the problems emerge, they try a bit of dieting here and there but nothing sufficiently concerted and holistic; and so the problem grows further, which makes dealing with it and cultural change progressively more difficult. But they constantly hope for some miracle solution, like a new technology, so that they can complacently ‘get away with it’ for longer and avoid individually modifying their own habits. It’s not just the fault of politicians – it’s like citizens say they care about the environment yet also want to live luxuriously, travel on aeroplanes or basically be free to do whatever they want.
A pattern from epidemiological research across the globe is that tackling poverty, inequality and low SES will potentially solve a host of other major problems too, like diseases, poor mental health, early mortality, overpopulation and violent crime.
A question is whether to measure differences between social groups by using absolute numbers or by relativity? In absolute terms, the health of all social groups have improved markedly over the past century – but in relative terms, infant mortality rates of non-white ethnicities compared to white ethnicities remains at about 2:1. This affects how statistics are presented, whether by the media or politicians (hence it’s always best to be able to review the methodologies of studies and purruse the full results for yourself rather than rely on headlines that could be presenting cherry-picked conclusions by others).
Advances in medicine have helped every SES group as a whole, but since medicines cost money, this can explain some disparities between the health of the rich and poor, especially in countries without universal healthcare systems. And since some technologies are or will be expensive (e.g. gene therapies, ‘designer babies’), some fear a resultant apartheid in health between those with the means and those without, simply by virtue of being born privileged or not.
Social systems generally dislike change though – trying to move low SES families to higher SES neighbourhoods results in a lot of reluctance to move or being accepted, and many will return to their old neighbourhoods. This is a conundrum in social epidemiology. Changing laws also involves much resistance and inertia, never mind changing cultures.
Some also contend that healthcare paid for by the public (or by one’s employers, or even privately paid health insurance via one’s own pocket) can disincentivise looking after one’s health. Some medications are so highly effective (e.g. for controlling cholesterol) that people will rely on them instead of controlling their own weight through personal lifestyle changes alone.
Even doctors may label obese people who don’t follow their recommendation of ‘eat less, move more’ as ‘non-compliant patients’. But whenever a teacher fails with so many different pupils then isn’t it, as it were, the teacher’s failure? Imparting advice isn’t always enough. When something fails so systematically, we look at the system, not the individuals – and that’s the ultimate responsibility of the government. Multibillion-dollar industries that profit from obesity, like Big Food, and perhaps Big Pharma, have enormous political clout though.
Meow!
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