The Macroeconomic impact of defining obesity as illness

Time for a reminder that caution is advised when allowing non clinical “health and science writers” to direct the narrative on health issues that have multifactorial underpinnings. No matter how much stated opinions might comport with ones own.

Whilst I tend to veer towards obesity being a result of individual bad habits (bad habits that I don’t possess and never have) I don’t see it as at all anomalous that obesity should receive disease classification…if , for no other reason than it allows for rebursement for patient education.

After all, periodontal diseases have ICD classification codes in spite of known, simple to implement prevention strategies. Drug abuse…aka Opioid Use Disorder…is considered a disease deserving of medical intervention (in spite of being strongly linked with illegal behaviour) Classification of obesity in the same way isn’t a sop to excuse making or even Big Pharma …it’s a recognition that the interaction of Nature and Nurture is a bit more complicated than folk have been aware of in the past.

Try changing the behavior of a friend or loved one with Bad Habits…alcohol abuse, illicit drugs, smoking etc … and you’ll have an answer to the question “Why don’t doctors just educate these people”

The WWII generation faced much higher rates of poverty when growing up. They left the stage much thinner than the Boomers are currently doing so.

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Sure. Everything can be classified as a disease. And [nearly] everyone can have some sort of disease (obesity, ptsd, long covid, pre-diabetes, etc). If the trend continues, everyone will have a “disease”, and then it just becomes part of normality. Only those very rare abnormal people will have no disease. Once it all becomes part of “normal”, then a lot of it won’t ever get treated, because … it’s “normal”.


Except that it wasn’t…at least, not in an o-FISH-awl blame worthy way. Historical revisionism at its finest.

Sugar has never achieved the status of a healthy nutrient. Even back in the time of Elizabeth I, contemporary writers attributed her poor dental health to an overfondness for “sweetmeets”. Even that old Food Pyramid…the real one, not the cartoon most folk are familiar with from the back of a SnackWell cookie box…has at the tippy top SUGAR listed as an additive to be used sparingly along with fats.

Folk got fat not by reducing fat in the diet and substituting carbs in an isocaloric fashion…but rather eating by more of everything. Especially low quality carbs.

This is probably true. But the lowest quality carb (sugars) is up by 30% in the last 50 years. That’s a big increase.

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Yes…because folk chose to eat more.

My example as someone arriving in the US in the early 1980s…with a background in understanding food choices and their impact, difficultly in effecting behaviour change etc…would be salad dressing. Absolutely Gobsmacked wouldn’t be too strong a phrase to describe my reaction to the amount of salad dressing on their greens. Forget the plethora of choices…even plain oil and vinegar. Now, if attempting to follow a low fat diet (which I probably do in absolute amounts) a rational person would reduce the amount used from the apparently obligatory cup to, say, half a table spoon. That did not happen. Given the moniker and heavily marketed Heart Health Halo of fat free, I’ll wager more than a few folk add an extra splash or more. Likewise SnackWell cookies.

Can’t blame a low fat diet for the obesity epidemic when folk didn’t actually follow a.low fat diet

Well, another way of looking at it is that with the passage of time, we understand more about how the body works and more about what’s going wrong under the hood that reduces our individual control over what afflicts us. I’ll give you two examples…

Take “breast cancer” and “heart disease”. Both are quite strongly associated with those poor personal choices we’re all blathering about…eating too much, drinking too much, smoking etc…and, at least as far as ASCVD is concerned, still is. However, over recent decades and the discovery of the various genetic polymorphisms that contribute to “breast cancer” and “heart disease” it’s become more apparent (at least to those with good cause to be aware) that, in a good many circumstances, lifestyle choices take a definite back seat to the genetic hand we’ve been dealt…and that exemplary Good Custodians of their own bodies can be struck down in a way that phenotypically resembles those who haven’t.

I think that when we all find out that we know a heck of a lot less about these things than we think we do, obesity will turn out to be as multifactorial as we know breast cancer and ASCVD to be.


This has been the story of my life since a massive heart attack three years ago. For 40 years my weight, diet (vegetarian for 22 of those years), Low and slow heart rate had doctors telling me “With BP like that you’ll live to be 100.” Since the HA they no long approve of the slow heart rate and low BP. Now I have a pacemaker.

All I’ve been hearing is “hey sometimes it’s just your genes.” or " Hey, it’s your genes more than people like to think." And I have even met two nurses who have had heart attacks.

Started having painful side effects from the statins after about 2 1/2 years.
Doc told me it’s OK to stop but I expected a new precscrip to follow. Nothing yet. And here I thought cholesterol was the Hitler of heart attacks. I guess not. All that diet, exercise, BP, cholesterol religion turned out to be crap.

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The message I took home is that once it’s classified as a disease, then INSURANCE (OPM) will cover the costs.

So, “normal” means OPM covers the treatment.

All that TAM, just waiting for someone to figure out how to tap it.

ralph. Follow the money.


Except when it’s not.

For close to a couple of decades, I’ve been reassured that my “mildly elevated” total cholesterol and LDL-C didn’t put me at high risk of ASCVD as my exemplary lifestyle choices and high HDL-C, low triglycerides and hs-CRP were mitigating factors. The sort of thing cholesterol denialists and statin phobics have been spouting for as long as I can remember…and still are. I will admit that it does kind of smack as thoughtful, enlightened medical management and looking at the Big Picture holistically. Well, it wasn’t. It was advice given on limited, inadequate information. Nothing different from the information most folk are working with…standard lipid profile, right? Problem is it was wrong and, as I’ve learned, out of date even per the standards of a decade ago

A total cholesterol of 230 and LDL-C of 120 or so isn’t “borderline high”, an HDL-C well over 80 isn’t necessarily protective and a hs-CRP of .8 doesn’t mean what everyone (including me) thought it did.

When I first heard/read of things like Lp(a) lipoprotein, Apo-b particles, Coronary Artery Calcium scans on longevity/cardiology websites a few years ago (including, but not limited to, Peter Attia’s) I thought “Oh yeah … more testing”…like you do. I bit the bullet this time last year, asked my new PCP to add these to my annual bloodwork and the rest is history.

The CAC score was really high…evidence of longstanding past disease. Subsequently, CT angiogram showed 3 severely blocked coronary arteries with restricted flow…and that “mildly elevated” LDL-C was due to high Apo-b particle.

It’s perfectly possible to walk around with an apparently unfavourable lipid profile and a CAC scan show a score of zero…as I’ve posted in cardiology related links previously…but that was not my good fortune. I wouldn’t have known without the scan…probably like most folk whose first intimation of disease is their debilitating stroke or heart attack “out of the blue”

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Italians are gobsmacked when they see the quantity of sauce on pasta in the USA. After they scrape off 3/4 of it, they are gobsmacked once again when they taste it … because it is ridiculously sweet compared to the sauce they are used to in Italy.

Most people cannot follow a low-fat diet because it is nearly impossible due to our biology. That’s because you become too hungry on a low-fat diet, and eventually you will almost surely succumb and eat eat EAT.

So you can blame the “low fat diet” because it is nearly impossible for humans to do it.


On a somewhat related topic, morbidly obese people have trouble getting standard medical treatments. My sister needs hernia surgery, but can’t get it until she loses 50 lbs. On the other hand, her doctor offered to staple her stomach right away. This seems fishy to me, but what do I know?

The problem with losing weight is that it takes 40 years to gain it, but people want to lose it in a year.

For some people, food is their primary pleasure. That is hard to change.

I think that is both right and wrong.

Yes, Americans on average eat too much. Yes, Americans on average don’t move enough. But I am convinced from my personal experience that there can be - not that there always is, but there can be - more to it.

My wife was obese to morbidly obese from the day we met to the day she died. So was her mother (WAY more so). So was her father. So was her brother. So were/are most of her aunts and uncles and cousins - particularly in the descendants of her maternal grandparents. Who - although I never met them - were also certainly at least overweight if not obese.

You can’t convince me that those two parents, 6 of their 7 children, the majority of their grandchildren, and plenty of their great grandchildren are all overweight just because they ate too much and moved too little. There has to be a genetic component to this. Not always. Not everywhere. Maybe not a majority. But in some significant number of cases.

The problem I have is when people put the blame squarely on the shoulders of the obese and say that their weight problem is entirely of their own making. It’s their own fault for eating too much and moving too little. They just need more self control to eat less and move more.

It turns the issue into what is effectively a moral judgement on the obese. And it places those pre-disposed to a thinner physique on a pedestal of higher morality. “Look at them! They don’t eat too much. They don’t sit around all day. That’s why they are at a lower weight. Do what they do.”

I’ve said before, and I’ll repeat it to my dying day - I saw how hard my wife worked to keep her weight down. She ate a pittance. She ate about half of what I did. Yes, she could have moved more, and in her younger days she did. But the weight just wouldn’t go down. Bariatric surgery helped. For a while. That helped her lose about 75 pounds over the long run.

When you fight the same battle for 20 or 30 years, you get tired of fighting it. You get tired of never getting ahead. So I’m not going to shame the obese for being obese.

When you say “that’s all there is to the obesity problem,” you are shaming the obese for lacking the will power to eat less and move more. You are saying their problem is entirely of their own making. You are denying that there may be - and I believe likely are - other contributing factors in plenty of cases. If you don’t address those contributing factors, eating less and moving more doesn’t really solve the problem. It may help with the symptoms while leaving the problem untouched.

I really wish medical science would look harder at this issue.



I can certainly agree that some portion of obesity is genetic. My lowest adult weight was 200 lbs in my 30’s for about two months, after one year of extreme diet and exercise. I am 5 ft 10.
The only way for me to lose weight is to restrict carbs to less than forty a day,and calories to about 1500 per day with moderate exercise. I was 240 when I got married at 21, 250 today. Definitely a lifetime of obesity and to get to just overweight is a long and tedious commitment. Have not stopped trying. Yet. Sugar,for me is more addictive than smoking.



If we had more unprocessed foods for the general public, raw foods, we could eat more and weight less.

I’m not convinced such foods are unavailable. It’s not hard to find rice (often in bulk quantities) and vegetables. Tonight we had stir fry… vegetables (including riced cauliflower) and chicken. Not to save money, but to save calories and to get good food in us. Otherwise, I had oatmeal today, some carrots and some ham (6 oz, 182 cal). My weight loss plan gives me 1727 calories a day. Not hungry at all… but…

Confession: I plan to follow up in a few minutes with a Skinny Cow ice cream sandwich.

He is no fool who gives what he cannot keep to gain what he cannot lose.



Raw foods!

The problem is cooked foods are easy to metabolize. Raw foods need energy to metabolize them. More energy than going for a longer walk.

This is so true; my sister had the same issues prior to her passing. Sadly, we are also doing the same with the poor - it is their fault and is entirely of their own making!


We have to regulate the farmers to the super markets. The corporations in between have to be the target of the regulations.

Nabisco/Kraft are worthless to our existence.

In 1988 the Philip Morris Companies acquired Kraft, Inc., a large maker of cheeses and grocery products, and in 2000 it purchased Nabisco , maker of snacks such as Oreo cookies and Ritz crackers. All these acquisitions were merged under what eventually became Kraft Foods Inc.

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I really wish medical science would look harder at this issue

Well, I think it’s safe to say it’s doing just that (even if us casual posters aren’t aware)

This popped up on one of the somewhat scholarly “lifestyle as medicine” websites I follow (not Peter Attia, for once)

Now, full disclosure, this bit if genetic insight was totally new to me so I thought let me see what this totally new discovery is and went a Googling on that FTO rs99…allele thingy. Just clicked on the first site and whaddayaknow, not that brand new after all… (check date of publication)

Not suggesting this particular genetic polymorphism is responsible for everyone’s woes but, as I mentioned upstream, when we know enough to realise we don’t know as much as we think we do, it’ll be obvious the topic is a bit more complicated than on first blush.