It's really shocking how quickly Americans' weights increased. The map also shows the increases are usually more pronounced in the South and Midwest first, then spread to the coasts (skipping over Colorado, of course)
The sheer speed with which this happened undermines many theories about what's causing it. People talk about idle desk jobs, a car-dominated culture, and abundant cheap food. Those things were just as true in 1990, though, and far fewer people were obese.
Based on my memory, they were somewhat less true in 1990, if you look at how much it happens and not just whether or not it happens.
Focusing on kids, because that's where I've got the clearest reference for making my own comparisons: 30 years ago, kids in my neighborhood spent most their time running around outdoors. I'm not even sure everyone's parents knew where they were half the time, and it was fine as long as you made it home for dinner. Nowadays, kids seem to spend most their time playing Minecraft or Fortnite or whatever. I don't see them often on the sidewalk unless they're headed to or from school, and the playgrounds are generally pretty quiet. Over the same time period, hours of TV watched per household is up by about 2 hours per day, and consumption of the Internet has gone from zero to whatever it is right now, so that's where I'm guessing all the kids have gone.
In the early and mid 90s I was playing a lot of Zelda, Super Mario World, and Mario Kart on SNES, but also had a Genesis, then a Saturn, and a PS2, then N64... ;)
Definitely watched a lot of Nickelodeon and Cartoon Network too.
I really wouldn't point to modern video games as the blame, look more toward how the food has changed.
Anetdotal, but the majority of people I know eat like shit.
the thing is, it takes a decade of delay for this to set in because fast-food and other harmful food like substances are much more harmful in child hood. So, if you were raised descently well on normal food until your 20s, then started eating horribly, it's not nearly as bad as if you started eating horribly in your childhood.
We can see this clearly in China. The older generation seems to have some resistance to junk food in terms of weight gain: this is why asians have a reputation for remaining slim, even if they eat junk food. But, it's not due to their genes: they were simply lucky enough to not be introduced to those bad foods until their adulthood.
If you look at the newest generation in China in the cities, their obesity rate is skyrocketing at an extremely high rate.
They mean that if you do overwhelm your metabolism or fail to learn motor skills as a child, you may be ruined for life.
I know some people who just hate exercise. I think they has no habit of movement of any sort. Likewise, people who were fat or weak as a child have no baseline sense of what it feels to be healthy - and neither do their bodies cells.
So kids can handle more sugar, but if messed up the consequences are worse.
I don't know about how much eating at home has changed, but I think people today would be shocked at how small a restaurant meal was in 1990. Back then the large, upscaled items would be the "small" of today.
absolutely. When my family goes out to eat, we usually only order 1 meal and split it between the 3 of us, the meals are that HUGE. half the family don't get what they want, but it is cost effective.
From personal experience I can attest to it being sitting all day and not really moving around much plus eating a lot. People always go on about how you should change but it's just so freaking hard to break out of it once you're gone.
in 1990, we still had a lot of manufacturing jobs. I think the "idle desk jobs" still makes sense. Probably demographics is more important though. For example, median age is going up. In fact, a lot of the things we complain about today can be at least partially attributed to that.
> The amount of fructose in the Standard American Diet (SAD) is a major culprit in obesity and obesity related diseases.
> The body metabolizes fructose differently than other carbohydrates. Fructose has become the default cheap carbohydrate additive for food, and it is found in nearly every packaged food in America. Human bodies have not evolved to handle these levels of fructose.
I think that this is probably a combination of spurious correlation and a food additive whose name implies things about it that aren't necessarily true.
High fructose corn syrup is, from a nutritional standpoint, pretty much equivalent to table sugar. The most substantive difference between the two is a hydrogen bond that is easily broken by even fairly weak acids - it doesn't last long at all once it hits your stomach, so what actually hits your bloodstream is (typically) a 42/58 fructose/glucose mix for solid foods with HFCS, a 50/50 mix for table sugar, and a 55/45 mix for HFCS-sweetened beverages. Those numbers also imply that, unless you just guzzle soft drinks, the industry replacing sucrose with HFCS presumably actually tilts the fructose/glucose mix in your sugar intake away from fructose. And if you do guzzle soft drinks, blaming HFCS for your metabolic situation seems just a bit dissonant.
I think we should be looking first at the big picture: Overall calorie consumption over the past 50 years is way up. If you break that down, fat, having nearly doubled, comes in first, followed by complex carbohydrates (up by about 1/3), and sugar is comparatively a quite small portion of what's changed.
Over the same time period, caloric expenditure from physical activity has gone way down, too.
To me, that picture doesn't imply, "Nabisco changing the sugar they put in my Wheat Thins is ruining my health." It implies, "Driving my car to the supermarket and coming home with a back seat full of Wheat Thins is ruining my health."
FWIW, the word "additive" also has a tendency to be a bit of a weasel word in this context. The glycemic index for starches and sugars is typically about the same, and your metabolism doesn't care that the starches are typically considered the food itself while the little bit of sweetener that's added for flavor is just an additive.
The glycemic index is problematic for lots of reasons.
If by "a little bit of sweetener" you're referring to HFCS in packaged foods, I disagree. HFCS prevalence seems much much larger than that.
You're right on that sucrose (table sugar) is not much different than HFCS.
Fructose != starches. The body metabolizes the two differently (See below).
A bit of knowledge about fructose rumbling around my brain...
1) Fructose is metabolized differently than glucose. All fructose has to be metabolized by the liver and go through the portal vein. This is not the case for glucose or other non-fructose carbohydrates.
2) Metabolizing fructose via the liver, especially in excess leads to fatty liver. Think foie gras but in humans. Non-alocholic fatty liver disease is now a huge thing, happening even in children. In prior decades if you saw a fatty liver it was because the person was an alcoholic.
3) Fructose is unique in that it short-circuits your bodies methods of letting you know you are full and to stop eating.
Human bodies, metabolism, and our food supplies are all complex dynamic systems so, it's unlikely that one single thing can answer the obesity epidemic.
Nonetheless, if I had to pick one place to start, I'd begin at fructose and see what kind of web is woven around it.
Two places to check out if you're interested in some of what has informed my thinking.
All of that is fine and well. The source of my skepticism is that I think there's a big leap to make between, "studies that are laser focused on the metabolic effects of fructose find that it's metabolized differently from glucose", and "fructose consumption is the primary cause of a major public health event." There's a whole chain of cause and effect that needs to be established to get there. The first link in that chain might be very strong indeed, but the rest of the links seem to be, judging by the information I'm aware of, somewhere between weak and nonexistent.
Here's a good satirical paper aimed at illustrating the dangers of trying to extrapolate large-scale effects from a constellation of individual metabolic effects: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001541/
Heard loud and clear. You make good points, communicate them well, and I appreciate the satirical link about using cigarettes to enhance endurance training.
I wonder where is all that extra fat coming from? Very counter to my expectations that carbs were most of the increase. I thought in the past people ate slightly more meat, esp. red meat, full fat dairy etc. I suppose it could reflect the shift from home to restaurant/snack food because when you put a chunk of butter in something you can tell how much it is, but already baked in it tastes like much less.
Supposedly it's mostly in the form of vegetable oils. (Consumption of animal origin fats, including butter, is actually down.) Based on that, I could hazard a few guesses:
My first would be that a lot of it is that increases in the availability of vegetable fats that are solid at room temperature (originally thanks to hydrogenation, now thanks to more refined palm and coconut oils) means that it's easy for food manufacturers to add more fat to packaged foods without them seeming greasy.
There's also the whole "Mediterranean diet" thing fueling the perception that olive oil is a health food and making us feel comfortable drizzling it all over everything we eat. It's perhaps relatively healthy compared to other fats, but it's still darn near the most calorie-dense food possible.
I wouldn't be at all surprised if the amount of french fries that get piled on one's plate as a side at restaurants has doubled over the past 50 years.
Heck, even avocado toast. Avocados are way more available than they used to be. Everyone thinks of them as a healthy food, but they're chock full of fat.
Insulin causes cells to convert glucose to fat. Liver can convert fructose to fat.
Also the amount of glucose in you blood is highly regulated and the amount is 'less than you would assume'. Least as I understand. Probably consuming even moderate amounts of sugar sets off a desperate attempt by the body to stash glucose as fat to keep glucose blood levels normal.
A quick search on the history of High Fructose Corn Syrup (HFCS) in the food chain has a timeline that works. This is where I'd start:
> The first corn syrup in the United States was produced in Buffalo, New York, in 1866. A major breakthrough occurred in 1967 with the patenting of an enzymatic process to convert dextrose to fructose, a 6 carbon sugar that is sweeter tasting than sucrose.
High fructose corn syrups was developed in the 1970s. Americans began producing starch sugar from cornstarch instead of potato starch. Its cheaper than table sugar.
In 1971, food scientist in Japan found a way to produce a cheaper sweetener from corn. HFCS began to appear in frozen foods to protect against freezer burn and in vending machine products to preserve taste.
In the 1980s, both Coke and Pepsi switched from a fifty-fifty blend of sugar and corn syrup to 100 percent high fructose corn syrup, saving them 20 percent in sweetener costs. [0]
I'm going to guess the "throwback" soda that came out a few years ago was probably almost entirely the result of corn prices rising due to ethanol production. (itself the result of government policy)
> Of all high income countries, the United States has the highest rates of overweight and obesity, with fully a third of the population obese-a rate projected to rise to around 50 percent by 2030.
I would change that to "can sometimes be fixed" as type 2 diabetes can damage the pancreas (and other organs) to the point that "proper diet and some exercise" alone will not rejuvenate them.
I guess my point is that once you figure out that you need to bandaid the problem by giving yourself insulin, it can be fixed. Honestly when it gets to that point the doctor should be telling you that you need to reverse course asap.
I don't think many (any?) type 2 diabetics have artificial pancreases. Also, even with good glucose control, type 2 diabetes still seems to lead to some pretty bad comorbidities.
It talks about unhealthy food habits, lack of exercise etc. There is probably solid science behind it, but my gut feeling is that there is something missing. I mean people have been eating beef steaks and gobbled sweets in front of TVs for ages now haven't they?
There is a lot of missing science here - yes we have the whole 'calories in - calories out', but we are missing some detailed biochemical descriptions of what's going on. The human body is more complex than a 2 term math expression using subtraction.
For example, we do not really fully understand the role of biochemical stress hormones, and weight gain. Or how exactly insulin, leptin, cortisol, inflammation markers (eg: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4155060/) all interact. Note that leptin is created in adipose tissue, potentially suggesting a cycle - and this is something borne out in experience, it is harder to lose weight the more you have to lose. Definitely an area of research to learn more.
The epidemiological approaches reveal interesting things, but there are a lot of variables, hidden and not, that is pointing that the advice accumulated from these studies is not really having the impact we want.
After all, the current advice is "hey do this thing that is very hard for you to commit to, and has uneven outcomes". Some research even references 'the big loser' because of the inability of people to maintain weight losses.
Typically discussions about this devolve very quickly into coded (and not so coded!) shaming. "unhealthy food habits"? How about "unaffordable healthy food" or "habit forming unhealthy food"? Why not that framing? Go to any average 7-11 and enumerate the list of products that aren't designed to generate "repeat customers". Bananas (in-so-far as they are sold) and water are the only ones I can come up with. Non-edible items not eligible.
For me, the local 7-11 and/or liquor store is enemy number one, lately Starbucks is number two, and it's taken long term thinking about habit manipulation to fight it off. And it's something you have to fight, or just be lucky enough to avoid -- in the modern world you might be default alive but you're not default healthy.
There's very, very cheap food now that's also low-effort and craving-satisfying and/or inducing. All sorts of crappy low- or zero-prep food has gotten both cheaper and better at being hard to resist. Meanwhile, sedentary entertainment has gotten much better and also very cheap.
Yes I think this is a big factor - also the social barriers to eating this junk food is lower. It used to be you'd eat at home and seldom buy and eat anything when out, social eating at a restaurant was a special occasion and you'd eat 'treat' foods like cake or ice cream. This sort of eating is now nearly every day, all it takes is 100-200 calories to much a day and you're a fatty in 10 years.
I suppose a good example of this is to look at asians who have a traditional diet - they sit around as much as the westerners but are still predominantly thin, though you can tell who's adopted a western diet.
I am convinced that a huge factor in the obesity epidemic is due to environmental pollutants. Many household chemicals have been shown to be related to obesity. Fungicide and pesticide exposure have been linked to obesity. And, with all of these there are probably compounding effects with each generation.
I think it largely has to do with not being as active. We have a lot more desk jobs now than we had in the past. In the past people didn't have to go to the gym to not be overweight, they burned it all off when they were going throughout their day.
I really think it has less to do with that—though not nothing to do with that—and more to do with economic and convenience factors that lead to more people choosing very cheap and awful food in excess, consistently, while not getting any exercise
A fun hypothesis I've heard with absolutely no backing whatsoever: it's psychiatric drugs, which were only really widely prescribed starting in the 1990s.
Depressed people eat less; people with anxiety have higher metabolisms due to constant adrenal activation; people with ADD fidget more (= non-exercise activity thermogenesis). People treated for these conditions all gain weight as a result. It's enough to create a pretty big statistical bump.
Funny how obesity accelerated with the decline of smoking. Sure lots of obese people smoke, but my anecdotal experience with my immediate family tells me that a decline in smoking is a factor.
Everyone who quit smoking in my family replaced it with food (except for one, who replaced it with alcohol, and then later replaced alcohol with food when they realized they were becoming an alcoholic). Instead of reaching for a cigarette they reached for a snack.
It hit my grandparents the hardest because they quit smoking in the late 80s when there was also a war on coffee/caffeine with wild studies blaming it for a ton of health problems.
Boom - they lost two appetite suppressants in one fell swoop.
I am not advocating for smoking, which has worse or comparable health effects to obesity, but I do think it is a factor in a multi-factor phenomena.
If you made a time machine, went back about 45 years, and brought my then overweight teen self who was probably in the top 5% for obesity then to today...I think his reaction would be the same as Jack the Ripper in the 1979 movie "Time After Time" when Jack was brought to modern San Francisco [1]:
> I belong here completely. In our time, I was a freak. Today, I'm an amateur.
[1] Briefly, in the movie H.G. Wells actually builds the time machine. Jack steals it to escape capture coming to our time. Wells, fearing he was unleashed a monster on what he expects to be utopia follows (the machine had been set to automatically return when Jack stole it).
I feel like people have become far more health conscious in recent years. Working out regularly and caring about your diet used to be fringe activities, but now it seems like almost all anyone talks about! Maybe these trends are concentrated in urban areas? That would help explain why the highly-urbanized West and Northeast have managed so much better than the less-urbanized South.
Fitness activities and being fit are major upper-middle-class (talking social class here, not strictly income) markers right now. There's pressure to be or become fit(ter) if you run in those circles, so you don't seem "other". Not so much in other classes—of course perpetually being about to try some new diet or other is a thing in certain groups, but not the same kind of conspicuous fitness stuff the upper-middle's currently big on. Of course upper-middle culture is fairly urban (aside from their vacation houses on the lake or in the mountains) for a bunch of reasons so the trend is most noticeable there, aside from urbanites trending thinner generally than country dwellers (in the US, at least).
Upper middle class jobs are almost universally desk jobs, even in industries that have a lot of physical activity, e.g. building engineers vs. construction workers.
When you sit 9 hours a day you need to hit the gym or diet. When I was waiting tables and bartending in college (and a lil after) I didn't need to workout -- a doubleshift on my feet kept me very lean.
When you have money and a real need for activity then yeah the gym lifestyle becomes a thing.
The urban areas in 2010 had significantly higher obesity rates than even the rural areas in 1990. So regardless of what people are yapping about, it's not working.
I mean, even if we attribute 100% of the urban-rural difference to yuppy diet fads -- neglecting the almost-certainly much more important class, income, genetic, and cultural differences -- the effect of those fads are being absolutely crushed by the general nationwide trends. Whatever it is that us urban people get out of talking about diet fad that people in the rural areas don't keep up with, I don't think it's motivated by a desire to understand the obesity epidemic.
Idk, where I live in the city I find these trends pretty shocking. Mind you 2010 is 10 years ago, but just from looking at the people around me I'd expect this to have leveled off or reduced.
It’s also possible you’re simply used to a certain level of adiposity without realizing it.
Almost everyone over 30 has some level of gut now, even those considered comparatively fit and thin. This wasn’t normal decades ago, but is normal now.
How often do you see people shirtless? Clothes hide a lot of bellies. Having muscles, being a jogger, eating salads or riding s bicycle is completely consistent with abdominal fat.
So, what standard are you using when you say urban people now are likely thinner than rural people in 1990?
Maybe it's because more people HAVE to be health-conscious or else they'll become obese. From what I've read, peer groups matter a lot [1] and this research would suggest most peer groups are more overweight than they used to be.
The old adage was "genetics". If you had the right ones you could eat anything.
Clearly 20-30 years is not enough for genetics to play in so what is going on? I know we blame fast food and sugars or possibly even fats a lot, but I feel like a lot of those have existed.
Could be more cars and computers that pushed sedentary life on people or plenty of other things too: more effective sugary food advertising on better screens, food producers figuring out that sugar is addictive and starting to put it into everything, or all of the above.
Father in law is a doctor -- a family doctor in a small town, and the only one in private practice (not in a hospital) within 100 miles. Much of the population in that area are his patients, so he gets to see everything, from mundane stuff to exotic illnesses and injuries, and is well-positioned to discern long term trends.
In recent years, he's suddenly treating hypertension, high cholesterol, and type 2 diabetes in his pediatric patients. With few exceptions, these kids are morbidly obese. He says these things were unheard of fifteen years ago.
Let that sink in. High blood pressure, cholesterol, T2 diabetes in teens, pre-teens, and in some cases even younger. This. is. fucked. up.
Lots of factors contribute to our "obesogenic environment", and it isn't quite as simple as pinning it down on any particular food, habit or practice. I recently read this paper on the "ecology" of obesity and I thought it provided a fairly good assessment of this viewpoint:
The truth is is that it happened all by itself. That's because someone coming along saying that someone with deep pockets is responsible will lead to a multi-million dollar PR offensive to convince you otherwise. For example, just look at how much Monsanto had to pay out when they failed at the PR war [1]. Before they eventually failed at their PR war, they had a well funded department devoted to discrediting any criticism of Monsanto [2].
I think the numbers are likely exaggerated to the point of being almost useless. It all depends on how BMI is measured. If it's not measured, the number are useless. The website says:
> There are a number of ways to measure body fat. Some are well suited to the doctor’s office, such as calculating a person’s BMI.
That seems to suggest a simple calculation given height and weight. That is not a proper way to measure BMI. BMI must be measured. Otherwise it simply is not a reflection of anything but an inaccurate calculation that doesn't apply to most people and overestimates the number of overweight and obese people. Yes there are a lot of overweight and obese people, but exaggerating the numbers by using inaccurate formulas and pretending like the numbers were measured instead of calculated doesn't do anyone any good.
Every time BMI is mentioned someone brings up this point. I sometimes wonder if it is mostly an opportunity to humblebrag about how much time they spend in the gym and "Dude, I am 6' tall, weigh 240 lbs and have 3% body fat but the BMI says I'm obese. See, the BMI is bullshit."
Yes, there are individuals for whom the BMI metric is spectacularly bad, a modest percentage for whom it is simply poor, but those people already know they aren't obese. At a population level, the BMI metric is just fine.
BMI is defined as (weight in kg) / height in meters ^2. It can’t be measured any other way. There’s no controversy about this, no other answer.
Now, many people argue that BMI is not a good measure of obesity, or health, since it does not account for percent body fat or other health metrics. That’s totally true. But BMI is BMI.
It's really shocking how quickly Americans' weights increased. The map also shows the increases are usually more pronounced in the South and Midwest first, then spread to the coasts (skipping over Colorado, of course)