The ingenuity gap of the obesity epidemic

[jacob]

https://en.wikipedia.org/wiki/The_Ingenuity_Gap
http://cassandralegacy.blogspot.com/201 ... oblem.html

[7Wannabe5]

What's the big mystery? Nobody at McDonald's says "You better eat those lima beans." or "Get outside and don't come back until dinner time." There simply was not prepared food available everywhere at all times 40 years ago. Even if you had a mother who was a very good cook, it's not like she would be willing to run a 24 hour buffet.

[apocryphal]

http://www.monbiot.com/2015/08/11/slim-chance/

[El Duderino]

first reaction is that the ingenuity gap book seems to be the exact opposite of a book I'm currently reading, Abundance. That's probably horribly reductionist, but it's a first reaction.

The obesity article kinda negated itself in the last paragraph. Of course it's all down to personal choices and the issue, from a change management perspective is getting awareness that there is a problem and something needs to be done -- on a personal level. People expecting a magic diet pill or menu changes at fast food shops to accommodate their poor food choices and decision to not exercise enough will probably stroke out or develop conditions long before their savior comes along.

Though a population of unhealthy people is scary in that it could break healthcare and just be a terribly inefficient use of resources to produce the food and then fixing the resultant problem, climate is more scary because it's decentralized and nobody feels like they are responsible for the problem or the fix. It's going to get a lot worse before it gets better, IMO.

[jennypenny]

There are complicating factors like sitting too much and eating too much sugar, but I'm starting to wonder if the epidemic is really in mental illness and obesity is just a manifestation of that. When you look at charts like the ones below, all forms of self-medication are increasing at similar rates. Maybe (in the West at least), food is taking the place of nicotine as an OTC option? I'm not discounting the role of lifestyle and processed foods, just wondering if there's more to it than that and those issues aggravate, rather than cause, the problem.







The last chart makes me wonder if the problem started a century ago, only the drugs of choice during the first 50 years were cigarettes and alcohol. No doubt, it's a big problem to solve with several complicating factors. Based on past success with other risky behaviors, focusing on children and teens might give the best long-term results. If they are taught to live a healthy lifestyle *and* how to deal with problems and learn coping skills as a matter of course (and not waiting until after a problem has developed), maybe they can avoid the need for self-medication as adults.

It's so hard to say. Maybe the mental illness is a product of our unhealthy lifestyles?

[Chad]

I'm not sure the links Jacob posted are suggesting we don't know how to not be obese, as much as they are suggesting we don't know how to get people to actually do it. Pure education won't do it. It needs to be built in to society somehow.

Here is a part of the "why" in the obese equation:

http://www.scientificamerican.com/artic ... ng/?page=1

A calorie is not a calorie, but no one realizes it.

[7Wannabe5]

@jp- I think you may be right. Do you know how much whiskey the average pioneer family took west with them? OTOH, it is true that our cooking and eating habits have gone downhill independently. The recent immigrant children I teach are quite a bit thinner on average than their American peers and I see what their parents purchase to eat in the neighborhood markets, baskets full of vegetables, and I see them running around playing in groups on the streets all the time. The ice cream truck gets massive business here and there are all kinds of spun sugar delicacies in the shops, so it's not like they don't like or eat sweets. It's more a matter of proportion. OTOH, it is also true that it seems like most of the adult men around here smoke.

[GandK]

All the ingenuity lately seems to be aimed at making sure everyone feels good about themselves in spite of their girth. "Everybody gets a trophy," but applied to weight and body size. I have extremely mixed feelings about this.

Multiple studies have suggested that the average woman in the US is now roughly a size 14 (and 5'4" tall). This is about the place where plus sizes begin, and many women take issue with the idea that "half of all women" are now being called "plus size." But disturbingly, I've seen far less uproar about half of all women being at elevated risk for heart diesase and Type II Diabetes. The main focus online and in the media (surprise, surprise) is on appearance. There was a Daily Beast article back in February about how the SI Swimsuit issue was featuring a woman who was roughly that size. The article tagline was: "There’s been great fanfare over Sports Illustrated’s first plus-size model, but she is a normal size, has a toned stomach, and ‘real’ women remain absent from our magazines." People are bent out of shape about the perceived discrimination. Not a word is said about the underlying reasons for the larger sizes.

Now, while I don't think fat shaming is a good thing, I also don't think it's healthy to just shrug our shoulders and say, "Oh well, this is reality," and embrace larger sizes as the new normal. I'm 5'5", and when I gained weight with each of my pregnancies and entered the realm of these sizes, I felt bad. Not bad as in ashamed of myself (gaining weight with a pregnancy is good and healthy, if you're unfamiliar), but bad as in less energy, less concentration, and less overall happiness. I didn't feel better until I got the weight back off again. As a machine, my body works better in every way I've noticed when it's carrying a certain amount of weight/fat/muscle, and a size 14 was simply too much weight for my small frame to carry around gracefully. I assume that others have their own ideal weight range for optimal health, too. Completely separate from how any of us appear, to ourselves and to others, is that concept. But because we don't dare "judge" anyone for anything anymore, no one can say this stuff out loud now. Even when you're concerned about a parent or a partner, mentioning their weight is taboo. I've even heard the term "weightist" a few times lately, and when I asked what the speaker meant, I was told it was, "Like a racist, but prejudiced about weight."

[7Wannabe5]

I also have extremely mixed feelings about this issue because I "naturally" roughly have the same body type as the SI model in that article. I am at my own personal ideal of "magnificent creature" when I am a perfect size 12 at 5'9". My waist-to-hip ratio is right around .7 and my stomach is quite reasonably flat even if my weight is a few pounds into the overweight zone according to BMI. All my other health measurements are excellent and in alignment with my WHR rather than my slightly overweight BMI status. So, it is annoying to me that such a one-size-doesn't fit all standard as BMI is always used and cited when I know I am so much more fit and healthy than some scrawny guy who looks like he swallowed a playground ball. Of course, the other stereotype that intermittently annoys or amuses me is the standard assumption that women with curvy figures are idiots. OTOH, if I didn't derive some benefit from this stereotype (such as rarely having to change a flat tire myself) , I guess I wouldn't choose to still be a blonde ; )

[jacob]

The technological ingenuity problem is that medical ("there's a pill for that") science has reached a limit because human physiology is too complex to fix metabolic problem hitting just one kind of molecule in the body. Fixing an overloaded metabolism is not as easy as hiding the symptoms of a headache or lowering blood pressure.

In short, we can't fix the cultural problem of obesity with technology because it's too hard.

The cultural ingenuity problem can't be fixed because most humans innately adopt the behaviour of those around them and take the choices they are given instead of making their own. (Same as the ERE vs consumers).

This means the cultural problem is also beyond our aggregate ingenuity. This is compounded by the fact that there are strong commercial interests in keeping this culture(*) because it's very profitable if most consumers buy and eat a lot of bad food, get sick (but not dead) from it, and then take pills to cover the symptoms for many many years. Consider how some of the largest companies in the Dow do exactly that---junk food producers and distributors along with medical companies selling statins and insulin make up a big part of the US economy. There are profitable side-effects too. Consider how a family where wife and husband each weigh north of 300 pounds. They'd need at a half-ton truck just to get around lest they risk breaking the axles. Crazy!

(*) See my post in the food stamp thread for how such systems come about.

I don't have mixed feelings about this. I have strong feelings. It's a huge problem. Literally.

So here's the cultural problem ...

Americans (both genders) have on average gotten heaver by 30 pounds (and taller by 1") since the 1960s. This means that the average 2015 woman now weighs more than the average 1960s man. The average American is 33 pounds fatter than the average Frenchman. 40 pounds fatter than the Japanese. I say fatter because it's not like we're all linebackers vs their kickers. We're rather very out of shape kickers.

http://www.washingtonpost.com/news/wonk ... the-1960s/

The "individual problem" is simple enough that individuals can solve it for themselves. In that sense, it's no different than ERE is a solution to the "individual problem" of rampant consumerism which is another cultural problem. Individual persons can choose how they respond to a screwed up system and make optimal choices that will keep them as healthy as the average Frenchman ... and not need a half-ton truck to drive around safely.

I've managed to keep my "original" size, diet, and activity level, so I have some outside anthropological observations to contrast and compare.

It's absolutely true, like GandK said, that the "ingenuity" is currently being used to ignore the problem or rationalize it away.

I've been in the country for little over 10 years now and already vanity sizing has moved me from XL to L which was annoying until I figured out what was happening and switched to a smaller "label-size". Your grandmother's size 12 dress would be a modern size 6. Some short healthy-sized women now have to shop in the children's department.

Because this is a wide problem that affects nearly everybody, the understanding of what's normal or average is shifting. What an American calls "average", a [western]-European calls overweight (bordering on fat as you go east).

It holds in reverse too. Every family dinner I go to result in some comment about how it's possible for me to "eat so much and yet be 'thin as a rail'". The idea that someone can be "very active" and/or not carry an extra 40 pound of fat-padding has disappeared from the collective consciousness. (My lean mass is 164 pounds. If I had the same BF% as the average, I would weigh 210-220 pounds, but I only weigh 178. However, I carry more lean mass than the average US male and I'm more active, hence why I "eat so much"). But two and two aren't put together because it's outside the common experience of being sedentary and overweight. IOW, it's a case of it "you're the outlier, so it's obviously not us who have a problem". Basically, people compare themselves to the relative standard of other people (I'm not fat because everybody weighs about the same as me) rather than an absolute standard (I'm fat because I carry extra spare tires around my body).

Anecdotally I know many more Americans who can't cook even basic meals than who can cook. And I don't recall any European I've met who can't cook. Oftentimes, American "cooking" turns out to be of the "add a jar of Preprocessed X to the pot and salt to taste and heat" which isn't cooking---it's heating! It's even found in recipe books: "1 package of Rainbow Cookie WonderMix, 2 eggs, and a cup of water. Mix until even. Bake for 30 minutes".

I can count on one hand the number of Americans I know IRL who cooks exclusively with raw ingredients. This is not normal in a global comparison. It's distinctly weird to me. The general food selection in a supermarket blows my mind every time I see it. Like, who buys this preprocessed crap?! Turns out ... people who think they're cooking.---That is, people who think they're doing the right thing.

Probably because of that, there are some screwed up perceptions of what constitutes healthy food. I'd say most non-US people have some instinctive understanding. However, if I had a dollar for each "it's zero-fat"- or "it's light"-justification I've heard ... If the people I know (family, neighbours, etc.) are representative, the majority are simply completely clueless. (Unless they're part of some fitness, paleo, etc. enthusiast group.)

For example, European (or any country for that matter) salad tends to contain only vegetables, maybe some fruit. Maybe a dollop of ranch dressing if you're lucky.

US salads (if they are eaten at all and not dismissed with a "Yuck! Kale gives me nightmares, where's the meat and sweet potatoes?!") are loaded with ranch dressing, shredded cheese, and "But's it's low-fat?!?"-bacon to the point where the salad is more like a yellow-white-brown cocktail of mayo-cheese-bacon with a slight crunch in it from the iceberg lettuce. But again, most think they're doing something good for themselves with this.

Incidentally, this problem is slowly being exported to the rest of the world. Europe is lagging about 20-30 years but European weight is increasing too because "convenience food" is becoming more popular; home economics is being phased out of schools; and double-working parents no longer teach their kids any skills. I haven't been shopping in a European supermarket in almost 10 years, so I don't know how it is today. But it was underway when I left.

In any case, that's the ingenuity problem. It's pernicious too. My commuter bus has this fancy hydraulic system that lowers the door intended for senior citizens to make it easier for them to step up. I've noticed that the driver doesn't lower it for kids or healthy adults. However, he does do it for 250 pounders. So they never realize that they've crossed a physiological point where it gets too hard to take just a single step upwards (much less walk an entire set of stairs, but that's why there are ^$%^!@$# escalators everywhere now and the real stairs are locked down and reserved for emergencies like fires).

<deep breath>

My point being that there's an entire system whose effect is to keep people fat or make them fatter. It's not a conspiracy as much as it's an emergent property that grows and feeds on inherent human weaknesses.

And it's not just a body-image thing either. I think focusing on body image is a way to shame the fat-shamers with political correctness to protect that system. "Look you're so shallow". Oh snap! But it's a red herring intended to draw attention away from the real problem of health and the loss of quality life. US longevity is now DECLINING because of this---quality is declining even more. Rent-seeking and corruption is not the only reason US health care cost are so much higher than other developed countries. There's also the cost of 400 pound rated cranes to move the patients, extra complications from overweight, etc. Not to mention 60 year olds being stuck in front of the TV all day because their bodyweight approximates their 1 REPMAX squat and prevents them from standing up without spending a good ten minutes psyching themselves up for the effort. That's no way to live.

[7Wannabe5]

Jacob said: The cultural problem can't be fixed because most humans inately adopt the behavior of those around them and take the choices they are given instead of making their own. (Same as the ERE vs consumers).

True. That's the number 6 reason why I chose to leave my recent-ex who looked like a cross between Paul Wheaton and Nassim Taleb, but more so. The things we find attractive are not always good for us (sigh.) OTOH, I don't really like it when a man just serves me chicken breast he dried out on the grill and a chopped green pepper for dinner., even if I know that sort of behavior has positive correlation to likelihood of good circulatory flow into his 70s. Decisions, decisions, decisions...

[jennypenny]

@jacob--I'm not disagreeing with anything you said. Lifestyle and cultural influences are huge factors. I just don't think they are the only factors or possibly even the original reason for the weight gain. We know that some people can drink alcohol but not become addicted. Others have a genetic marker that makes them much more susceptible to alcohol addiction. It's not a stretch to think that other substances like sugar might have the same effect in some people. We know that epigenetics plays a large role, and in some cases the behaviors of our ancestors influence our susceptibility to diseases like diabetes. (Did you ever watch this? If you don't want to watch the whole thing, the bit I'm talking about starts @36.) They've also proven that what's in our food has lowered the age that American girls begin menstruating. Makes you wonder what else it's doing to our bodies.

I don't think it's all about making proper lifestyle choices. Or, at least, I don't think it's only about making proper lifestyle choices.

The technological ingenuity problem is that medical ("there's a pill for that") science has reached a limit because human physiology is too complex to fix metabolic problem hitting just one kind of molecule in the body. Fixing an overloaded metabolism is not as easy as hiding the symptoms of a headache or lowering blood pressure.

Maybe, but if a significant portion of obesity stems from other issues (like mental health issues or genetics/epigenetics) then there might be a scientific remedy for those issues that helps to alleviate the underlying reason for weight gain. I recently read this article about how fish oil helps prevent the chance of a psychotic episode in young people with an increased risk. That's an easy fix for what can be a debilitating problem.

Maybe science shouldn't only be trying to figure out a way to make people thinner. Maybe the time is better spent trying to figure out when and why people put on weight in the first place and fix that problem. Then lifestyle problems might be easier for individuals to manage.

[jennypenny]

Now that I've said that, I'll add my own rant ...

All my friends talk about is making kids safe. Some parents go to ridiculous lengths to protect their kids. I'm talking about things like school buses instead of walking to school, crazy limitations on recess and sports, things like those catcher's masks ffj said the infield players had to wear, keeping kids indoors when the weather isn't perfect, antibacterial everything, etc. It's too much. I feel like we're raising a generation of softies. Let the kids get tired and dirty, even if it means they occasionally hurt themselves. An active childhood might be a little less 'safe' but might instill a lifestyle that, in the end, is much more healthy as an adult.

[George the original one]

Now that I've said that, I'll add my own rant ...
All my friends talk about is making kids safe.

So many kids need to be protected from their parents!

[chenda]

Now that I've said that, I'll add my own rant ...

All my friends talk about is making kids safe. Some parents go to ridiculous lengths to protect their kids. I'm talking about things like school buses instead of walking to school, crazy limitations on recess and sports, things like those catcher's masks ffj said the infield players had to wear, keeping kids indoors when the weather isn't perfect, antibacterial everything, etc. It's too much. I feel like we're raising a generation of softies. Let the kids get tired and dirty, even if it means they occasionally hurt themselves. An active childhood might be a little less 'safe' but might instill a lifestyle that, in the end, is much more healthy as an adult.

Its a bit of a cliché but its amazing the amount of freedom children had before ~ WW2. Took themselves to and from school, sent out on their own to play in the streets or countryside all day at the weekend. Then it was normal, now parents doing this would be reported to social services. Is the world more dangerous ? Or are we just more paranoid ?

[jacob]

Maybe, but if a significant portion of obesity stems from other issues (like mental health issues or genetics/epigenetics)...

But that's just not the case (except for the side-effects of antidepressants ... but then again, Americans use more prescription drugs than practically any other place---and that's yet another problem with similar dynamics).

The significant portion of obesity stems from diet and exercise; then stress, which factors that on average are completely under the individual control but which are systemically or culturally different in the US than in say France. Heuristically this is kind of obvious since if you take a group of Frenchmen and put them on a US diet (French immigrants, say), they'll get fat too despite potentially different epigenetics; whereas one has to use serious statistics to figure out any epigenetic impact. Similarly take a group of immigrants with a different genome and put them on a US diet. Same problem. The diet impact is strong. The epigenetic impact is not. And groups average out the genetic impact.

Note how diet and exercise moves the entire bodyweight distribution. It's not like the American weight distribution is bimodal where there's a fat group that stands out because they lost the genetic lottery. It's essentially a bell curve that's skewed towards fat and which is moving towards ever heavier in time. If it's epigenetic, then something must have significantly impacted nutrition during the 20th century in some way that was radically different between the US and Europe ... but I don't recall any such thing.

We already have science trying to figure out how to engineer food to be more addictive. We know how to trigger the desire to eat more. This is the exact problem. Science knows but the science is being misused to profit from an uninformed public. This is why this is a cultural ingenuity problem. However, some people can be sufficiently and individually informed and so they would know this and know what to avoid. If they do this, the problem will be fixed in the vast amount of cases except for the rare cases of people who get fat on a diet of real food eating in correct proportions because they have some genetic settings. However, informing/convincing ALL people rather than just some people is much much harder.

Basically, we (the US leads) are in the same situation with food as tobacco used to be. Cigarettes are researched and things are added to make them more addictive so that more can be sold even if those additives are dangerous. We also know that smoking greatly increases the odds of lung cancer. The correct response to this (misuse of science and knowing the statistical impact) seems to be to be for individuals to stop smoking rather than to figure out what special genetics made Uncle Henry live to 90 years old and somehow avoid lung cancer despite smoking like a chimney or alternatively what kind of pill we can take to prevent smoking from causing cancer.

[black_son_of_gray]

@ Jacob: I am noticing a lot of parallels in what you are saying to some of the main points that Taleb makes in his Precautionary Principle article (http://www.fooledbyrandomness.com/precautionary.pdf). In particular, that 1) "obesity" is a complex system; 2) as in the Monbiot link that apocryphal posted, it could be considered 'incurable'; 3) all of this may fall into 'ruin' problem territory.

The purpose of the PP is to avoid a certain class of what, in probability and insurance, is called “ruin" problems. A ruin problem is one where outcomes of risks have a non-zero probability of resulting in unrecoverable losses. An often-cited illustrative case is that of a gambler who loses his entire fortune and so cannot return to the game. In biology, an example would be a species that has gone extinct. For nature, "ruin" is ecocide: an irreversible termination of life at some scale, which could be planetwide. The large majority of variations that occur within a system, even drastic ones, fundamentally differ from ruin problems: a system that achieves ruin cannot recover. As long as the instance is bounded, e.g. a gambler can work to gain additional resources, there may be some hope of reversing the misfortune. This is not the case when it is global. Our concern is with public policy. While an individual may be advised to not "bet the farm," whether or not he does so is generally a matter of individual preferences. Policy makers have a responsibility to avoid catastrophic harm for society as a whole; the focus is on the aggregate, not at the level of single individuals, and on global-systemic, not idiosyncratic, harm. This is the domain of collective "ruin" problems.

So I wonder if the ingenuity gap problem turns obesity into a 'ruin problem'. On an individual level, obesity can be 'fixed' - but on a society level, it can't. Perhaps the cultural problem is not only unsolvable, but also spreading (hence the term, obesity 'epidemic'). Of course, the conclusion to this logic would seem to be "humanity is headed towards unrecoverable losses", which big part me thinks is pretty silly to think, but I'm not completely sure.

[jacob]

I don't think obesity is a ruin problem. Mainly because the systemic dynamics of the junk food-medical complex is parallel to the tobacco industry and that problem was solved by regulation. Of course learning what to eat and how to cook is intellectually harder than simply not smoking but I don't think it's a skill that's beyond ... well .. basically everybody. The other problem that makes food harder than smoking is that tobacco is a limited/narrow product category, so it's easy to single out as in "your problem is THAT ONE behavior". It's similar to how the ozone problem was easy to solve by banning halocarbons because there were just a few different kinds and they were made by a limited number of companies (and there was a convenient substitute). Compare to climate change where the culprit is basically our entire way of life.

[Ego]

There are definitely factors that are beyond the control of the individual, but most are within our control. I wonder how much of the problem is that it demands greater ingenuity from those who are least capable of it.

This study turned the commonly held assumption on its head.
http://personal.lse.ac.uk/kanazawa/pdfs/COEDO2014.pdf

[bryan]

@jp- I think you may be right. Do you know how much whiskey the average pioneer family took west with them?

Tangent: buddy and I did some bicycle touring and one of the most important items we brought along was a bottle of whiskey for social consumption. Also, from living in a barebones van I would say having some beer is pretty high on the checklist (though it's definitely after water, sleeping bag, mouthwash, multitool, lighting).