Life expectancy rise in rich countries slows down: took 30 years to prove
nature.com131 points by andsoitis 18 hours ago
131 points by andsoitis 18 hours ago
Our organization (the American Federation for Aging Research) is hosting a webinar with Jay Olshansky (author of the paper) and Andrew Scott, a leading economist in longevity to discuss Jay's results on 10/22.
The gist is that this isn't quite as cut and dry as it may seem.
We also paid to make the Nature Aging paper open access.
> We also paid to make the Nature Aging paper open access.
That’s awesome! Did you make a deal with the authors to pay for the fee during publication or is this something anyone can do by approaching the journal itself?
Thanks! I wasn't directly involved in that discussion, but I imagine anyone can do it. It is a requirement for some grants and for some research funders.
Edit: if you need to know I would just ask the editor if it's an option
>We also paid to make the Nature Aging paper open access.
What a world to live in.
For an interesting side piece:
Curiously, however, for a system apparently stultified by the dead hand of government, Australia’s health system far outperforms the free market-based US healthcare system, which spends nearly twice as much per capita as Australia to deliver far worse outcomes — including Americans dying five years younger than us.
Source: https://www.crikey.com.au/2024/10/16/pubic-private-healthcar...
Bypass: https://clearthis.page/?u=https%3A%2F%2Fwww.crikey.com.au%2F...
Overall, we now have the fourth-highest life expectancy in the world.
This is contrary to the narrative that pervades the media about our health system — one in which our “frontline” health workers heroically battle to overcome government neglect and inadequate spending, while the population is beset by various “epidemics” — obesity, alcohol, illicit drugs.
In fact, Australian longevity is so remarkable that in August The Economist published a piece simply titled “Why do Australians live so long?”
The Economist: https://www.economist.com/graphic-detail/2024/08/23/why-do-a...
AU Gov Report: Advances in measuring healthcare productivity https://www.pc.gov.au/research/completed/measuring-healthcar...
> the free market-based US healthcare system
market, maybe, "free" market? I doubt it.
It's not a very free market when there is such a large power differential between the buyer and the seller. You can't exactly shop around for the ambulance or the hospital when you need it, nor can you realistically circumvent the artificially constrained supply [1] of doctors to get cheaper healthcare (unless you live next to the border).
When the alternative is a one-sided market like this, government becomes rather more appealing.
1. https://en.wikipedia.org/wiki/American_Medical_Association#R...
To me that is the funny thing today if you look at markets Chinese markets under it's communist system are actually freer than US. China is not interested any 1 company getting a monopoly and becoming more powerful than the government so they promote finance multiple companies resulting in a truer capitalist market than the US.
> You can't exactly shop around
The vast bulk of health care is by appointment, not a dash in the ambulance.
You’re still significantly limited by your insurance carrier’s network and also the consolidation of the healthcare industry. I used to live in a city of 1 million that had essentially two hospital networks that bought everything. You could not find a specialist not associated with those two companies. Pre-natal, allergy, cardiac, two choices. When my seventy year old doctor who ran a practice out of his house retired he sold the practice to one of the two.
It’s not shopping for a tv. You can’t choose not to buy. It’s often time sensitive even if by appointment. Pricing is incredibly complex as are the details of the product. Your average person does not have the information necessary to navigate the market.
Even so, when was the last time someone needed cancer treatment but said "ooh, that's pricey, nah, I'd rather buy a new car instead".
This is my main argument against private healthcare: there's no real choice involved. Without even getting into what a free market is and perfect information etc, the main advantage of a capitalist society is you get to choose what you like. Nobody chooses healthcare (at least, not the super expensive part).
Free market-based US healthcare system? Which US are we talking about?
"Free market" is one of the best examples of a technical term people use with complete confidence despite not knowing what it really means. Furthermore, even if you do know what it means you probably remember it as something you learnt on day 1 of economics class before learning all the reasons they never really exist and what governments try to do about that.
Always when I read this I think they are comparing too very different societies where healthcare is just one factor. Americans are so much less healthy than Australians due to lack of exercise, poor diets, stress, no holidays, guns and crime. Its a miracle that if the US health is nearly as good as Australians it shows how great the US healthcare system really is.
Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
Back in the 1970s the AU Government was running campaigns such as Life. Be In It: https://www.youtube.com/watch?v=GNjEge3Awl8 (many short segments airing with commercials on TV).
Planning requirements typically require open spaces, walking paths, sporting facilities, etc.
A "healthcare system" needs to be more than simply "immediate care for the injured, sick, and|or dying".
> Part of the Australian national, state, and local health care system is policy to encourage healthy life styles and to discourage, limit, or ban food additives, tobacco, etc.
There's a book or two in the backstory of why neither Dentistry nor Mental Health get the same inclusion in traditional health systems :(
Unfortunately, obesity rates are rising worldwide, including in Australia.
> Ozempic has entered the chat.
This honestly feels like the kind of thing where 20 years from now we'll be more aware of the side effects and people will shake heads about how stupid "we" were today.
If this is going to be an exception, it'd be truly interesting.
There are already a bunch of studies showing that the ozempic causes massive muscle loss and lessens bone density. And before anyone remarks "just do resistance training", I doubt the people that take the easy solution will do it in conjunction.
AFAIK Australian healthcare system is mixed public private with a heavy lean on private. The healthcare market is open to market forces as the government works through subsidies. Plus I think many of the hospitals are religiously run institutions which helps protect from private equity influence.
The US has massive government regulation and dysfunctional state intervention in healthcare if not directly then vicariously with rules around Medicare. The US government helps make the dysfunction that private equity later exploits.
So I’m not sure that it would be correct to use Aus and the US as examples of the either end of the private / public continuum.
I would use UK or France as an example of a public system and Singapore as a light touch private, and perhaps India or Turkey as a laissez-faire system.
The UK and France systems appear to be degrading and do not appear long term affordable and I think they will soon be adopting Canadian style Maid systems to cut cost.
Germany is a weird one because it seems like half the doctors there are homeopaths and the Germans love their insurance but I’m not sure if they get value for it.
Personally I’d prefer the Australian or Singaporean style systems but I’d classify those as mostly private.
I had private health insurance in Germany. It was quite expensive and had a very high deductible — so pretty bad incentives around routine health care, I never made a claim in 13 years.
The upside was that if you needed, say, a brain transplant for ten million Euros, as long as it was medically necessary they would pay for it.
Now I have a policy elsewhere that is cheaper, still covers me when I go to Europe, and has a much better copay structure while being 100% private. Downside is I can’t afford that brain transplant, but I’ll probably be OK for everything else.
Australia absolutely has a hybrid health care industry with layers; health, medical, surgery, pharmacy and mostly outcomes based regulation rather than much assistance to maximise financial profits.
The current system grew out of a more fully public system under a many years past Whitlam government, people like the universal health for all aspects and wanted additional private services in the mix. It's evolved from there, with government oversight directed towards keeping things accessable and fair.
The US appears to have "massive government regulation and dysfunctional state intervention" as the end result of a lot of fingers in the pie bending regulation toward "middlecare" providers that don't apply splints or save lives, just diddle about with insurance schemes. (Admittedly that's just an impression from afar).
> The US government helps make the dysfunction that private equity later exploits.
My feeling is the US government is largely an arm of private interests in many matters.
Health Care in Australia embraces public policy such as Food Regulation to ban and limit additives, parks and sports grounds to encourage exercise, limiting access to tobacco, and some interesting national level drug acquisition deals to keep pharmacy costs low.
These cause a flow on of less per capita input into the medical side; lower heart disease, less smoking related issues, etc.
I don't disagree that there is a lot that Australia does right and the US would be better off with an Australian style system complete with a universal healthcare. Australia could have gone the NHS route but did pivot to the mixed system under Howard. Additionally it does appear to me that the National Disability Insurance Scheme is absolutely rife with fraud - I'm not even sure who'd you'd blame for that as it seems intentionally set up for such an outcome to undermine the very idea. So I'm not sure how well the Australian system will last even if it has lasted well up until now. Of course being Australia they'd combine NDIS with Robo-Debt and mistakenly hound a bunch of poor people to death.
I'm assuming the rational behind drawing the distinction between the US and Aus systems is to somehow inform what the US should do, I don't think giving an already corrupted government system more power will help. It's very hard to uncorrupt things and because of that reason I think the US would benefit from a more laissez-faire system.
Additionally Australia has many advantages that the US does not and the US could not emulate Australia even if they wanted to. I don't know how long that'll last either - mathematically I would assume a country could not get rich and stay rich repeatedly selling houses to each other but it does seem to have lasted a very long time. I assume at some point the Aus government will run out of ways to prop up the housing market. The combination of negative gearing and all sorts of first home buyer grants is just insane.
The US is hardly a free market health care system.
For example, Medicare.
If you wish you could take that up with Bernard Keane who wrote the piece.
https://www.crikey.com.au/author/bernard-keane/
Bernard is well across many aspects of US, UK, and AU political views, government systems, media etc. with his own particular views as we all have.
In context he's writing for an Australian audience about a conservative Australian trope that the Australian health system is weighed down with government meddling and would do better with, for example, a "US free market" approach.
I think we all appreciate that's an illusion, a myth spun for children.
I expect it has more to do with Americans’ high level of obesity and other poor lifestyle factors.
Australians are not exactly a svelte lot either, ranking 10th in the OECD countries for obesity (US is the third), and on par with the UK.
Yeah, Ozzies also drink like fish, at least when I was living there. Good lord, so much boozing.
Is the US health system free market? The government provides healthcare via Medicare and Medicaid for seniors, the people for whom life expectancy and healthcare quality have the highest correlation.
It’s a mixed bag, but the funding source doesn’t necessarily make it a controlled market, to the degree that Medicare and Medicaid pay non-government providers and allow competition (which again, is mixed). Medicare and Medicaid coverage make up one third of the US population. The other two thirds are on group/employer insurance, private insurance, or no insurance at all.
For non-seniors, the medical insurance system certainly sometimes doesn’t feel like a free market from the consumer perspective, but the insurance companies are private for-profit institutions, and the medical providers are too, so it may well fit the definition.
> the people for whom life expectancy and healthcare quality have the highest correlation.
What do you mean by this? Fatalities among the young will have a much larger impact on lowering nationwide life expectancy than fatalities among the elderly.
The quote is from a Crikey reporter, I (an Australian) wouldn't agree that the US health system is classic free market .. but it appears to have more regulatory capture by vested commercial non government profit orientated interests than by social policy best outcome for the masses civil authorities.
( Describing various systems in various countries as either communist of free market capitalist is pretty simplistic, it's not much as a linear spectrum either )
I'd also argue that the foundation for a high life expectancy doesn't start with good health care for seniors .. unless the metric is "life support via artificial means" .. life expectancy is grounded in healthy living and excerise from an early age well maintained with good health programs.
demographics in the US are very different than Australia, I suspect those in the bottom 1/3rd of US health drag it down significantly.
I assume you are referring to a larger amount of people living in poverty in the US?
Could this also (partially) be explained by the cost of healthcare? Something like a downwards spiral where average people end up poor either due to direct costs of healthcare or neglecting their own healthcare due to cost?
demographic differences of all kinds:
- greater usage of surgeries and prescriptions, leading to greater exposure to medical malpractice (the 3rd leading cause of death in the US.)
- higher birthrate. more pregnancies.
- less cultural tolerance of abortion. Greater willingness to take on risky pregnancies
- single parent homes (people with less family support)
- ethnicities which are more susceptible to certain disease and lifestyle risks
- greater exposure to crime in impoverished areas
- more life time spent traveling in cars
- more restricted access to health insurance (as you said only accessing healthcare in dire emergency)
The US is a different world than most countries which tend to be geographically tight and culturally homogenous. It's very difficult to make comparisons, not to mention differences in data collection and reporting ethics.
> medical malpractice (the 3rd leading cause of death in the US.)
Not to downplay the malpractice problem, but this doesn’t sound remotely plausible. Do you have some sources to back up this claim?
I googled around a bit and it appears to come from some sloppy misuse of statistics in a journal one time, plus internet amplification.
The issue with most of these is that they have better health outcomes overall but when it comes down to the uncommon cancer your mom has, she will have a much higher chance of survival in the US. The difference is a lot of poor folk without adequate healthcare die of relatively straightforward conditions like diabetes while if you do have healthcare you end up getting the state of the art though it might bankrupt you.
There's nothing in the Australian health care system that precludes people with uncommon conditions seeking specialist treatments either in Australia or abroad.
> she will have a much higher chance of survival in the US.
Without a deep dive it looks ballpark the same, to be honest.
AU Cancer Survival Rates:
The 5-year survival for cancer in 1991–1995 was 55% and by 2016–2020, the rate had increased to 71%. Even with decreasing mortality rates and increasing survival, the number of deaths from cancer has been increasing.
US Cancer Survival Rates:
Five-year survival rates have also been increasing for an even longer period of time. The overall cancer survival rate was 49 percent in the mid-1970s. It currently sits at 68 percent
Interesting, Australia seems to be actually doing better with cancer survival rates. I truly wonder what the downsides are if any.
We/Australia has a massive focus on early detection of skin cancer due to our overly sunny weather. It's possibly that we detect more cancer and treat it earlier thus the better outcomes?
> Can we overcome ageing?
75% American are overweight..
Just let it sink a second, they speak about how many baby born after 2000 will reach 100 years old, how we are reaching the absolute limit of human survival.
75% overweight... Everyone know fat people don't live long. I bet all the studies done in the 90's that predicted we would easily be able to reach 100 years old didn't take that into account.
I'm thinking that ozempic and zepbound will have something to say about this. When ozempic becomes available as a generic (2032) it's going to be available for $10 a dose and a huge amount of people will be taking it.
How do you know they don’t have side effects that would reduce max life expectancy?
Entirely possible they do - but those effects would probably manifest in some fashion earlier than actual death. We'll have at least 7 years to see if we can spot them. But, even if they do exist, they will probably be small (given we haven't found them so far), and the positive effect on life expectancy via weight loss is huge.
i.e. the benefits of the weight loss almost certainly outweigh any side effects that are likely to manifest.
People have been taking them for decades for other reasons, so if they had side effects reducing max life expectancy worse than being overweight surely we'd know by now.
have they? why are they only gaining prominence now?
Because they have been made available for weight loss.
Viagra's original purpose was for heart conditions, that purpose didn't make the headlines (or spam folders) either.
A study by researchers from the University of British Columbia (Canada) shows a link between drugs intended for diabetics and severe gastrointestinal diseases: pancreatitis, intestinal obstruction, biliary pathologies and gastroparesis.
Only fools would convince themselves a drug has no sideeffect.
The worst is that these drugs were created for legitimate use but are now being abused by what I would call lazy fat who can't get their finger out of their arse and start eating healthy.
When there is a natural, effective and no side effects alternative, why go the medication way.
When I was at university, I made a game of spending as little as possible on food. 50p/day. Didn't realise until someone here refused to believe me, that my diet then was about 1100 kcal/day during term time. Didn't feel bad at all.
A few years after graduation, for unrelated reasons, I was on antidepressants. I massively over-ate, became obese, gained stretch marks that will likely remain for life.
There was no voice in my head telling me I was even over-eating, there was no awareness of what I was doing to myself even when I felt the weird tingle in my belly that in retrospect was the tearing flesh that has the outward sign of a stretch mark — I ate without thought.
There is no "natural, effective" solution, because our natural instincts are at odds with our unnatural world.
So the solution is to take a hormone so we can still eat all the junk food we massively produce?
Ozempic is exactly the type of drug Unilevel/Nestlé would create if they were tasked with reducing obesity. I wonder if they'll include a free 7 day dose of it with Mars bars.
We don’t know if MMR doesn’t but we still give kids[0] the vaccine in infancy. The vaccine is too young (<60 y old). So I suppose ask yourself what proof you need and why.
0: most kids, I just got the disease instead and the vax later
We do know MMRV causes more seizures in kids than MMR and countries (like Canada) still choose to administer the vaccine with riskier outcomes due to costs and the fact parents don’t like to come back for more shots.
Wait, doing amphetamines for weight loss is cool again and has no drawbacks of it's own?
Ozempic isn’t anywhere near the amphetamine class of weight control prescriptions, where are you getting your misinformation from?
Welcome to the 80s part 2. Hope you enjoy the ride.
Ozempic et al are nothing like amphetamines. They definitely have side-effects but we have far, far more evidence that the benefits are outweighed than we did for stimulants in the 80s.
Every decade or two I hear this about some wonder drug only for them to turn out just as bad as what they were replacing. The opioid epidemic being the latest one.
To be clear, it looks like the health stat term "overweight" means anything greater than "normal", which includes obese.
Quick Google search:
> what percent of australians are overweight?
> Over the last decade, the proportion of adults who were overweight or obese has increased from 62.8% in 2011–12 to 65.8% in 2022.
US NIH says: 73.1% are overweight (includes obese). Ref: https://www.niddk.nih.gov/health-information/health-statisti...
Sure, 73.1% > 65.8%, but Australia is still plenty overweight. Both are appalling.
That’s a bizarre hill to die on, I see all kinds of larger people survive into their 90s when I was living near and volunteering at a nursing home as a teenager
I see all kinds of larger people survive into their 90s
So dangerous to extrapolate from anecdotal observation like this. If I see old people smoking, doesn't mean smoking is safe. It just means it doesn't kill at 100% effectiveness.
> It just means it doesn't kill at 100% effectiveness.
If you wait long enough, everything has a 100% effectiveness.
if you wait long enough, obesity actually becomes a protective factor for serious issues; like Falling & Sarcopenia.
I see “plenty” of life long smokers making it to their 80s and 90s too, that doesn’t mean it didn’t take out 90% of them along the way.
That’s the funny thing: at homes and nursing homes all around America you will find WW2 veterans. One could conclude that WW2 wasn’t dangerous from that, I suppose.
> Everyone know fat people don't live long.
studies estimate that moderate obesity takes about 2-3 years of life expectancy (defined as having a BMI of 30-35), only people with severe obesity (BMI of 40-45+) lose on average 6-13 years, comparable to smoking.
Given that severe obesity is still uncommon even in the rich world it only has a small impact on life expectancy overall.
Combined with getting in your car and driving absolutely everywhere (most Americans)?
This is what people also don't realize. When these sorts of people get old they become immobile as they lose what precious little of actual muscle mass they had and unsupported joints start failing left and right. Sure your life expectancy might only be 2-3 years shy. What about your health span? That's what most people are actually interested in extending when they talk about living longer.
Yeah, this is why I lift everyday and I plan too until I can no longer do it. Lifting is also good for mobility if done correctly. Especially deep squats.
Hunched over old people do not have the muscle mass to help keep them upright, I guess amongst other things.
Lifting is universally recommended to keep you healthy as you age, that and 30 min of moderate to intense cardio per day.
Lifting does very little for mobility.
> Lifting does very little for mobility.
Weightlifting can improve mobility by:
- strengthening muscles around joints allowing for more controlled movement.
- increasing flexibility: Dynamic movements in weightlifting, like squats, lunges, and overhead presses, can stretch and strengthen muscles simultaneously, improving flexibility over time.
- improving joint health because loading the joints with resistance can increase the production of synovial fluid, which helps lubricate joints and promote better movement.
- promoting balance and coordination because exercises often challenge stability and coordination, which can help improve motor control and range of motion in everyday movements.
My neurosurgeon and my rehabilitation program would both disagree with you.
Why do people on HN think the US is special about (quantity of) driving? All wealthy non-microstate nations are driving nations. And, they drive a lot. That includes Australia.
Bicycle are pretty common in Europe, infrastructures are designed around it and pedestrian since the middle 90's.
Most people still have a car but you wouldn't think about taking the car to go buy bread for instance.
Being slightly overweight is associated with longer lifespan. Really look it up, the longest lifespan is slightly overweight and top of normal bmi. Lifespan gets down when you move toward obese, somewhere in the middle of overweight segment.
The worst life expectations are in underweight category.
There is probably a distinction to be made between
"here is the theoretical limit given adherence to modern recommendations on cardiovascular health, exercise, etc."
and
"you all didn't listen and got fat instead"
> The decline in the United States is driven by increasing numbers of deaths because of conditions such as diabetes and heart disease in people aged roughly 40 to 60.
People are asking if we should be surprised by the headline but are missing this. As suggested in the article by the researchers, there is something dragging down the average since the 2010s. Not even hitting the general expectation of ~75 years. We don’t have solid answers yet, only theories.
So yes, generally while going up against the process of aging is going to create barriers (eg can we get to 130 years old), we are also failing to raise the baseline which is the bigger issue that people might not grasp when it comes to “life expectancy rates”.
> We don’t have solid answers yet, only theories.
The exact quote you gave had a pretty solid answer, certainly not just "theories".
That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.
We have research on what can affect heart health, like what things might be linked to it, such as smoking and alcohol. We also know genetics plays a huge role.
So we don't actually have solid answers, actionable answers as to the rise of heart health issues. Look at this analysis[1] regarding how dietary guidelines specifically for fats (saturated, trans) have very little substantial evidence supporting it. Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid. In another study[2] we find that reducing your fat intake still resulted in the same rates of mortality as those who ate more. This is also why more in the space are shifting away from these sort of claims ("only eat x amount of saturated fat per day") and more to general food composition (eg who cares if a fish has saturated fats, eat the fish with vegetables).
It's quite challenging to figure out, everyone has their theories. All I'm saying is we don't actually have the answers yet.
[1]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9794145/ [2]: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092457/
Perhaps there are many causes of heart disease and diabetes. It is likely that actionable information would require a case-by-case assessment. That is exactly what doctors do, so getting people time with doctors seems pretty useful.
Regarding other factors, American culture is fairly similar to Canadian culture. However Canadians have free healthcare, meaning more Canadians see doctors than Americans. So I wonder if they have lower levels of obesity, heart disease and diabetes, and if their lifespans have also been decreasing.
> However Canadians have free healthcare
Also, Canadians are pretty fat. It looks like 65% are overweight, which includes obese. Ref: https://www.statista.com/statistics/1317268/overweight-obesi...
Fair point, it isn’t “free” of course. But it is accessible to everyone. No copay/deductible/coinsurance bs.
> It is extremely hard in a highly advanced economy to provide quality healthcare at less than 10% of GDP.
In the US we pay 17% of GDP towards healthcare and tons of people still can’t afford it.
The general view of US healthcare is that not much of the money paid toward better health outcomes reaches the target.
A quote from another comment here is:
Australia’s health system far outperforms the .. US healthcare system, which spends nearly twice as much per capita as Australia to deliver far worse outcomes — including Americans dying five years younger than us.> Yet this gets repeated by the average person, that fats are the ultimate evil you must avoid.
I've been hearing this complaint (that the guidelines claim fat are the worst) for way too long, when in (my) reality, all the guidelines I've seen in the last 25 years has put more emphasis on carbs than on fats (i.e. too many carbs is evil).
I know "low fat" diets were the craze a long time ago. And sure, advertisers still like to slap "low/no fat" labels. But I believe the actual recommendation has been to lower carbs since around the 90's.
This is ultimately a strawman.
To be fair the framing of “carbs are evil” is also lazy. The root cause of most cardiovascular disease and type 2 diabetes is obesity due to excess calories of any sort (although once you’re diabetic or prediabetic carbs are a HUGE problem no matter what).
The modern lifestyle is incredibly sedentary and every civilisation is built on staple foods that can feed hours of manual labour (with modern snacks thrown on top).
Calling a major food group evil is just a good scapegoat because it’s much more palatable than telling people that they don’t move enough and eat too much food.
One thing I think that we can be very specific about: Diets high in saturated fat surely increase your chances for cardiovascular disease.
Also, I agree with your general sentiment: Framing carbs are evil is lazy. First, calories matter. Second, if your calories are general under control, most people need fewer calories as they age. Many choose to restrict carbs to maintain weight.
All of this shit is stupid. Research has pretty conclusively shown at this point that a high proportion of calories coming from saturated fat specifically will raise LDL cholesterol levels, in people who have neither genetic predisposition toward low or high LDL. If you have one of those, it won't make a difference either way.
Whether that leads to actual heart disease is iffier, but not terribly controversial among cardiologists as far as I can tell. It's only doubted on the Internet where everyone wants to be a galaxy brain with some answer the doctors don't want you to know.
But nobody ever demonized fat in general, and demonizing carbs is just as stupid. Eating enormous amounts of carbs is fine as long as you actually use them. My daily calories right now are around 3,900 with carbs at 650 grams a day, a fair amount being syrups I eat early in the morning while running. If you listened to the Internet, you'd believe I was diabetic already, yet basically every remotely serious endurance athlete eats like this and is fine. Glucose that is continuously and immediately shuttled into muscle cells to power mitochondria and provide energy for movement does no harm whatsoever. It's roughly the entire point of animal metabolism. Glucose that sits around in your blood forever because you're sitting around staring at a screen for 16 hours a day while stuffing your face is what causes problems because of all the oxidizing effects of glucose when it isn't taken apart quickly and turned into ATP.
My BMI is 21.6 for what it's worth. As far as I can tell, the whole "mystery" behind why no diets work is because no diet can magically make people eat less when they spend the overwhelming majority of their time not moving and hunger decouples from energy expenditure. If you're sufficiently active as a lifelong athlete, every diet works. I ate super sized McFlurries, entire boxes of Entenmann's donuts, and Little Debbie's treats as a teenager as staples of my diet. As an adult, I've tried paleo, zone, mediterranean. Right now, I pretty much just eat the standard American food pyramid. None of these has managed to magically poison my brain or destroy my metabolism because metabolic function can be trained just like any other bodily function and it is trained by doing regular athletic activity with a high energy demand. Just like your muscles atrophy if you never do any resistance training, your metabolism atrophies if you never do any aerobic exercise.
I can't claim to know the secret to weight loss but I know how to never get fat in the first place. On every team I was ever on from middle school to college to my time in the Army, whether that be cross country, track, volleyball, basketball, tennis, or general outdoor adventurism and long-haul hiking with a weighted pack, the overweight rate was never 0 but it sure as shit wasn't 70%. And we were all eating the same "poisons" and manufactured foods from evil Nestle that the rest of you were eating.
I recommend studies about stain medication in increasing life expectancy.
We're talking years of increased life expectancy.
Sadly statin is not without its downsides.
We're talking years of increased life expectancy.
Huh? Statins are a medication type in which increases in life expectancy are extremely hard to point to all. I think they're almost a "poster child" for medications that correct a problem to an extent but whose overall benefit is quite dubious.
(and given that these medications were highly prescribed before any long term studies were finish - creating considerable incentive for people to find benefit - I'd personally wager they are overall harmful but that's me guessing - the main point is they definitely aren't boost-life-expectancy-by-years drugs but probably aren't reduce-life-expectancy-by-years drugs either, given the studies)
Link from google: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3531501/
Every few years, the lobby inserts op-eds insisting that statins are of such indisputable benefit and zero side effects that they should go into the water supply. I understand this from the companies themselves, but I have no idea which studies are convincing normal people that this is sane.
There is no lobbying like the lobbying for massively selling classes of drugs of dubious effect.
> That's not what I meant. A solid answer as to why those conditions are happening, not the fact that they are happening at all.
Nestle ? McDonalds ? Burger King ?
Portion sizes. The average plate is larger than it was, say, in the 60's.
Portion Sizes and the No/Low Fat craze from the 90s mentioned in another post are related.
This is all my THEORY, a speculation that I would like someone to study or to find a study about.
Theory / speculation:
Humans evolved with natural sugars, fats, proteins/meats; primitive cooking, probably some grains (more recently). That's what our bodies know how to process, to react to.
All the fake sugars, modified foods that lack the components our bodies use to regulate internal processes; highly processed foods which also lack those components we need to feel satiated and to produce the messengers to digest correctly: those are likely the causes of obesity (not feeling full, so more eating) and bodies behaving poorly.
'Food Deserts' and corporations that are geared around selling large portions of tasty but unsatisfying food, or only offering huge sizes rather than also offering adults a tasty portion that's not intended for take home leftovers also contribute.
Also: my main vice for this topic. Can I _please_ have lightly caffeinated + carbonated water that isn't outrageously expensive?
Caffeine addiction gets cheap when you stop beating around the bush and start just buying the caffeine pills that are like a cent a pop.
Insane prices for insulin?
edit: you really think insulin prices don't have an effect on the lifespans of diabetics?
Are they insane, though? How many hours average man should work to pay for average monthly dose of the average quality insulin? May be even more affordable than in other countries.
Insulin is cheap elsewhere.
> U.S. manufacturer gross prices per 100 international units of insulin were on average 9.71 times those in OECD comparison countries combined.
It is 10 times more expensive in USA.
I don’t think the average man should have to work any hours to pay for an average monthly dose of average quality anything that they require to stay alive. Perhaps I’m insane.
Who then will work to provide these average monthly doses of things they require to stay alive?
I don't believe being able to work is an ethical prerequisite to survival. I don't believe being willing to work is an ethical prerequisite to survival.
The government can work to provide the medication that its citizens require to stay alive. Under such a system, those who are able and willing to work can, via taxes or other contributions, provide medications that some citizens require to stay alive. Many such systems seem to cost less overall than the system currently existing in the United States, so the average man who will work will have to work fewer hours to pay for an average dose of average quality anything required to stay alive.
Alternatively or in tandem, the pharmaceutical companies can sell such medications at cost, with rebates and coupons for no/low-income patients, while still making plenty of profit on reasonably priced pharmaceuticals that patients do not technically require to survive.
https://www.mayoclinicproceedings.org/article/S0025-6196(19)...
I think the distinction there is between immediate cause and root cause. Heart disease and diabetes (or complications thereof) is the immediate cause of death, but what is causing an increase in those diseases is theory at this point.
Is it not clearly obesity? Why everyone is obese is perhaps unclear (although portion sizes, ultra processed foods, screen time and sedentary lives, etc, all seem to likely play a clear role), but I’d be surprised if the level of obesity that exists didn’t cause more heart disease and diabetes.
Yes. Why is everyone tiptoeing around this? The obesity rate has increased by something like 50% since the turn of the century. It is a major risk factor for all the causes of death being discussed here. Sure there are probably many factors but this is clearly a big one.
Go here https://www.cdc.gov/bmi/adult-calculator/index.html and enter your height and weight. If you fall above the healthy category, you are part of the obesity rate and are what most research points to when it comes to increased cardiovascular risk. Also for asians the numbers are slightly lower.
I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
I mostly get mad not because obesity isn't a problem, but because BMI is a bad way to measure it. It may work in the general, but it can give bad information in specific cases.
I'm a good example of how it fails. I have long arms and legs which causes my BMI to be fairly low. However, my body fat is fairly high. I need to lose fat but were I to rely solely on BMI I'd think I'm fine.
What I'd want instead of BMI is body fat percentage. I think that gives a much better measure of health problems.
> If you fall above the healthy category, you are part of the obesity rate
No. If you fall above healthy, you are "overweight". You need a higher BMI to be classified as obese.
Is it not the case that as BMI increases the risk increases? My BMI is not healthy - and I don’t deny that makes me subject to increased risk - but I would still think morbidly obese is far worse than obese which is worse than overweight, in terms of risk of diabetes, cardiovascular disease, etc.
Not strictly. Over the past few decades I've occasionally but regularly seen evidence that "overweight but not obese" (BMI 25-30) might actually be healthier than a normal weight (BMI 18.5-25). In those studies obese did have a worse outcome than both.
IIRC mostly they had to do with seasonal sicknesses like the flu, the theory being that your body can burn the extra fat during periods you aren't able to eat well.
> when I point this out, people often get mad. They feel they aren't obese
We’ve normalised being fat.
Still remember my first time ever setting afoot in USA, Newark airport coming from Norway, in 1999, going to a tech conference.
I saw more grossly obese people at that airport in the first ten minutes than I had back home in probably the previous year. It really stood out to me.
It must be your general dietary makeup and lifestyle. All that corn syrup. Also, I don't see any reason why it would have gotten better since then.
Just calling a spade a spade from an outsider's perspective..
> must be your general dietary makeup and lifestyle. All that corn syrup
It’s not just America [1].
Norway’s obesity rate runs at roughly half America’s [2]. But the trend across the world is increasing rates of overweightness, obesity and--most worryingly--child obesity.
[1] https://news.ycombinator.com/item?id=41634611
[2] https://en.m.wikipedia.org/wiki/List_of_countries_by_obesity...
People hate fat people. Everywhere I look, everyone is obsessing with diets and weight. People go to unhealthy extremes to try to loose weight, then predictably fail and cycle.
Disordered eating is a norm and being ashamed is a norm.
My result: 18.5 to 24.9. "Healthy Weight".
I tried adding 10kgs and it said "Overweight".
Seems ok to me.
They even warn that BMI should be used along with other indicators.
Mechanick, J. (2013). “What If” Being Overweight was Good For You? Endocrine Practice, 19(1), 166–168.
https://doi.org/10.4158/endp.19.1.50042678317gx698
The evidence that being overweight is healthier is a bit dubious, but the evidence that having a "normal" BMI is healthier than "overweight" is nonexistent.
Please correct me if I’m wrong, I believe that for aged women, being slightly overweight predicts longevity?
In anyone afaik. The healthiest weight is to be slightly overweight. The worst results are for underweight people and for obese people. The curve makes nosedive in its ends.
> I find that when I point this out, people often get mad. They feel they aren't obese. But the research doesn't support them, if you are anywhere outside of the "healthy" categorization you are at the same risk (that we know of so far) as "clinically obese" people.
Depends. All cause mortality is notoriously lower for "overweight" people than "normal weight" people.
Really smells like one of those “some alcohol is healthier than none” things where there’s a subset of the otherwise-healthiest group that’s in the otherwise-healthiest group because they’re very sick.
Normal weight and overweight were determined by percentage of population at some point. The boundaries are not about lifespan, they never were.
Why? "Overweight" and "normal weight" weren't determined by reference to what's better.
I find obesity a weird problem societally because literature to get people to stop being obese on a population level just kind of sucks. All we know is stuff that doesn't really work. Shaming fat people, pointing out their fatness, or other public pressure doesn't do anything. Strict diets like keto or OMAD don't work on a population level (individuals can get great results but I'm talking enough to statistically move the needle as a population). Ozempic and other injectables seem like the best widespread treatment, but that doesn't tell us any causes.
We're not making movement on this because we're not calling it what it is -- an addiction.
We dance around it and call it 'obesity' but the real medical cause of obesity is an addiction to unhealthy food.
This is compounded by the fact that it is completely legal for people to make their food more addictive and therefore unhealthy and advertise it to addicted people with underhanded marketing techniques that take advantage of their addiction.
Until we recognize this as an addiction issue that is compounded by dealers being able to operate with impunity we won't make any headway -- short of technological advancements like Ozempic that allow people to side step their addiction.
To the best of my knowledge, there's actually no diet that has been proven to yield long-term weight loss. (There are of course individual success cases.)
There are tons of diets that have been proven to work. Getting people to adhere to them long-term is the problem.