“I don’t for the life of me understand people who are willing to pay an extra $500 per month in premiums, year in and year out, because they’re afraid they might, someday, possibly, just maybe, get really sick or really hurt and have to cough up the full $10,000 family deductible.”

Long story short, especially now in the recession, a $500 a month ‘gamble’ is a lot less ruinous then a $10,000 payout (or more!) should something bad happen.

Yes – in strictly business terms – such monthly payouts are utter silliness. But accidents happen and diseases strike at the most unpredictable times.

Well, the cure for that situation is to take the smaller premium and set aside some savings each month. Long term, it’s usually the better deal. I had to shell out the entire $10,000 in one year when I needed surgery and my first daughter was born. But over time, it’s still been much cheaper to take the high deductible.

Ohreally said:
‘So, are obesity rates in third world countries the result of the third world countries’ governments advocating for a high-carbohydrate/low fat diet? Unlikely, it is more likely the obesity rates in third world countries are the result of economic conditions. Starchy foods are cheap.’

Ask you why are they cheap? Maybe it is cheaper to import (highly subsidized) wheat, rice and corn from Europe and the US and export bananas/cocoa/coffee than grow your own food.

Ohreally said:
‘You can lose weight under a cyclical carbohydrate diet, comprising complex carbohydrates, in which you vary the level of carbohydrates throughout the week based upon activity levels. Under a high carbohydrate/low fat diet you can achieve weight loss, so long as you vary your level of carbohydrates (the complex variety) and you exercise.’

Nobody said you can’t lose weight on a high-carb/low-fat diet, it is because it somehow works that it is advocated. But it doesn’t change the fact (backed by intervention studies and innumberable annecdotal evidence) that it is much much easier with a low-carb/paleo oriented diet.

Ohreally said:
‘Correlation is not causation.’

This applies only to observational studies. The research going back decades Tom was refering to is not limited to observational studies.

Ohreally said:
‘Your premise, essentially, can be summed up as, “people are automatons and do whatever the government tells them.” If this were true, then why is only a segment of the population affected and why not everyone?’

You should work on your reading skills, that’s not the message of Tom. In fact it is exactly contrary to his thinking and if you had actually seen his movie and read a little bit more his blog, that it would be in contradiction to his libertarian leaning.

Ohreally said:
‘he government’s message was not, and will not be, the only factor in determining how people eat.’ and
Again, a strawman, dismissing Toms message that government advocacy is a reason for the obesity epidemic by limiting it to being the only factor. Reread what he wrote, he doesn’t exclude other factors, but accuses the government to be a big contributor to that.
And by the way, you should not forget that the rules put in place by government have to be followed in federal institutions (prisons, schools, hospitals, army, alphabet soup agencies…), even Bill O’Reilly got that argument when Dr.Eades was on his show.

This said, you’re right when you say that people do not follow government advice to the lettre and fortunately so, or else the situation would be even worse.

She ate more, hence she gained weight. It was not just the macro nutrient breakdown. Many people throughout the world eat primarily a rice based diet without excess weight gain.

“Third world governments don’t have to advocate for starchy diets, because that’s all people can afford. Our government did advocate for starchy diets — look at the Food Pyramid, for pete’s sake.”

This is precisely my point. Society’s drive to starch based diets are a result of economic conditions, while government messages, at best, are mostly a secondary driving force.

“The calories-in/calories-out theory gets the causality backwards. If you eat foods that tell your body to store calories as fat, you will end up eating more because you run out of fuel. Hunger is a function of available fuel, not calories consumed. If you eat foods that don’t tell your body to pack the calories away as fat, you will be satisfied on less food, because more of what you’re eating is available for fuel.”

The causality of calories-in/calories-out is correct. You are addressing whether someone will be hungry under the philosophy of measuring calories consumed versus calories burned and be driven to eat more. That is a different question. Strict adherence to a caloric deficit will result in weight loss, even if you are hungry (it may not be easy, but it is certainly possible). If you act on that hunger and corrupt your caloric deficit, then you are going to gain weight. The issue you raise is hunger management, not whether eating under a caloric deficit will cause you to lose weight.

“What the really recent research suggests is that restricting calories long-term — which once again, is done on IMPRISONED ANIMALS, because it’s not natural to starve – works by lowering insulin levels. Insulin ages you inside. You don’t have to starve to lower your insulin levels; you just have to give up sugar and starch.”

Never argued to the contrary. There are people who voluntarily eat a restricted caloric diet, just because it is uncomfortable does not mean it is impossible. Recommended, probably not.

“No, it’s patently true. Read the friggin’ research. The effects of insulin, including promoting fat storage and and inhibiting lipolysis (the burning of body fat) are listed in biochemistry textbooks. That’s why type I diabetics waste away without insulin — they can’t store body fat, which insulin enables. Teenage diabetics will risk their health by giving up insulin shots because they know they’ll lose weight. Aneroxics are treated with insulin because it makes them gain weight.

Some people can lose weight on cyclical carb diets because they’re not insulin-resistant. People who are insulin resistant lose weight much more easily by restricting carbs — again, borne out in recent controlled clinical research, which I take it you haven’t read. Given the prevalence of type II diabetes, it’s safe to say many, if not most, fat Americans are insulin-resistant.”

Americans are “insulin-resistant” as a result of extreme consumption diets comprised of starches and fat. For people who are not born with diabetes yet develop diabetes, it is a result of diet. And the development of diabetes is reversible, even while consuming complex carbohydrates. You can eat oatmeal, rice, and potatoes as part of a healthy weight-loss diet, so long as your consumption is structured around exercise. But soda, breads, and other such processed carbs cannot be part of that diet. You have simply lumped all carbohydrates together and pronounced them all as dangerous. That is entirely disingenuous. Even a fat American can eat cyclical carbohydrate based diet and lose weight.

“Correlation is not causation, and not everyone cares what the government tells them to eat. I don’t, since I know better now. But I lived on a low-fat, high-starch diet and gained weight, like many others, because the USDA and FDA told me it was the smart thing to do. It would be a heck of a coincidence if we just happened to drastically increase our consumption of carbohydrates right around the time the government, universities, doctors and countless commercials told us it was the right way to eat.”

Just because two events correlate in time does not mean that one event caused the other. People hear government messages all the time, yet choose to ignore them. An example of ignoring a government message, during the previous administration as part of sex education the government took an abstinence only position. Guess what? Teenagers still had sex and the message had virtually no measurable effect.

The fact that you believe that the government message caused people to ramp up their consumption of carbohydrates is purely an opinion (my opinion is that is was a result of economics and advertising from industrial food manufacturers, and the government’s message was fuel for the fire but not the source). If you are able to backup your statement with scientific journals, studies or articles that show a direct causation that the government’s message was the primary factor for the increased rate of carbohydrate consumption then you can assert that relationship as fact. Otherwise you do yourself and your message a great disservice by portraying your opinion as a fact.

If you can demonstrate with data that the government’s message was the primary factor in increased starch consumption, then I will be persuaded. But I am unwilling to accept an opinion as fact.

Furthermore, the fact that third world countries have the same problem, as you stated above, with carbohydrate consumption lends more credibility to the idea that economics dictates diet, not the USDA’s food pyramid.

“How can you claim people eat starch because it’s cheap (which is true) and then excuse our government for making starchy foods cheap through grain subsidies, by the way? Do you honestly believe corn subsidies haven’t led to high-fructose corn syrup being added to nearly everything in the grocery store, including bread? Do you not believe the reams of research that have concluded that HFCS damages the liver and promotes weight gain?”

I never made an excuse for the government, their enabling of a social ill is deplorable. My point of disagreement with you is merely who owns the primary responsibility of promoting starchy based foods. Your blog contends that US citizens eat they way they do because the government promoted a high carbohydrate/low fat diet, I disagree. While the government promoted such a diet, I believe it was the industrial food industry that, not only promoted, but enabled the obesity epidemic with cheap (subsidized) starchy foods and the people willing to eat their products. And I do not think a change in the government’s message will have a substantial impact on the health and diet of this country.

Simply, I think you overstate the effect of the government’s advice because economics play a much bigger role in determining one’s diet.

Gosh yes, I’ll go look up those clinically controlled studies where they randomized people into groups who were either given the government’s dietary advice or not then monitored for the next 30 years to see how they ate. I’m sure there are dozens of those.

I once shared your beliefs on that issue. Then I read up on the science, which you clearly haven’t. Do yourself a favor and pick up a copy of Good Calories, Bad Calories, read the chapters on hormones and fat accumulation, including the studies where animals got fat despite having their food supply cut in half, or were starved to death without losing their body fat, then come back and explain to us how Gary Taubes got the wrong idea after reviewing 100 years’ worth of research. In the meantime, I’m not going to burn out my typing fingers trying to open a closed mind.

And yes, our consumption of carbohydrates increased dramatically once we were told by government bodies that fat is bad, low-fat(therefore usually high-carb) is good, and we should live primarily on grains. Do you really think all those “avoid cholesterol!” messages from the federal government had no effect in scaring people into choosing cholesterol-free cereals over bacon and eggs?”

So, are obesity rates in third world countries the result of the third world countries’ governments advocating for a high-carbohydrate/low fat diet? Unlikely, it is more likely the obesity rates in third world countries are the result of economic conditions. Starchy foods are cheap.

Your wife, and in general, gained weight because she consumed more calories than she burned. This is true of any diet irrespective of the food content. A person can go to any fast food restaurant for every meal and not gain weight, so long as they exercise enough to burn-off all the calories they consume. For most people, this type of lifestyle is not practical because of the hours of cardiovascular exercise it would require. Ultimately one’s body composition is based upon whether one is in a caloric deficit or surplus. The type of food one eats controls the difficulty in maintaining either a caloric deficit or surplus.

“The argument that no fat people walked out of concentration camps so it’s all about discipline, etc., is one I used to make, but not after reading the actual scientific evidence. You can starve people thin because in the near-total absence of food, insulin will go down and allow fat to be burned for fuel. But newsflash: starvation isn’t good for your health, and you pretty much have to imprison people to make them endure it.”

Actually, recent studies have shown that maintaining a diet at or very near a caloric deficit prolongs life and improves health. Body composition is entirely about one’s discipline, your body reflects what you eat and how much you eat. No one but you controls what goes into your mouth. You may not control your circumstances but you certainly control the choices you make. The government is not placing food directly in your mouth, it is still a choice of free-will.

“Most people try — again, government advice — to cut calories while still eating high-carb foods that raise insulin and discourage fat-burning. The result is starvation at the cellular level; that is, the cells run out of fuel because the fat they’re supposed to burn isn’t actually available. The body responds by slowing metabolism, which makes it even easier to gain weight when the dieter finally gives in to the raging internal hunger and eats more.”

This is patently false. You can lose weight under a cyclical carbohydrate diet, comprising complex carbohydrates, in which you vary the level of carbohydrates throughout the week based upon activity levels. Under a high carbohydrate/low fat diet you can achieve weight loss, so long as you vary your level of carbohydrates (the complex variety) and you exercise. Carbohydrates, in general, are not the enemy. It is the choices you make in carbohydrates, some carbs are good and some bad.

“This has all been documented in research going back decades.”

Correlation is not causation. Your basic premise “the government spread the message of high carb/low fat, so we have an obese society” over simplifies the nuanced relationship between society and food. The government’s message was not, and will not be, the only factor in determining how people eat. The government could broadcast tomorrow that everyone should eat a diet comprising only whole foods, devoid of starches and grains, and we would still have the same problem we have today. Foods high in sugar, salt and fat cost very little and they are engineered to create hunger and over-consumption. A change in message from the government is not going to change this.

Your premise, essentially, can be summed up as, “people are automatons and do whatever the government tells them.” If this were true, then why is only a segment of the population affected and why not everyone?

If people listened every government message, then everyone should be able to read the nutritional labels on the back of foods because it was government mandated and the message was spread by the government. But a vast majority of people cannot read nutritional labels. In addition, the government advocates for a balanced diet with healthy portions of fruits and vegetables but how many people know what these portions are and abide by them. Again, conduct a poll and determine how many people know which diet the government advocates.

I realize it is convenient and popular to blame the government, but to suggest that the average diet is a direct result from the diet the government advocates, as opposed to just one of many factors, is a short-sighted and misleading. Your point that it is all “the government’s fault” comes across as hyperbole, the media took the ball and ran with it. For the most part, over-weight people do not look in the mirror and contemplate, “well, this is what the government told me to eat . . . .”

My wife gained weight because carbohydrates raised her insulin and stored calories as fat – which will cause people to eat more, because they’re running out of fuel. She lost the weight soon after returning home and dropping the starchy diet. She didn’t go from disciplined, to undisciplined, to disciplined again in three years. The diet had a biochemical effect.

We are responsible for what we eat, but knowing what to eat requires information, which is why I made the film.

People do not eat the way they do because the government prescribes a specific diet. Conduct a poll and pose a basic question that asks which diet the government advocates, most people can barely find the United States on a map let alone guess the diet the government directly advocates. People eat the way they do because of economics and taste. The government enables food manufacturers to profitably produce certain types of foods.

You suggest that societal behavior is predicated upon the advice of the government; however, if this were true then a mere message change from the government would alleviate the country’s obesity and health epidemic. But we know this is not the case. Even if the message changed, people eat what appeals to their tastes. Corporations have determined that people like to eat foods high in sugar, salt and fat. Hence, most of the foods in the grocery store isle comprise manufactured foods with high quantities of sugar, salt and fat. In addition, manufactured foods are engineered to increase hunger to drive the consumer to even greater levels of consumption.

Deprivation and exercise do work. The problem is deprivation and exercise are taxing and require a certain amount of self-control, discipline and education. Yes, thanks to government and corporations the system is stacked against the average consumer. Society should not rely upon either the government or corporations to keep society’s best interests in minds. We should help our fellow citizens understand government and corporations promulgate dangerous messages.

The answer is simple: just say no (thank you, Nancy Reagan). Third world countries do not suffer from outrageous rates of obesity because food supplies are much scarcer then the United States. You simply do not see a fat man amongst the starving complaining that he is an anomaly and his condition is the result of “genetics.”

Ending grain subsidies is not going to change consumers’ diets, it will merely increase the size of their grocery bill (corporations will still find a way to get their profits). Diet change is a personal choice; therefore, consumers must elect to change their dietary behavior by shopping in only two isles in the grocery store: produce and proteins. Avoid any and all manufactured foods and stick to lean proteins (fish, poultry, and beef) and fresh fruits and vegetables.

The responsibility for the health of our citizens lies with consumers, government and corporations. Though ultimately the burden is on the consumer, because we have a choice of what we put in our mouths.

There is, in fact, quite an obesity problem in many third-world countries where people live on cheap starchy foods. It’s well documented in Good Calories, Bad Calories. My wife saw plenty of huge people during her time in the Peace Corps, living in an impoverished country. She also gained weight on the local diet, which was mostly starch.

This has all been documented in research going back decades.

don’t quit your day (or night) job.

Whatever obesity epidemic exists, we can thank the geniuses in government who told us carbs are good and fat is bad.

Hope this doesn’t qualify me for lampooning in one of your “inane comments” posts…

That’s a good post. I especially like the point that insuring against the predictable isn’t insurance; it’s pre-payment. We have exactly the type of insurance your number-crunching points out is the best deal: high deductible, low premium, pay the routine stuff yourself.

I don’t for the life of me understand people who are willing to pay an extra $500 per month in premiums, year in and year out, because they’re afraid they might, someday, possibly, just maybe, get really sick or really hurt and have to cough up the full $10,000 family deductible.

Thanks, Tom.

Best,

Brent

Looks like we have been ‘writing in parallel’ on this kindred notion regarding healthcare.

Check out my latest essays on my blog, Healthcare Epistemocrat, for similar takes on health policy and health reform.

epistemocrat.blogspot.com

In particular, ‘Physiological Economics’ and ‘ATP: Aliens, Triangles, and Physicians’ would be the two best essays to peruse first:

http://epistemocrat.blogspot.com/2009/09/physiological-economics-for-healthcare.html

http://epistemocrat.blogspot.com/2009/08/atp-aliens-triangles-and-physicians.html

I agree completely: We need health reform first. Healthcare reform can follow later.

It’s, as Pollan states, the ‘elephant in the room’.

I am doing my best to shine light on it.

Or, as my good friend Keith Norris at Theory to Practice says:

“No system can be created that will not ultimately implode under the weight of a diseased citizenry.”

I realized this a few years ago; everything else in health policy wonkering has just been background white noise since then.

Ancestral Fitness is health reform for me.

Good stuff, Brent. I enjoyed Taleb’s testimony too. He’s exactly right about the disastrous combination of capitalist profits and socialized losses. A giant “everything is free” system will only socialize more losses.

We currently have the kind of inexpensive, high-deductible policy that imposes at least some cost for bad health decisions on the consumer, where it belongs. I don’t know what’s in the final Senate bill, but an earlier version would have outlawed exactly that type of policy. All policies would’ve been required to be “comprehensive” — thus insulating even more people from the cost of their own decisions. If you ever needed proof that most politicians have no concept of economics, there it is.

Considering that we eat slightly less fat than we did a generation ago, I think we can let you off the hook.