Nearly 3 in 4 young-to-middle-aged U.S. adults were considered to have obesity according to BF% from DEXA scans

Of course its just calories in vs out. You cant change reality. Denying this is denying biological reality. This board has really lost it.

The reason is people simply eat too much because eating gives people a nice feeling. People are bored and eat. Thats it.

i'd like to also point out that many people who are overweight feel like the battle to get in shape is so difficult it's not even worth trying because they figure they're destined to fail

but, even getting in the habit of walking around the block before and/or after dinner, whether it's a total of 1/2 mile or 1-2 miles can be life changing for many otherwise sedentary people

even if they don't lose weight they'll still be healthier overall

generally people who get in the habit of walking after dinner or meals in general will not lose weight from the walking itself so much as the fact they know they are going to go for a walk after eating and will tend to eat a little bit less

of course, getting in the habit of doing so can be difficult. i hope our society and communities in general will start going outside to walk more. whether it's alone, with their spouse, kids, dog or meeting up with a neighbor or group of neighbors for the 7pm walk around the block i think a lot of people/communities could benefit from such a simple thing

Of course there's variation in what people need to eat. I know a 50 something year old woman who is short and she said that she has to eat 1200 calories to maintain. If she goes over that she gains weight. To me the difficult thing about that would be ensuring that you get all of the right nutrients because it doesn't exactly leave much room for error. A hefty man who is six foot six and very active would be emaciated on that amount and may need to eat 3000 calories a day but everyone's body will have their own set right amount which might vary.

The gut microbiome may cause variation in calorie demands but weight will still function as a result of calorie balance. Just as someone who fidgets all day will cause a different amount to be needed to maintain a stable weight.

If people eat less in terms of calorie content they lose weight. There are people that say this isn't true and I find it a bit bizarre as it has been proven over and over again. You put someone (an obese patient) in a controlled environment in a hospital and feed them a low calorie diet and they will lose weight. They do! It's maintaining it in the real world that's the issue. The weight loss injections seem highly effective so I suppose we should see where that takes us. Drum roll, they work because... they help people to eat less/reduce their calorie intake.

Calorie balance also includes the gut microbiome consumption. Read those studies I linked. They are measuring the calories in the poop, which represents what the gut microbes are consuming. There are more calories in the poop of the people with diverse gut microbiome. . . i.e. those gut microbes are eating part of the food. So if you feed the exact same amount of calories to a skinny person and fat person and have them burn the exact same amount, the skinny person stays skinny, the fat person gains weight. The fat person is taking a higher percentage of the calories that enter the mouth out of the food for him-/herself, leaving less for the gut microbes.

"It's maintaining it in the real world that's the issue." You are making the argument for why you need to look beyond calories in/calories burned.

Here, read this study too. The introduction has a good explainer for why scientists are studying more than calories in/calories burned that some of you people think is the ultimate scientific explanation, but really isn't.

pmc.ncbi.nlm.nih.gov

Energy-balance studies reveal associations between gut microbes, caloric load, and nutrient absorption in humans1

Background: Studies in mice indicate that the gut microbiome influences both sides of the energy-balance equation by contributing to nutrient absorption and regulating host genes that affect adiposity. However, it remains unc...

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I think a lot of the issue is that getting in the bare minimum of exercise is something that Americans need to go out of their way to do instead of a necessity like in a majority of the world. If you can spend all day in a climate controlled building or car, then you're pretty sheltered from the negative impacts of being overweight in addition to having a lower baseline activity, so there's not really much incentive to change your lifestyle.

This starts at a pretty young age. For example, apparently 98.3% of Japanese kids walk or bike to school vs 10.7% in the US. I imagine this has a lot of knock-on effects, such as:

1: You'd expect the Japanese kids to have a higher baseline rate of burning calories.

2: This would give them a higher baseline level of fitness. Since exercise is more unpleasant the less fit you are, you'd expect this to make additional exercise over the baseline rate less unappealing.

3: You'd expect the Japanese kids to get physical feedback about the downsides of being overweight: overweight kids might take a bit longer and have a less pleasant experience on their commutes. You'd expect them to get sweatier and smellier on their commute, maybe leading to some embarrassment, putting pressure on them to get healthier. These sorts of ill effects are largely mitigated if your trip is instead in an AC'd car.

4: You'd expect the habits from this to carry over to other things. If you're already walking a few miles a day to and from school, then walking to a friends house or a restaurant or just hanging out outside or whatever is going to seem more normal.

pmc.ncbi.nlm.nih.gov

Walking to School in Japan and Childhood Obesity Prevention: New Lessons From an Old Policy

Objectives. We analyzed the Japan’s walking-to-school practice implemented in 1953 for lessons useful to other cities and countries. Methods. We reviewed background documents (gray literature, online government information, l...

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You seem to be alluding to processed food being the culprit. Its part of it, but a bigger issue is how hard it is to exercise in the US. Our cities, especially suburban ones, are built for cars, not people. Most Americans probably can't even walk 5 miles from their homes safely and if they can, its probably a mind blowingly boring walk past strip malls.

As adults, we have a work culture - 8.5 hours at work (or more), 2 hours in the car. Of course people don't want to exercise after that. As someone who loves running, its hard, for someone just exercising it might be next to impossible.

Then we don't value cardiovascular activity, especially for men. Unless you go to a specialty store, all the men's workout clothes are baggy, long, loose fitting things - not something you're wearing for any kind of running, cycling, or even long walks. The only fitting clothing is winter gear - but the winter gear is all designed to feel comfortable training in Duluth, not where most Americans live.

I like the part you wrote about Americans on meds - thats true. Doctors in the US are trained not to treat, they prescribe, not treat.

Diet is part of it too - because Americans have time for one healthy meal a day, or at least one cooked meal. Of course, they are sacrificing time they could be exercising. You can't go 16 hours a day, every work day, you just can't. 5 free hours and if 2 are committed to training (remember the design of our cities - you have to commute again if you want to run or workout (yes, you can run from your house if you want to be bored out of your mind and hate doing it - see how Americans can't even walk 5 miles) This leaves 3 hours for cooking, chores, and unwinding - not enough time for any but the most stoic, something has to give. For most Americans, that is fitness.

When I was younger I felt obese people were to blame except for rare occasions. As I've gotten older and learn the world isn't always black and white I think it's a much more nuanced problem.

Our food system is broken and promotes highly processed food over fresh produce. Well it's easy for me, a middle class educated person whose parents cared about the food I ate, to criticize people for not knowing better the fact of the matter is the working poor don't have the mental capacity or maybe a better word is bandwidth to stay on top of all these things.

In a societal level it has to be fixed from the top even if at the individual level we have more power over our own choices.

Cheap, ubiquitous fast food, carry-out, delivery, calorific foods everywhere but one corner of the grocery store, cars to carry all that food home, subsidized sugar in everything in obscene quantities, sedentary lifestyle, no walking, no stair climbing, no exercise.

In Europe, most climb stairs in their buildings, walk to subway and bus, carry groceries by hand, walking, back home; soft drinks are consumed in small quantities, as they have generally much smaller portions and are more expensive than beer; they consume appetite-suppressants, coffee/cigarettes; much fewer potato chips; much smaller meals; much less fast food. All in all, a much healthier lifestyle is much easier to attain here. I have drunk maybe one soft drink in the past five months here, vs. 3-5 a week in the U.S., and I eat almost no fast food, since it's disgusting.

No, rather unlikely, all the bogeymanry notwithstanding.

That's my point. People need completely different amounts. If they cut calories to below the amount they need to maintain, they lose weight. Just as someone who is short will need a lot less than someone who is tall. Someone who is female will usually need less than someone who is male. If someone needs less calories as a result of their gut microbiome, that doesn't suddenly negate the issue of calories in versus calories out. If gut micobiome composition influences metabolism and/or calories leaving in faeces and they need e.g. 116 calories less it simply means they need 116 calories less, just as someone shorter has a similar (but much bigger) issue. You honestly think that if someone cuts their calories significantly from where they're maintaining they don't lose weight? That's the essence of calories in/calories out. Calories in poo are calories out (with variation), just as exercise, daily activity, metabolism, fidgeting, height, weight, sex (M/F) and so on. People need different amounts (e.g. the woman I know who maintains on 1200 kcal per day). It simply means they have a lower set point to maintain which could be changed by diversifying gut flora or, if someone doesn't want to do that, eat less to lose weight i.e. negative energy balance.

Also I don't think it's a simple as if you feed the exact same amount of calories to a skinny person and a fat person the skinny person stays skinny and the fat person gains weight. Aside from anything else, fat people have increased calorie demands to maintain their weight. If someone is morbidly obese they often lose weight on high calorie diets (e.g. going from 6000 to 3000) whereas someone who is underweight will (generally) gain on that. Gut microbiome variation isn't significant enough in terms of kcal to overcome the greater variation between underweight and overweight in terms of maintenance kcal (on average).

The Nature study (the one on the metabolic ward) talks about energy balance and negative energy balance in terms of losing weight. That's exactly calories in versus calories out. They're all accounted for - none vanish into the ether.

I used to have a career in academia and have been published over the years in many journals and society reports including in an area that isn't too dissimilar to this. I don't think this repeated denial of calories in versus calories out is helpful for anyone.

I also had a head injury after leaving the last university that I worked at that affected my ability to write so it is frustrating sometimes as I know what I want to say yet it gets obfuscated but I am trying the best that I can. People tend to pick at that, so I mention it here because honestly, I am tired of it. Thanks for the interesting discussion and articles.

That’s like the moderate drinkers living longer correlation, one that doesn’t imply a causation. People buying healthy stuff tend to be generally health conscious, but the key separator between them and the obese ones is just overcalorification. You could say that overcalorification becomes easier with packaged foods because they tend to be less bulky. But again if it were just that simple, a fiber supplement would fix America’s obesity.

Yes, and there is truth to that too.

11 years prior to Visaria et al's 2023 study a separate group of researchers released the finding of another study that showed that 64% of 9,000+ adults at a New York clinic were classed as obese using a similar DXA scan methodology. At the time of this 2012 report the standard BMI calculation for the study participants classified only 26% as obese.

medicalnewstoday.com

Obesity Rates In USA Probably Underestimated

Christian Nordqvist

Nearly 40% of Americans who are classed as slightly overweight are likely to be obese, according to a study published in the Public Library of Science (PLOS ONE).

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This study looked at records collected from 1998 to 2009. The average age was 51. So older than the more recent study.

No he’s not. Stop making up crap

In fact the last study, ironically enough, is an energy balance study literally referring to the equilibrium of energy intake and energy expenditure in the opening line of the introduction.

You couldn't make this sh!t up.

Why wouldn't this be due to "calories in vs calories out"? Do you ever track your daily calories to see how easy it is to exceed the needed daily intake? It's so easy to do with access to sugary, fatty, and calorie-dense foods, even just in one sitting. Couple that with fact that most people sit at work at day, then play video games or mess around on their phones in their free time, and it isn't surprising.

So yeah, synthetic foods and such are part of the problem, but it still comes doen to eating too many calories.

There are at least three good books that explain the obesity epidemic... Good Energy, Metabolical, and Your Guide to Cellular Health. Hint: It's for all the reasons that have been cited in this thread, which can be clumped under the heading of Metabolic Dysfunction.

The author of Good Health is Casey Means, MD. She and her brother Calley are insiders in the MAHA movement. In fact, Calley was instrumental in arranging the first meeting between Trump and RFK Jr immediately after the Butler, PA assassination attempt.

Everyone seems to be focused on RFK Jr and how he will handle vaccinations, but Big Food is definitely going to be one of the first areas RFK Jr will address. His confirmation hearings will begin Wednesday. Hopefully, he will be quickly confirmed so he can move this agenda forward.