NHS surgery ban proposed for smokers and obese

[Man o War]

Thoughts?
I think I'd have lots more days off.

NHS provokes fury with indefinite surgery ban for smokers and obese

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[nimbus]

Lol

 

[Psai]

It makes a ton of sense, not sure why people are mad. I've never understood why we give out knee replacements like candy to people who obviously did it to themselves.

 

[deleted171991]

Thoughts?
I think I'd have lots more days off.

NHS provokes fury with indefinite surgery ban for smokers and obese

People don't understand that the only way to have modern medicine for those who actually need it is to cut costs by refusing luxury care to those who don't really need it.

It's common sense. I used to do it all the time as an ICU fellow: I did not admit patients who didn't really need the ICU, so that the patients in the ICU could get better care from the same number of healthcare workers.

 

[Quizlet04]

It makes a ton of sense, not sure why people are mad. I've never understood why we give out knee replacements like candy to people who obviously did it to themselves.

Most surgeries are for **** that people did to themselves. You'd have to cancel all of cardiothoracic if you were handling cases of heart **** just due to bad luck.

 

[anbuitachi]

It makes a ton of sense, not sure why people are mad. I've never understood why we give out knee replacements like candy to people who obviously did it to themselves.

Of course the surgeons are against it. They are losing business

 

[killerleaf]

It makes a ton of sense, not sure why people are mad. I've never understood why we give out knee replacements like candy to people who obviously did it to themselves.

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

 

[chocomorsel]

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

Why were his knees so bad in the first place? Running? Injury? What.
Clearly there are exceptions. But let's face it, thin people don't have knee relacements as much as fat people. And obesity is endemic in this country.

 

[Psai]

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

Finding someone who doesn't call him hubby

 

[anbuitachi]

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

diet alone is not cutting it? why not? i feel like 100% of the people ive met lose weight when they stop eating

 

[Ezekiel2517]

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

Agree. Even with obesity, people act like it's always their fault, that it's their choice. Like obese people enjoy being fat. Issue is more complex. Problem is that most docs have had charmed lives. They don't get that the vast majority of the population don't have it so easy.

 

[anbuitachi]

Agree. Even with obesity, people act like it's always their fault, that it's their choice. Like obese people enjoy being fat. Issue is more complex. Problem is that most docs have had charmed lives. They don't get that the vast majority of the population don't have it so easy.

Lol 40% obesity rate in USA and the problem is most docs have had charmed lives?
I dont think so.
The vast majority of the population don't have it so easy... I agree, when you compare to doctors. But when you compare to impoverished countries in other places, they do it have it easy. Not many poor countries have better welfare than we do... According to the 2017 OECD obesity update, US is 38.2% obese compared to 7% for China, 5% for india and 19.5% for OECD. US was of course not surprisingly #1 on the list. (mexico #2 at 32%). Are you really saying that the problem isn't with Americans? That our poor people's conditions are worse than the poor in all these other countries? Seems like this country is just really good at finding excuses.

 

[nimbus]

Lol 40% obesity rate in USA and the problem is most docs have had charmed lives?
I dont think so.
The vast majority of the population don't have it so easy... I agree, when you compare to doctors. But when you compare to impoverished countries in other places, they do it have it easy. Not many poor countries have better welfare than we do... According to the 2017 OECD obesity update, US is 38.2% obese compared to 7% for China, 5% for india and 19.5% for OECD. US was of course not surprisingly #1 on the list. (mexico #2 at 32%). Are you really saying that the problem isn't with Americans? That our poor people's conditions are worse than the poor in all these other countries? Seems like this country is just really good at finding excuses.

Go USA!! #1

 

[deleted162650]

You know you've got it rough when you're cursed with too much food.

 

[deleted162650]

There's actually a recent orthopedic paper that shows more patients gain weight than lose weight after receiving a total joint.

 

[deleted171991]

Lol 40% obesity rate in USA and the problem is most docs have had charmed lives?
I dont think so.
The vast majority of the population don't have it so easy... I agree, when you compare to doctors. But when you compare to impoverished countries in other places, they do it have it easy. Not many poor countries have better welfare than we do... According to the 2017 OECD obesity update, US is 38.2% obese compared to 7% for China, 5% for india and 19.5% for OECD. US was of course not surprisingly #1 on the list. (mexico #2 at 32%). Are you really saying that the problem isn't with Americans? That our poor people's conditions are worse than the poor in all these other countries? Seems like this country is just really good at finding excuses.

You have to realize that healthy organic food doesn't make you as fat as the industrial fodder we call food in this country. Poor people cannot afford the former, hence they get fat on HFCS. Cheap tasteful crappy "food".

Respectfully, our welfare is a joke, compared to most other developed countries. And our food is worse, for the simple reason that our politicians are sold out to farming (read corn!) interests in the swing states, so one can barely find something that doesn't have corn in it. Even our gas has corn-derivatives in it. They would subsidize corn even to put it inside corn, if possible.

Plus we live much more stressful lives than the average OECD nation. What we call capitalism is called jungle elsewhere. At will employment? Try to find it in Europe. Those people work less than 40 hours/week, hence there is less stress, less cortisol, less obesity. Their food may be more expensive than ours, but it's more natural (let's not say organic). A lot of those taxes they pay go finance a much stronger social security safety net. E.g. one cannot get bankrupt just from getting sick or disabled. Etc, etc, etc.

Please stop blaming the poor. They are the ones who actually need a nanny state, because they are also less educated and take a lot of poor (!) decisions. Bad food being one of them.

 

[Psai]

You have to realize that healthy organic food doesn't make you as fat as the industrial fodder we call food in this country. Poor people cannot afford the former, hence they get fat on HFCS. Cheap tasteful crappy "food".

Respectfully, our welfare is a joke, compared to most other developed countries. And our food is worse, for the simple reason that our politicians are sold out to farming (read corn!) interests in the swing states, so one can barely find something that doesn't have corn in it. Even our gas has corn-derivatives in it. They would subsidize corn even to put in inside corn, if possible.

Plus we live much more stressful lives than the average OECD nation. What we call capitalism is called jungle elsewhere. At will employment? Try to find it in Europe. Those people work less than 40 hours/week, hence there is less stress, less cortisol, less obesity. Their food may be more expensive than ours, but it's more natural. A lot of those taxes they pay go finance a much stronger social security safety net. E.g. one cannot get bankrupt just from getting sick or disabled. Etc, etc, etc.

Please stop blaming the poor. They are the ones who actually need a nanny state, because they are also less educated and take a lot of bad decisions. Bad food being one of them.

All food is organic.

Everyone is free to make their own choices. Then you should live with the consequences of those choices, not rely on others to foot the bill to patch up your mistakes.

 

[deleted171991]

All food is organic.

As opposed to inorganic?

 

[Man o War]

Come on guys/gals, let's not overcomplicate this.
Admit someone to the hospital and put them on a low calorie strictly supervised diet and they will lose weight.

 

[Man o War]

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

He's eating/drinking too much still, simple as that. If you can't do much activity wise, you don't need very many calories.

 

[anbuitachi]

You have to realize that healthy organic food doesn't make you as fat as the industrial fodder we call food in this country. Poor people cannot afford the former, hence they get fat on HFCS. Cheap tasteful crappy "food".

Respectfully, our welfare is a joke, compared to most other developed countries. And our food is worse, for the simple reason that our politicians are sold out to farming (read corn!) interests in the swing states, so one can barely find something that doesn't have corn in it. Even our gas has corn-derivatives in it. They would subsidize corn even to put in inside corn, if possible.

Plus we live much more stressful lives than the average OECD nation. What we call capitalism is called jungle elsewhere. At will employment? Try to find it in Europe. Those people work less than 40 hours/week, hence there is less stress, less cortisol, less obesity. Their food may be more expensive than ours, but it's more natural. A lot of those taxes they pay go finance a much stronger social security safety net. E.g. one cannot get bankrupt just from getting sick or disabled. Etc, etc, etc.

Please stop blaming the poor. They are the ones who actually need a nanny state, because they are also less educated and take a lot of bad decisions. Bad food being one of them.

And how does this compare to China/India, where obesity rate is 1/7th the obesity of USA? Are their foods so healthy that they aren't becoming nearly as obese as us? Are their welfare that great or do they work that few hours? Are they less stressed than us?

 

[vector2]

All food is organic.

Everyone is free to make their own choices. Then you should live with the consequences of those choices, not rely on others to foot the bill to patch up your mistakes.

Personal responsibility is important and everyone needs to take some degree of responsibility for their lifestyle choices, but chalking up overweight/obesity and its related health effects solely to gluttony and sloth is ridiculous. For instance, look at separated identical twin concordance studies. How can the issue predominantly be choice when you have a set of identical twins who grow up thousands of miles away from each other and raised by different parents, but yet they are within 2 lbs of each others' weight at adulthood? My wife grew up in a household with pretty standard southern (aka bad for you) fare and accessibility to bunch of snacks and other junk. Her dad and brother are big guys. Her mom and her bordered on underweight in their 20s and continued to be lean since. My wife does not think compulsively about her food choices- she just feels full and naturally stops eating when there's still a large amount of food left on her plate. She doesn't have to beg and plead with herself or hire a personal trainer to get motivation to hit the treadmill- she just has a surplus of energy which she has to burn off or else she'll feel worse for wear.

I don't think organic, per se, is the answer to anything. I do think if you're gonna eat meat/milk/eggs then you should try to get grass-fed / pastured because the omega3/vitamin/mineral profile and environmental impact is better. Rather, I think eating a low-carb or ketogenic diet would benefit the vast majority of people eating the standard American diet. Eating 60% F/30% P/10% C macros allows fasting and post-prandial insulin to plummet while avoiding big spikes and troughs, lowers inflammation, improves triglycerides and LDL particle size, improves satiety, and spontaneously causes caloric intake reduction without explicit calorie counting. I don't think it's the only way though- if you're fat and insulin sensitive (haven't already developed what looks like a blooming metabolic syndrome) and can actually stick with a hypocaloric, low-fat 10% F/30% P/60% C diet, by all means go for it. Whatever the case, eating the standard 30-40% F/20% P/40-50% C when it's comprised of refined starches/sugars and industrial corn/seed/veg oils (horrible omega 6:3 ratio) is the absolute worst thing we're doing now.

 

[Mad Jack]

Lol 40% obesity rate in USA and the problem is most docs have had charmed lives?
I dont think so.
The vast majority of the population don't have it so easy... I agree, when you compare to doctors. But when you compare to impoverished countries in other places, they do it have it easy. Not many poor countries have better welfare than we do... According to the 2017 OECD obesity update, US is 38.2% obese compared to 7% for China, 5% for india and 19.5% for OECD. US was of course not surprisingly #1 on the list. (mexico #2 at 32%). Are you really saying that the problem isn't with Americans? That our poor people's conditions are worse than the poor in all these other countries? Seems like this country is just really good at finding excuses.

Clearly the answer is impoverishing our country so we can be thin like China and India. Epidemic solved.

 

[deleted171991]

And how does this compare to China/India, where obesity rate is 1/7th the obesity of USA? Are their foods so healthy that they aren't becoming nearly as obese as us? Are their welfare that great or do they work that few hours? Are they less stressed than us?

Their food is probably healthier than ours, to begin with, simply because there is less industrial farming.

And what they call work you wouldn't. On average, they are less stressed. In China, absolutely. That's one of the few good things about living in a socialist country.

 

[deleted171991]

Personal responsibility is important and everyone needs to take some degree of responsibility for their lifestyle choices, but chalking up overweight/obesity and its related health effects solely to gluttony and sloth is ridiculous. For instance, look at separated identical twin concordance studies. How can the issue predominantly be choice when you have a set of identical twins who grow up thousands of miles away from each other and raised by different parents, but yet they are within 2 lbs of each others' weight at adulthood? My wife grew up in a household with pretty standard southern (aka bad for you) fare and accessibility to bunch of snacks and other junk. Her dad and brother are big guys. Her mom and her bordered on underweight in their 20s and continued to be lean since. My wife does not think compulsively about her food choices- she just feels full and naturally stops eating when there's still a large amount of food left on her plate. She doesn't have to beg and plead with herself or hire a personal trainer to get motivation to hit the treadmill- she just has a surplus of energy which she has to burn off or else she'll feel worse for wear.

I don't think organic, per se, is the answer to anything. I do think if you're gonna eat meat/milk/eggs then you should try to get grass-fed / pastured because the omega3/vitamin/mineral profile and environmental impact is better. Rather, I think eating a low-carb or ketogenic diet would benefit the vast majority of people eating the standard American diet. Eating 60% F/30% P/10% C macros allows fasting and post-prandial insulin to plummet while avoiding big spikes and troughs, lowers inflammation, improves triglycerides and LDL particle size, improves satiety, and spontaneously causes caloric intake reduction without explicit calorie counting. I don't think it's the only way though- if you're fat and insulin sensitive (haven't already developed what looks like a blooming metabolic syndrome) and can actually stick with a hypocaloric, low-fat 10% F/30% P/60% C diet, by all means go for it. Whatever the case, eating the standard 30-40% F/20% P/40-50% C when it's comprised of refined starches/sugars and industrial corn/seed/veg oils (horrible omega 6:3 ratio) is the absolute worst thing we're doing now.

So what is keto diet based on? Meat, eggs and fresh vegetables, preferably the antibiotic- and hormone-free sort (because they make you sick and fat). Does any of those strike you as cheap? Nope. What's cheap is the industrial carbage that occupies 75% of grocery shelves.

Metabolic syndrome is a Western disease. Our food (and lifestyle) sucks, and that's why our health does too. Bad food and stress make a killer combo.

 

[anbuitachi]

Personal responsibility is important and everyone needs to take some degree of responsibility for their lifestyle choices, but chalking up overweight/obesity and its related health effects solely to gluttony and sloth is ridiculous. For instance, look at separated identical twin concordance studies. How can the issue predominantly be choice when you have a set of identical twins who grow up thousands of miles away from each other and raised by different parents, but yet they are within 2 lbs of each others' weight at adulthood? My wife grew up in a household with pretty standard southern (aka bad for you) fare and accessibility to bunch of snacks and other junk. Her dad and brother are big guys. Her mom and her bordered on underweight in their 20s and continued to be lean since. My wife does not think compulsively about her food choices- she just feels full and naturally stops eating when there's still a large amount of food left on her plate. She doesn't have to beg and plead with herself or hire a personal trainer to get motivation to hit the treadmill- she just has a surplus of energy which she has to burn off or else she'll feel worse for wear.

I don't think organic, per se, is the answer to anything. I do think if you're gonna eat meat/milk/eggs then you should try to get grass-fed / pastured because the omega3/vitamin/mineral profile and environmental impact is better. Rather, I think eating a low-carb or ketogenic diet would benefit the vast majority of people eating the standard American diet. Eating 60% F/30% P/10% C macros allows fasting and post-prandial insulin to plummet while avoiding big spikes and troughs, lowers inflammation, improves triglycerides and LDL particle size, improves satiety, and spontaneously causes caloric intake reduction without explicit calorie counting. I don't think it's the only way though- if you're fat and insulin sensitive (haven't already developed what looks like a blooming metabolic syndrome) and can actually stick with a hypocaloric, low-fat 10% F/30% P/60% C diet, by all means go for it. Whatever the case, eating the standard 30-40% F/20% P/40-50% C when it's comprised of refined starches/sugars and industrial corn/seed/veg oils (horrible omega 6:3 ratio) is the absolute worst thing we're doing now.

Well of course genes has something to do with it. We are all determined by our genes. But how will that solve things? Are we going to undergo gene therapy for obesity? Maybe in the distant future. But anyway, genetic composition doesn't change fast but obesity clearly skyrocketted in the past few decades. If your genes are giving you a disadvantage, you just have to try harder to make up for it (obviously not talking about severe genetic abnormalities like prader willie). It's the same w school. Are you going to say hey i did bad because i was born with bad genes? You think employers will give a crap about that excuse? In the end , how you change mostly depends on you.

And I agree w low carb diet, but it's not the only answer. It's not all about what we eat, but also how much we eat.

 

[vector2]

Their food is probably healthier than ours, to begin with, simply because there is less industrial farming.

And what they call work you wouldn't. On average, they are less stressed. In China, absolutely. That's one of the few good things about living in a socialist country.

So what is keto diet based on? Meat, eggs and fresh vegetables, preferably the antibiotic- and hormone-free sort (because they make you sick and fat). Does any of those strike you as cheap? Nope. What's cheap is the industrial carbage that occupies 75% of grocery shelves.

Metabolic syndrome is a Western disease. Our food (and lifestyle) sucks, and that's why our health does too. Bad food and stress make a killer combo.

Trying to look at the entirety of India or China and extrapolating from nationwide statistics is just not going to work because those nations are too heterogeneous from an economic, dietary, and lifestyle standpoint (those countries have a growing number of billionaires and a large number of people subsisting on 2 dollars per day while only recently developing a Western-like middle class). What we do know is that the richest states in India and China have already developed overweight/obesity rates like the US, likely due to industrial food and more sedentary lifestyles (backbreaking farming vs. office jobs).

Yep, that's pretty much what a keto diet is. If Americans would eat a veggie omelet cooked in some coconut oil for breakfast, protein shake for lunch, and ate a steak with some non-starchy vegetables cooked in pastured butter, obesity rates would probably plummet. Eating organic/grassfed/pastured is expensive, but even eating a similar meal with industrial eggs and meat would still be beneficial. Clean eating can be done cheaply (looking out for deals on beef and frozen chicken breasts, big bags of oats, yogurt, lentils, beans, greens and then buying in bulk). The problem is that cheap, clean eating is still more expensive and requires more effort than stopping at the Wendy's drivethru.

 

[vector2]

Well of course genes has something to do with it. We are all determined by our genes. But how will that solve things? Are we going to undergo gene therapy for obesity? Maybe in the distant future. But anyway, genetic composition doesn't change fast but obesity clearly skyrocketted in the past few decades. If your genes are giving you a disadvantage, you just have to try harder to make up for it (obviously not talking about severe genetic abnormalities like prader willie). It's the same w school. Are you going to say hey i did bad because i was born with bad genes? You think employers will give a crap about that excuse? In the end , how you change mostly depends on you.

And I agree w low carb diet, but it's not the only answer. It's not all about what we eat, but also how much we eat.

Obviously change depends mostly on you once the damage is done. I agree that genetic composition doesn't change fast- but Indians and Chinese in their countries' fattest states did not magically develop a mental weakness and become gluttons in the last 20 years after a 5000 year span of being lean. It sounds absurd at first to most people, but I think the paradigm will change about the direction of causality with obesity. Conventionally, we think overeat->caloric surplus->obesity. I think future research will more accurately show toxic food exposure->hormonal dysregulation (insulin, leptin, ghrelin, neuropeptide YY etc) / inflammation->steady state diversion of basal calories to adipose->overeating (to make up for disordered energy partitioning). This is analogous to the case of a growing teenager, wherein it would be ridiculous to say that a 15yo 'overeating' is what caused him to grow 5" in a year, but rather the overeating was a consequence of genetics/hormonal milieu. Ultimately, my point is that 'choice' plays a sufficiently small enough part that denying medical care because someone is fat is absurd.

 

[Psai]

Personal responsibility is important and everyone needs to take some degree of responsibility for their lifestyle choices, but chalking up overweight/obesity and its related health effects solely to gluttony and sloth is ridiculous. For instance, look at separated identical twin concordance studies. How can the issue predominantly be choice when you have a set of identical twins who grow up thousands of miles away from each other and raised by different parents, but yet they are within 2 lbs of each others' weight at adulthood? My wife grew up in a household with pretty standard southern (aka bad for you) fare and accessibility to bunch of snacks and other junk. Her dad and brother are big guys. Her mom and her bordered on underweight in their 20s and continued to be lean since. My wife does not think compulsively about her food choices- she just feels full and naturally stops eating when there's still a large amount of food left on her plate. She doesn't have to beg and plead with herself or hire a personal trainer to get motivation to hit the treadmill- she just has a surplus of energy which she has to burn off or else she'll feel worse for wear.

I don't think organic, per se, is the answer to anything. I do think if you're gonna eat meat/milk/eggs then you should try to get grass-fed / pastured because the omega3/vitamin/mineral profile and environmental impact is better. Rather, I think eating a low-carb or ketogenic diet would benefit the vast majority of people eating the standard American diet. Eating 60% F/30% P/10% C macros allows fasting and post-prandial insulin to plummet while avoiding big spikes and troughs, lowers inflammation, improves triglycerides and LDL particle size, improves satiety, and spontaneously causes caloric intake reduction without explicit calorie counting. I don't think it's the only way though- if you're fat and insulin sensitive (haven't already developed what looks like a blooming metabolic syndrome) and can actually stick with a hypocaloric, low-fat 10% F/30% P/60% C diet, by all means go for it. Whatever the case, eating the standard 30-40% F/20% P/40-50% C when it's comprised of refined starches/sugars and industrial corn/seed/veg oils (horrible omega 6:3 ratio) is the absolute worst thing we're doing now.

Oh please. How many black and white photos do you see of the whales we have now? Obesity is a very recent phenomenon and I doubt that there has been some sort of genetic shift causing massive weight gain in so many people. You simply take it much more than you need, it is really that simple.

 

[vector2]

Oh please. How many black and white photos do you see of the whales we have now? Obesity is a very recent phenomenon and I doubt that there has been some sort of genetic shift causing massive weight gain in so many people. You simply take it much more than you need, it is really that simple.

I didn't say there was any kind of genetic shift. Re-read my post.

 

[deleted171991]

Oh please. How many black and white photos do you see of the whales we have now? Obesity is a very recent phenomenon and I doubt that there has been some sort of genetic shift causing massive weight gain in so many people. You simply take it much more than you need, it is really that simple.

No, it's not. Read the good nutrition books. All calories are not made equal. That's why people lose weight on keto even without significant calorie restrictions. Fructose and sugar are simply toxic to the human body in anything but moderate amounts. The insulin resistance and pro-inflammatory state they induce are a virtual guarantee of weight gain and difficult weight loss.

"Everything in moderation" stops working when "everything" we are offered is junk/industrial "food".

Also, some people have bad genes. Couple that with bad nutrition and it's a recipe for disaster. They will be overweight/obese for life, without significant nutrition control.

 

[anbuitachi]

Obviously change depends mostly on you once the damage is done. I agree that genetic composition doesn't change fast- but Indians and Chinese in their countries' fattest states did not magically develop a mental weakness and become gluttons in the last 20 years after a 5000 year span of being lean. It sounds absurd at first to most people, but I think the paradigm will change about the direction of causality with obesity. Conventionally, we think overeat->caloric surplus->obesity. I think future research will more accurately show toxic food exposure->hormonal dysregulation (insulin, leptin, ghrelin, neuropeptide YY etc) / inflammation->steady state diversion of basal calories to adipose->overeating (to make up for disordered energy partitioning). This is analogous to the case of a growing teenager, wherein it would be ridiculous to say that a 15yo 'overeating' is what caused him to grow 5" in a year, but rather the overeating was a consequence of genetics/hormonal milieu. Ultimately, my point is that 'choice' plays a sufficiently small enough part that denying medical care because someone is fat is absurd.

The difference is that in China, the rich are getting obese. Because they have access to all the food they want, and in some places chubbiness is a status symbol for being well off (though becoming less common). In America, the poor are the most obese.
The bottom line that was presented to me in my 6 month long obesity class is that all these little things may play some role, but in the end it is still energy in vs energy out. You can eat all 'healthy' food, and still be obese. You can eat mcdonalds daily and still be thin. Just have to adjust the quantity.

 

[deleted171991]

The difference is that in China, the rich are getting obese. Because they have access to all the food they want, and in some places chubbiness is a status symbol for being well off (though becoming less common). In America, the poor are the most obese.
The bottom line that was presented to me in my 6 month long obesity class is that all these little things may play some role, but in the end it is still energy in vs energy out. You can eat all 'healthy' food, and still be obese. You can eat mcdonalds daily and still be thin. Just have to adjust the quantity.

It's almost that simple, but not that simple. There is food that makes you hungrier, and food that doesn't. The former may even have less calories than the latter but the consequences are much worse, because it messes with your brain and hunger and hormones, and, overall, results in increased food intake. That's why it's so difficult to lose weight long-term while eating a lot of carbs (i.e. cheap food), even if one counts them. And now we are back to the poor people.

 

[GA8314]

Thoughts?
I think I'd have lots more days off.

NHS provokes fury with indefinite surgery ban for smokers and obese

Yeah, basically I'd lose my job. lol

 

[GA8314]

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

Not to derail, but he should look into metformin.

 

[GA8314]

You know you've got it rough when you're cursed with too much food.

I know that was tongue in cheek, but it's the TYPE of food. Calories in does not equal calories out, because of the major metabolic/biochemical differences in how the body processes the different macronutrients......

 

[GA8314]

Obviously change depends mostly on you once the damage is done. I agree that genetic composition doesn't change fast- but Indians and Chinese in their countries' fattest states did not magically develop a mental weakness and become gluttons in the last 20 years after a 5000 year span of being lean. It sounds absurd at first to most people, but I think the paradigm will change about the direction of causality with obesity. Conventionally, we think overeat->caloric surplus->obesity. I think future research will more accurately show toxic food exposure->hormonal dysregulation (insulin, leptin, ghrelin, neuropeptide YY etc) / inflammation->steady state diversion of basal calories to adipose->overeating (to make up for disordered energy partitioning). This is analogous to the case of a growing teenager, wherein it would be ridiculous to say that a 15yo 'overeating' is what caused him to grow 5" in a year, but rather the overeating was a consequence of genetics/hormonal milieu. Ultimately, my point is that 'choice' plays a sufficiently small enough part that denying medical care because someone is fat is absurd.

I would agree with most of what you said in bold. This, while some elements need further elucidating, is literally THE problem. However, there are choices. They just don't taste as good (by very deliberate design).

 

[GA8314]

Oh please. How many black and white photos do you see of the whales we have now? Obesity is a very recent phenomenon and I doubt that there has been some sort of genetic shift causing massive weight gain in so many people. You simply take it much more than you need, it is really that simple.

You aren't really arguing against Vector's point. I suspect he'd agree with you, in fact. However, what has happened to those countries too in terms of the types of food (sugar and processed grains) they consume is likely the source of the severe metabolic derangement he/she is suggesting.

 

[GA8314]

No, it's not. Read the good nutrition books. All calories are not made equal. That's why people lose weight on keto even without significant calorie restrictions. Fructose and sugar are simply toxic to the human body in anything but moderate amounts. The insulin resistance and pro-inflammatory state they induce are a virtual guarantee of weight gain and difficult weight loss.

"Everything in moderation" stops working when "everything" we are offered is junk/industrial "food".

Also, some people have bad genetics. Couple that with bad nutrition and it's a recipe for disaster. They will be overweight/obese for life, without significant nutrition control.

You nailed it brother.

 

[GA8314]

What is amazing is how many of we docs are catching up with the science. This is highly encouraging.

If we don't go after big food the way the US did big tobacco, however, we won't see much change. The educated and elite with know, while the rest will still be consuming sugar/fructose with highly refined carbs (not to mention trans fats).

 

[vector2]

=The bottom line that was presented to me in my 6 month long obesity class is that all these little things may play some role, but in the end it is still energy in vs energy out.

This is the crux of the matter, isn't it? No one is arguing that the laws of the thermodynamics are being invalidated in this discussion of the pathogenesis of obesity. It is obviously axiomatic that there must have been an energy surplus for excess fat accumulation. The problem is that mainstream researchers and dieticians have ignored the question of causality and ignored the 'why' of obesity. Another analogy to explain the misunderstanding of energy balance: Consider a packed movie theater. If I ask why a movie theater is packed, it's axiomatically correct if one answered "because more people entered the theater than exited," but that answer provides me with zero useful information. A better answer to the pathogenesis of the packed theater is that it's full because it's opening night of a new Star Wars movie.

For decades, the answer to obesity has been that slothful gluttons are making a careless but purposeful choice to get fat. To fix it, just eat less, move more. Frequently one will hear the line that you just need to create a 3500 kcal deficit to lose 1lb of fat- a statement that is totally ridiculous since true energy expenditure is notoriously difficult to measure, not to mention it decreases as weight is lost (else an indefinite 500 kcal/week deficit from some arbitrary BMR would cause one to eventually waste into oblivion).

Granted, eat less move more will cause weight loss, but it is merely a treatment of the symptoms; the underlying disorder is not fixed. This is evidenced by the fact that a 220lb person who loses weight and gets to 160lb will have a lower basal metabolic rate than a lean person who has always weighed 160lb. The formerly fat person will constantly have a higher hunger level and lower energy level because there is a higher bodyweight setpoint that the brain desperately wants to get back to. See Biggest Loser Weight Regain Study and Commentary on dapagliflozin and weight loss. Dapagliflozin is an SGLT2 inhibitor DMII med which causes the kidneys to spill significantly more glucose into the urine than normal. A non-dieting pt on the med will lose some weight at first due to calories being pissed away, but he spontaneously and unconsciously will either have a lowered BMR and/or eat more to make up for the ongoing weight loss. Preventing obesity when one is significantly predisposed and then maintaining a post-obese lean weight requires a level of discipline and vigilance that someone who has always been lean will never understand.

 

[nimbus]

Anecdote time.

Based on what I ate during my youth I should have been a huge whale. I was a latchkey kid who ate fastfood every day and drank nothing but soda. Daily caloric intake was at least 4-5000. I ate more and much worse foods than a lot of fat people. Still I couldn’t gain weight. I entered college at 5’8” 118lbs. Didn’t break 130 til I hit my 30s. There’s more to it than energy in/out.

 

[GA8314]

I've said it many times, having some knowledge of how insulting sensitive you are is critical. Highly insulin sensitive? Likely going to be very carb tolerant. Insulin resistant? The SAD will make you obese. It's not totally that simple (and we are still learning more each year) but understanding the role and action of insulin is hugely important.

 

[killerleaf]

Not to derail, but he should look into metformin.

Why? his numbers are great...his A1C was in the 3's. His cholesterol is perfect.

Why were his knees so bad in the first place? Running? Injury? What.
Clearly there are exceptions. But let's face it, thin people don't have knee relacements as much as fat people. And obesity is endemic in this country.

He was a police officer for 25 years...and has done auto body work for the last 10. He was "bow legged" to begin with, and all the years of police work just wore his knees out.

I would also like to point out---once he got the knees (2 years ago) he is now back down to within 10 pounds of where he needs to be. Since he can now do things like stand up from a chair, and go up and down stairs without pain.

 

[vector2]

Why? his numbers are great...his A1C was in the 3's. His cholesterol is perfect.

An a1c in the 3s puts your est. avg. glucose in the 50s.

Metformin is a pretty incredible pleiotropic drug (look up AMP kinase) and can help people lose more weight compared to dieting alone without causing hypoglycemia.

 

[dhb]

Come on guys/gals, let's not overcomplicate this.
Admit someone to the hospital and put them on a low calorie strictly supervised diet and they will lose weight.

I dream of opening a weight loss clinic where i'd lock the fatsos up in a room which only energy source would be a treadmill: want to charge that phone? get on the treadmill, light? treadmill tv? treadmill
Water ad libidum and a slice of toast under the door.
Garanteed iron man finisher in 3 months.

 

[GA8314]

An a1c in the 3s puts your est. avg. glucose in the 50s.

Metformin is a pretty incredible pleiotropic drug (look up AMP kinase) and can help people lose more weight compared to dieting alone without causing hypoglycemia.

At the very least it is underutilized.

 

[dannyboy1]

Of course the surgeons are against it. They are losing business

So would we. Less surgeries = less need for anesthesiologists. Not sure why people always adopt a holier than thou attitude.

 

[GA8314]

So would we. Less surgeries = less need for anesthesiologists. Not sure why people always adopt a holier than thou attitude.

do not worry. this is the US of Entitlement. we will see no such thing here.

 

[Moose A Moose]

So, what would you recommend for my hubby? He was not overweight, until his knees got so bad he could barely walk, so his exercise level lowered. He cut back on what he was eating; but still gained weight. He was "bone on bone" in both knees. Ortho wanted to wait as long as they could to replace, because he was not old enough. Finally, they decided he was, (62) and did bilateral; there was no way either knee would stand up while rehabbing for the other. He is now losing weight, because he can get around so much better. So..what is a patient to do when they can't exercise, and apparently diet alone is not cutting it? Do you just say, "so sorry, you are fat, so you can't have new knees. Here's a wheelchair"

Of course there are extenuating circumstances. Smh