My Health Plan

I ride my bike everywhere, work out every day, never watch television, eat only small quantities of very healthy food – and haven’t had to use health insurance or car insurance for decades. Not to mention the thousands of dollars I save in automobile costs.

80% of US health care costs could be avoided by lifestyle changes, which would also improve people’s quality of life.

Healthy lifestyle vs. Obamination. Tough call.

About stevengoddard

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70 Responses to My Health Plan

  1. Gamecock says:

    “80% of US health care costs could be avoided by lifestyle changes”

    Not really.

    But 66% could be elimintated by:

    – Banning punative damages on medical lawsuits.
    – Require minimum of $3000 deductible on medical insurance. Make it insurance, not 3rd party
    – Stop requiring medical providers to give free care

    As long as I’m dreaming, eliminate the FDA and DEA.

    Steve, you will have large medical expenses before you die. Your methods are effective in postponing the expense, but they won’t eliminate it.

    • Gamecock says:

      I can summerize: keep government away from medical care.

      “In the current crisis, government is not the solution; government is the problem.” – Ronald Reagan.

    • R. de Haan says:

      That’s total BS.
      If someone remains healthy is determined by three factors.
      1. Genes
      2. Lifestyle, what you eat and how you exercise
      3. Luck

      I know plenty of people who got old without ever visiting a doctor.
      In fact I have them in my family.

      That doesn’t mean you don’t need a health insurance.
      I just think the entire system can be organized a lot more efficient.
      If we only could get rid of the insane liability insurance premiums that are needed to cover a simple GP practice taking 50% of the entire overhead we would have reached a great reduction in costs.

      The administrative layers and “health managers” a new class of paper shoveling morons further increase health care costs to no effect. This is just another attack on the US Middle Class.

    • kuhnkat says:


      I am 61. I will NOT have large medical costs before I die unless I am unconscious and they take me in and put me on life support and/or other care against my wishes.

      With my motorcycle riding and life style it was quite surprising to me when I woke up and realized I was thirty years old. Every year has been the same since. There is no particularly good reason I can think of to artificially extend my life if I do contract something ugly or have a disabling accident.

      Excessive End of Life health care is another Narcissistic symptom of our modern society.

      • R. de Haan says:

        “Excessive End of Life health care is another Narcissistic symptom of our modern society.”

        This is BS too Kuhncat. You’re talking like an Agenda 21 proponent.

        High quality health care is one of the great achievements of our timesvand it’s just plain stupid not to use it if you need it.

        It’s like a passionate biker ignoring bikes.

        As for the costs of health care in the USA there is some discussion necessary because these costs are excessive.

        Why healthcare in the US is so incredibly expensive:


        • kuhnkat says:

          R. de Haan you MORON, where did I even suggest that MY preferences should be made law and forced on everyone??

  2. R. de Haan says:

    I know you don’t mean it that way but what you wrote sounds like 100% Agenda 21 rethoric.
    They want our entire population riding bikes, eating healthy insects and take one minute showers once a week.

    I ride a bike too but I also drive motorcycles, fly planes and navigate boats.

    I love to continue these activities without being restricted by “green zones”, laughable speed limits, speed bumps that destroy the spoiler of your car”, limited landing and take off slots at airports that don’t deserve the name and the closure of waterway’s and lakes for ships with a diesel engine, even if this engine is electronically managed and the exhaust emissions are filtered.

    To be honest, I am fed up with the lot and that includes all the nice well intended advice from non smoking bigots who think they live a better and more healthy life than I do.

    I just want my freedom.

  3. NotAGolfer says:

    I got a note from BCBS yesterday saying my current plan does not meet the requirements of the ACA, and that I’ll be able to look for a new plan next week. Joy, joy.

    What I want is a plan that only covers catastrophes, with a huge deductible, but I understand I’ll be forced to get a “better” plan that covers more and has a lower deductible. I’m afraid of the cost.

    • beowulftoo says:

      That is the type plan my wife and had. Called a High deductible HSA plan, We basically paid cash for the first $6250 of expenses (per individual or about $7500 for both). The premiums were very low and we saved a bunch of money (about $35,000) to pay future medical bills. We still got about $27,000 of that. But with the advent of ACA The premium tripled. I was old enough to go on medicare. The last year of my wife’s HSAplan the premium was 250% higher (This was Nancy’s plan, get us to pay for others insurance. She complained about our plan during the ACA writing.) This was the plan that Whole Foods provided to their employees. Even obama pointed out the un-justice of it all. In any case. Those type plans were ideal for young people or Healthy people. (The plans got started under GWBush and the Republicans). If I could have had this type plan my whole working career I would have about half a million in the HSAbank. More than enough to comfortably see me to the grave.

  4. John B., M.D. says:

    Lots of money could be saved by reducing futile end-of-life medical care.

    I would not get rid of the FDA. There needs to be a check-and-balance against pharmaceutical companies who have repeatedly throughout history lied to the public and physicians to sell their drugs (not all snake oil, but I detest cover-ups of dangerous side effects).

    Agree with reducing (not increasing) the role of 3rd party payor. Obamacare increases the role of 3rd party payor, and single payor (liberal dream) completes the process. Cost decreases if patients have more skin in the game.

    The cost of defensive medicine also decreases if patients have skin in the game. A physician might order a test if there is a tiny possibility of missing something bad, just to avoid getting sued. A patient with skin in the game might defer if they do their own cost-benefit analysis and assume the risk of skipping a test.

    Healthy lifestyle improves morbidity and mortality and reduces health care costs in the short run. In the long run, it really all depends on how the individual chooses to use health resources if they are older.

    • Gamecock says:

      “Healthy lifestyle improves morbidity and mortality and reduces health care costs in the short run.”

      For the average person (not Steve with his super healthy regimen), it is short run only. Lifetime cost of healthcare is more related how long people live. Helping them live longer means they will be getting healthcare longer, costing MORE.

      I would prefer a trade industry association to the FDA.

    • John B., M.D. says:

      I’ve seen a lot of money wasted on futile care, like a 95 y.o. woman in a deep coma with poor quality of life before she got ill, having multiple surgeries, life support, etc., for over 6 weeks in ICU because family insisted “everything be done.”
      She had zero chance of returning to any measure of quality of life.

      That is just one example.

      Some patients with metastatic cancer get $100,000 in fancy new biologic treatments to gain 2 months of life, during which they are suffering, all in the hope they will be the outlier who survives 9 months instead of the average.

      All I’m saying is for people to be aware of these topics, and discuss with their family before they get ill what their wishes are, and to have a Power of Attorney done ahead of time (along with a will so your estate doesn’t go to probate).

    • Eric Barnes says:

      “Cost decreases if patients have more skin in the game.”
      Couldn’t agree more. Forcing people to pay other peoples medical bills (or forcing them to provide care) is slavery regardless of how noble it may sound.

      If an individual wants to pay someones bills, fine.

      Getting the government in the middle of this will only make it worse than it already is. The best socialism is that which comes from individuals who give it freely. When socialism is forced upon people it’s just totalitarianism in disguise.

      • John B., M.D. says:

        We pay auto insurance based on the value of the car and past driving habits (e.g. speeding tickets, collisions, etc.). It covers catastrophic expenses. It does not cover oil changes, repairs, or routine maintenance.

        Health insurance ideally would be the same – cover catastrophic expenses, penalize for bad habits (e.g. smoking, drinking, drug use, obesity). However, this is not the case. So in reality, it isn’t health insurance, but rather an entitlement. There is no financial incentive to live a healthy lifestyle. Furthermore, with the U.S. Preventive Services Task Force not recommending mammograms under age 50 or prostate cancer screening for anyone (controversial benefit of PSA testing, which is a different discussion), they are making these preventive services not covered (whereas a patient and doctor should be making the decision, not govt). For this and many other reasons Democrats don’t want to fix, health care will get more expensive under Obamacare (and CBO and other independent analysts agree).

        Dems paid off health ins companies, Big Pharma, unions, and the AMA (which most physicians do NOT belong to), and Obama/Sebelius granted waivers to political cronies.

  5. DGP says:

    It’s not my fault that the planet can’t support my lifestyle!

  6. Scott says:

    John B.
    I here that a lot – Most of the expense of health care is at the end-of-life. But is seems that many people don’t understand that you don’t always know when the end-of-life is untile your dead. I have seen an example of someone that most of us would assume was at the end of life at 75 and was saved by medical intervention and lived to 93.

    • Gamecock says:

      I lost my first wife, the Good One, to cancer when she was 34. We did not give up hope until the very end. I did in fact direct the doctors to stop treatment after they informed me that her coma had become so deep that critical body functions had stopped. That may have saved 2 days of expense after 10 months of treatment.

      I agree with you, Scott. I would never want to stop someone’s treatment as long as there was hope.

  7. GoneWithTheWind says:

    I wish it were true. Would riding a bike make me live to old age? All of my aunts and uncles, parents and grandparents lived into their 80 and some their 90’s and the only thing that they had in common is they never rode bicycles. Is there some special lifestyle change that would assure good health and long life? Again, I wish it were true. Statistically your health and life span is not dependent on your lifestyle except those who have genetic diseases like diabetes that require specific diets and lifestyle changes to minimize the symptoms and slow progression of their disease. Ironically it is often the very fact that diet and lifestyle changes for people with diabetes that makes people think it will benefit healthy people. After all if limiting sugar consumption can reduce the symptoms of diabetes, gee, it will work wonders for healthy people, right! Most of what we believe is true about diet and lifestyle is merely bias and superstition. My grandmother told me when I was a little child not to eat salt because it would give me high blood pressure. She knew just enough to jump to the wrong conclusion. Here advice was actually back-assward. The truth is if you are genetically predisposed to get high blood pressure from salt then eating excess salt will indeed result in high blood pressure. However if you are not predisposed to high blood pressure because of excess salt then the excess salt will not affect you. Superstition (often known as old wives tales) is usually wrong but the result of some small often unknown truth.

    • Your relatives didn’t grow up with a sedentary lifestyle eating foods full of toxic chemicals.

      • R. de Haan says:

        That’s BS Steven.
        Our foods today meet incredibly high standards and most of it is perfectly safe.
        Some people like it fat and sweet and lack any restriction in the size of the portions but
        to suggest that food in the past was free of toxic chemicals is not correct.

        I only have to point at the massive use of mercury in the potato industry and the incredible high rates of food poisoning due to fungal infestations and bacterial contamination of food products to debunk such a claim.

        As for “sedentary” lifestyles I can tell you this. Family members of mine were stuck in german slammers during the war, not because they were jews but they continued to escape the work camps. They were starved, abused, sprinkled with DDT to kill the lice and the flees when they came out and my grandmother worked years producing latex gloves standing over a bath filled with toxic chemicals without any protection.

        My grandfather, after his “German adventures” built a steel mill and I can tell you that there are healthier places to live. The strawberry fields in the vicinity of the mill produced strawberries that were black, just like the spinnach and the cauliflower. Hanging the laundry outside to dry was impossible because a white sheets turned black in minutes.
        The cows on the land near the plant must have produced milk that was contaminated with heavy metals as they grazed the fields near the mill in summer and ate the the hay in store during the winter. We never will know how contaminated the milk was because it was never measured and nobody thought about it at that time.

        This all changed in the Seventies. We have seen the clean up of our industrial society, the filters, scrubbers and catalysts placed in the smoke stacks cleaning our air. The introduction of water process plants providing clean surface water, all long before the general public went hysterical about the use of coal and oil and the use of chemicals in agriculture.

        I don’t claim we live in a perfect world today but food safety and sedentary life styles are the least of our problems.

        Statistics show our average life expectation is only rising.

        I know it’s hard to remain objective but please try because remarks like this have no merit and they make you sound like a micro biotic health freak which I am sure you’re not.

        • Most food being sold these days is complete crap, unfit for human consumption.

          When I was a child there were almost no obese people.

        • John B., M.D. says:

          Geez, take a breath.

          Both you and Steve have said things that have merit. This is not an all-or-none deal. Healthy lifestyle is important, so is a relatively healthy food supply, and decreased infectious illnesses due to vaccines, better sewage, water purification, etc.

          Medical advances have improved quality and quantity of life, though often can be expensive or have side effects and unintended consequences. Maintain a healthy lifestyle, and you reduce your chances of needing medical care prematurely.

        • Ben says:

          Objective link below.

          Obesity is due to one or more: genes, metabolism, behavior, environment, culture, and socioeconomic status.

          Off topic: Brian Oldfield was an extremely fit but overweight athlete from the 1970s. I watched him smoke a field of professional competitors, some half his weight, in the 100 yard dash. It was hard to believe and process what I saw. Brian is still alive and well

          Off topic #2: Jim Fixx was one of the healthiest people I ever met, the author of the “Complete Book of Running”. He died at the age of 52. Kenneth Cooper concluded he was genetically predisposed.

    • Diabetes and heart disease are major contributors to early deaths. Exercise can significantly reduce risk factors here. It may not protect you from certain types of cancers, though. Or getting run over when you cross the road.

  8. Gamecock says:

    “Obesity is due to one or more: genes, metabolism, behavior, environment, culture, and socioeconomic status.”

    NFW. It is caused by eating too much.

  9. GoneWithTheWind says:

    Obesity is genetic, you get it from your parents and you don’t “catch” it in a fast food restaurant.

    We all believe there were no fat people 50-100 years ago. After all we had to work and that kept us slim and trim. In the 60’s I lived in Germany where most of the “house frau’s” rode bikes. My god it was scary to watch a 300 lb German middle aged woman ride her bike to work. The same kind of work that supposedly kept us all slim. But even back in the good old US of A people got fat. Are their more fat people in the U.S. today then there was 50 years ago? Well, yes and no! First the goal posts were moved in 1998 such that overnight with the new metric (BMI greater then 30) the number of obese doubled. No one was any fatter but the new measurement doubled the numbers of obese people. Secondly blacks and Hispanics are genetically more likely to be overweight then whites. Today there are a lot more blacks and Hispanics in the U.S. which have indeed increased the rate of obesity. But this is a false or incorrect interpretation of the data. That is blacks and Hispanics are just as likely to be obese as they were in the 50’s and whites are no more likely to be obese but yet with the new population the numbers have increased. An uncritical look would allow the assumption we are all more obese. These two factors are the primary reason the data on obesity seems to have changed so much.

    Will riding a bike or getting other exercise improve your health or allow you to live longer? Well again, yes and no! If you have one of the genetic diseases such as diabetes or obesity then indeed exercise and other lifestyle changes will improve your health and may allow you to live longer. However if you do not have these genetic problems there is no evidence that exercise or diet or lifestyle changes will make you healthier or live longer. It would be great if it were true but the sad fact is you will probably die around the age your parents died unless you do something stupid.

    Is most food sold these days complete crap? Well I would argue that the propaganda around organic foods or Whole Foods is complete crap but for the most part food is food. As long as you get the MDR of vitamins, minerals etc, it really doesn’t matter if you get it from McDonalds or Whole Foods. Your body digests the food and once it leaves your small intestines your body doesn’t know if you paid 4 times as much for your carbs at Whole Foods or got something that actually tasted good at McDonalds. It is all broken down into the basic elements of food and your body uses it without the biases and propaganda your mind embraces. In the end it is all just food. Sure you don’t want to eat mostly fat or mostly protein or mostly carbs, but then that brings us to the only logical and useful diet advice which is to eat a diverse diet and avoid fad diets. And, really, if you want to buy your food at Whole foods and you can afford the markup I support that. But do not try to tell everyone that somehow because you buy at whole foods you will be “saved” and never get cancer or diabetes.

  10. Gamecock says:

    Obesity is genetic.

    People with my genes (aka – the skinny gene), when our pants start getting tight, we think, “My pants are getting tight. I need to start eating less.”

    People with the obesity gene, when their pants start getting tight, think, “My pants are getting tight. I need to go to the store and buy bigger pants.”

    • GoneWithTheWind says:

      You got it right. Even though I sense a little sarcasm you got it right. I too have the skinny gene (or probably more accurately the normal weight gene). I couldn’t become obese no matter how much I ate. I can’t do it. My sister in law has the obesity gene. She once lost 100 lbs over 1 year using Jenny Craig. But she has gained it all back and more at around 350 lbs and 5’2″ she is obviously obese. She can’t lose it. She diets, she anguishes, she hates it, she can’t lose it. (yes she did well under Jenny Craig but essentially it is a unsustainable diet and even after losing 100 lbs she was still grossly obese). Do you really think she wants to be obese and if she just ate a little less she would be slim and svelte? Her mother was obese, her sister is obese and 3 of her 4 children are obese. Obesity is a curse to assume that obese people simply accept it or prefer chocolates to being thin is naïve. She could not become thin (or even normal to overweight) if she had to and I couldn’t become obese no matter what I eat. It is not McDonalds fault it is our parents fault.

      • Gamecock says:

        Show me someone with genes that allow them to eat nothing and not lose weight.

        • GoneWithTheWind says:

          You miss the point entirely. Anyone can be starved to death Hitler proved that. But not everyone is the same. It is rare that you will find someone struggling with obesity and has been for many years who will say they can beat this problem anytime they choose to stop over eating. Even the need to overeat can be genetic for an obese person. It is what created survivors for thousands of years before we developed adequate farming and food preserving systems. It is genetic and those with skinny genes were weeded out in the many famines humans have endured.

        • Gamecock says:

          No, I got your point quite clearly: “My sister in law has the obesity gene. She once lost 100 lbs over 1 year using Jenny Craig.” If she controls what she eats, such as by using Jenny Craig, she will lose weight. YOU TOLD US SO.

        • GoneWithTheWind says:

          Absolutely true and if she eats normal food like you or I she will be back up to 350 lbs. The Jenny Craig diet is not sustainable it is a temporary treatment of the symptoms of a serious problem. I would be more inclined to recommend the Jenny Craig diet for someone who is 30-50 lbs overweight then for someone 230 lbs overweight.

        • In the English countryside most people are overweight. But in London very few people are. It isn’t the genes.

        • GoneWithTheWind says:

          Where are the young hip people? Young people are generally thinner then they will be when they pass middle age. Everyone can gain or lose a few pounds. Even though my weight is about where it should be if I were to enter the dating scene and wanted to wear the latest clothes I might want to loose 10-15 lbs. If on the other hand I lived in the countryside, happily married and happy with my lifestyle and no one to impress I might just eat that extra helping of fish and chips. But I still couldn’t eat myself into obesity.

      • John B., M.D. says:

        For many obese patients, blaming genetics is a way for them to absolve themselves of personal responsibility, which prevents them from making lifestyle modifications.

        I forgot to mention earlier that the mother’s dietary habits and weight changes during pregnancy also influence the developing fetus in utero, including a predisposition to be IBW (ideal body weight), underweight, or overweight.

        There are also clearly psychological disorders or symptoms (e.g. comfort eating) that increase obesity. And yes, these psych issues have both genetic and environmental components.

        • GoneWithTheWind says:

          There is a very real difference between “blaming genetics” and actually understanding the genetic predisposition to become obese. I have never meet an obese person who was happy being obese. Most would sell their soul to have a normal life. All have tried dieting and many have spent their life dieting. And all of them wish it were as easy as just eating “normally”. The problem for those of us who are not obese is we simply do not know what we do not know. We think because we are lucky enough to have a more normal body and genes that we are somehow better then an obese person. That is why you hear comments about them over eating or just sitting around. I happen to not like cigarettes or alcohol. And it’s true I cannot understand why anyone would smoke or drink. But I can assure you that millions and millions of smokers wish they could quit, ditto for drinkers. Should I act all superior because I don’t have that problem? Hell, I can’t even understand the problem because smoking stinks and alcohol doesn’t appeal to me. But I do recognize that for people who are hooked on these things the problem is indeed real.

    • John B., M.D. says:

      Obesity etiology is genetic + lifestyle + side effects of certain medications. Basal metabolic rate is genetic + lifestyle. Exercise increases metabolic rate both at rest and during exercise. Socioeconomic status influences lifestyle (diet & exercise). Metabolism slows with age. There are many genes that regulate energy balance (appetite, metabolic rate, athleticism, energy storage as fat, etc.).

      The same genes that conferred a survival advantage for humans when food was scarce are making people fat now.

      You cannot change your genetics, but you can change your lifestyle. This is more difficult for some than others.

      I’ve been athletic since learned to swim at age 2. Running has been my main sport for the last 16 years (I’m 44 now) and have also done triathlons. As I get older, I need to watch what I eat no matter how much I exercise. Both parents were near ideal body weight, so my genetics are fine. But I could easily get fat if I am not disciplined about diet and exercise. A few years ago I peaked at about 170 lbs (height 5’7″), but cracked down and now I’m around 152 lbs. I’d like to be 148 lbs, but below that I get weak with diminished exercise tolerance.

      Take home message: you are stuck with your genes, but you can make choices to lead a healthy lifestyle or not. Both determine if you will be obese or ideal body weight. Irrespective of BMI, if you can pinch more than an inch of body fat around your waist, you are above ideal body weight.

      • GoneWithTheWind says:

        “if you can pinch more than an inch of body fat around your waist, you are above ideal body weight.” Doctor heal yourself. Your own BMI based on what you wrote is too low and for you to want to get it lower makes me wonder if you have a little problem. The simple fact is no one knows what the ideal body weight is. Some would have you believe that it is a BMI below 25. But there is something called the obesity paradox (an unfortunate name) that where they discovered that the empirical evidence shows that the ideal BMI is 27.5 and below or above that health and risk of death increases equally with each incremental BMI change. That is a BMI of 32.5 is as healthy as a BMI of 22.5, etc.

        The BMI is a very poor measure of health as it relates to body weight. The measure itself is arbitrary and the decision of what BMI number is good or bad is subjective at best. Most athletes with the exception of distance running would be considered overweight to obese and most porn stars and other desirable women are as well. For example Mariah Carey is obese based on the BMI scale. But based on my scale she is just right.

        • John B., M.D. says:

          Obviously, we take a person’s athleticism into consideration when interpreting a person’s BMI.
          Athletes (and especially weightlifters) are only a small percentage of the adult population. BMI is a simple practical prognostic measure for the vast majority of people when advising about healthy lifestyle.

          The “pinch more than an inch” rule-of-thumb is suitable for everyone (I can’t think of an exception at the moment). Measuring body fat percentage would be ideal but that involves equipment and time and I find it adds very little information to BMI or “pinching an inch.”

          We also take a person’s medical history into account. When discussing the so-called “obesity paradox” (also known as a J-curve), don’t confuse correlation with cause-and-effect. It isn’t a paradox at all. Smoking, metastatic cancer, etc., tend to cause weight loss. So, if someone achieved IBW due to disease, that is bad. And at that point, the physician is not going to discuss BMI with the patient. BMI is important when discussing preventive health care – i.e. keeping BMI under 25 reduces the risk of multiple illnesses years and decades later. Yes, the cut-off is arbitrary, but disease risk starts increasing exponentially higher than a BMI in the low 20s (not 27.5).

          “Doctor heal yourself. Your own BMI based on what you wrote is too low and for you to want to get it lower makes me wonder if you have a little problem.” – Why is my BMI of around 23 as a distance runner too low? A good rule of thumb is to take into account the history and physical exam of the patient before forming your assessment and plan. I am in excellent health and can outrun 85% of MARATHONERS half my age.

          “… they discovered that the empirical evidence shows that the ideal BMI is 27.5 and below.” – Who is “they”? Cite your peer-reviewed reference.

          I leave you with some reading material (I am most familiar with NEJM as I have been a subscriber for 2 decades):

        • GoneWithTheWind says:

          As a runner or a rock climber your weight may help you. But your desire to lose even more weight says something that you should consider. You are too thin now and to want to be thinner you may have some issues going on more then your running.

          BMI is a totally made up metric with no basis in health research or logic. It is meaningless unless you actually try to use it to measure health or weight and then it becomes worse then useless. It makes shorter people appear to be overweight and taller people able to carry more weight and still keep a decent BMI. The selection of BMI of 25 is laughable because if this median number had any value it would undoubtedly not be a nice round whole number, it would be 25.17 or 27.5. And People with a BMI in the mid 20’s and lower look sick, emaciated, even like near death. Why would someone consciously choose to look like twiggy.

          “if you can pinch more than an inch of body fat around your waist, you are above ideal body weight.” Why? Why not 3/4 of an inch or an inch and 1/4? Why not an inch and a 1/2? The reason is that too is a made up phrase that someone felt needed to rhyme even more then it needed to be correct. SO tell me if I can pinch an inch and 1/4 how much sooner will I die then someone who can only pinch 3/4 of an inch? Will I get cancer for sure or do I need to be able to pinch an inch and 1/2? The simple fact is no one knows and most if not all of the hype around this is bias. It is reasonable and believable and you could probably get a room full of people to agree with it but in fact it is pure urban myth.

        • John B., M.D. says:

          Thanks for the advice, but a desire to lose of 2-4 more pounds and no history of distorted body image hardly constitutes a problem.

          Yes, “pinch more than an inch” is arbitrary, but medicine is an art not an exact science.

          Please consider read the links I provided elsewhere – that is as objective as I can get.

      • Gamecock says:

        “You cannot change your genetics, but you can change your lifestyle. This is more difficult for some than others.” These are fighting words. You diminish my accomplishment. IT’S DIFFICULT FOR EVERYONE. Those who choose to do what it takes to stay in shape don’t do it because it’s easy for them. They make the decision that they will do what it takes to stay in shape, whatever it takes. I work damn hard to stay in shape, and suggesting its easy is an insult.

        It’s like obesity. I could choose to value food more than fitness. I could eat myself obese. If someone were to suggest it’s easy for me, I’d be furious. I get just as hungry as everyone else. I like food as much as anyone else.

        • John B., M.D. says:

          “You cannot change your genetics, but you can change your lifestyle. This is more difficult for some than others.”
          I stand by my remark. Aren’t you just a wee bit defensive? If I say, “This is easy for everyone,” it insults those for whom it is difficult. If I say, “This is difficult for everyone,” it would not be a true statement. I used a relative scale, and left open all possibilities for all readers.

          And no, in my experience, some people find it easy, and others (especially those who never exercised in their entire life) find it impossible. For me personally, it is fairly easy, but getting more difficult as I get older.

          I tried in my numerous comments in this thread to provide useful information for a broad audience. It is not my intention to insult anyone personally. I am happy you work hard at staying healthy – that is a lot more than most people can say.

  11. GoneWithTheWind says:

    Regarding the reference:

    I think what is happening is that the science is confused with a chicken and egg riddle. Which came first the diabetes or the obesity? The chart is backwards it should reflect that if you have diabetes you are far more likely to be obese. At least that is the experience of the health community in the West. If you looked at all of the people from indigenous backgrounds you would find a high rate of both diabetes and obesity. Which caused which? The two often go together but did becoming obese cause diabetes or are they simply part of the same illness. Diabetes may well be a common genetic illness that in a culture that had to work hard to survive and ate basic low nutrient foods flourished. That is since the worst effects of diabetes was kept at bay by the exercise and diet of a indigenous culture the trait was passed on. When humans moved from the stone age to the farming culture and the food was better and the level of work, while still high, was less then diabetes would kill off some people before they reproduced. But to the Western mind where most Europeans do not have diabetes and in general do not have a genetic predisposition for obesity it was easy to believe that when you found someone with both diabetes and obesity that the obesity caused the diabetes rather then the more likely conclusion that obesity was one of the symptoms of diabetes. The rate of Diabetes is much higher in native cultures as is the rate of obesity. Which came first? Which one causes the other? I am saying we have it bass-ackwards. Obesity doesn’t cause diabetes it is merely one of the symptoms.

    Having said that I will throw a monkey wrench into it; most of the aboriginal Australians are diabetic but obesity is rare. Probably due to the fact the ancestors of all the present day aboriginals were a very small gene pool and the diabetes gene was passed down to most if not all of the descendants of this small group of original Australian immigrants.

  12. R. de Haan says:

    When I grew up, only tea, milk, coffee, water and lemonade concentrate was available.
    We had great bread with cheese, ham, or peanut butter and eggs. No sweet stuff.
    The evening meals: cooked potato’s, meat and big portions of vegetables and fresh salads.
    Apples, oranges, peaches and carrots and that was it.
    No snacks, no fast food, no pizza’s, no convenience food from the fridge.

    The vegetables, potatoes and the fruits came from the garden.

    Today we have entire generations growing up on Pepsi or Coke fast- and convenience food, oven or microwave meals.

    I never eat that stuff.

    When I was in the US recently, I was flabbergasted by the size of the portions served in the restaurants.
    They really are incredible. You order an orange juice and they serve you almost a liter of the stuff, not in a glass but a vase I use at home to put flowers in.
    You order a plate and you get food for an entire family.

    So it’s the type of food, the sweet beverages and most important the quantities served and consumed. Besides that we have this cult of snacks, the chcolate bars, the ice cream, you name it. People eat all day now.

    Loose your sweet tooth, stay away from the snacks, fast- and convenience foods and cook your own meals with fresh ingredients and you’re fine.

    • GoneWithTheWind says:

      Again it is an easy conclusion to jump to. It sounds logical, it appeals to our biases that we had from our youth. But it is simply not true. If it was the “bad” food (whatever that is) then we would all be obese. Next time you are in the U.S. go to a fast food restaurant like McDonalds near a high school at lunch time. You will find numerous girls and boys 16-18 years old eating fast food. Go there everyday and you will see more of them and the same ones as well. But you will also see that they are slim to normal weight. But how can that be if the meme is that fast foods and sodas make you obese? These kids clearly didn’t get the meme memo and aren’t cooperating. The claims are that 20% (some say more) of Americans are obese and so it must be the food. But that also means 80% are not obese and we all pretty much eat the same food. The evidence is overwhelming (using that logic) that the food keeps 80% of us from being obese.
      Then too obesity among black and Hispanic women is twice the rate of obesity in women of European origin. Oddly, those rates pretty much hold true when you go back to the country of origin for those races. Why? If it is the food and we all eat the same food why do the black and Hispanics get obese at twice the rate of people of European origin? If it is the food then why do blacks in Africa become obese at pretty much the same rate as blacks in the U.S.? Ditto for Hispanics in their country of origin vs the U.S. The answer is staring you in the face, it is genetic.

      • In ten years those kids will be severely overweight, like almost all adults who eat fast food..

        • GoneWithTheWind says:

          About 40% of the girls will be overweight by the time they are 40 and about 25% of the boys will be as well. But the paradox is many will not be overweight even though they eat the same food. Ironically some large percentage of these youth will also buy into the “good food, bad food” meme and spend money and effort to only eat the “good” foods but they will pretty much experience the same health outcomes as those who do not shop at Whole Foods or Trader Joe’s. I sincerely wish there was some “magic” food we could eat and live longer healthier lives but there is not. What there is, is grifters selling snake oil either in books or the organic stores. They need to make us believe that there is a “magic” food and they are selling it for a mere 400% markup. Others sell massive doses of vitamins or “essential” oils. It’s all the same game. People used to be tarred and feathered for this and today it is sanctioned by the government. I have to go start dinner now; some brown rice cooked in bottled water, vegetables from the organic farmers market and wild salmon. Actually I’m having my favorite comfort food. Homemade Boston baked beans and hot dogs. Yes, that’s the truth, I grew up in Boston in the 40’s and 50’s and it is my favorite meal.

  13. John B., M.D. says:

    GoneWithTheWind –
    Are you overweight? What are your diet and exercise habits? What is your educational background? Do you have any medical training? Dietitian training? Scientific training? Reading your comments gives me the impression of someone untrained who has gotten their info from websites written for lay persons. You seem to have an odd set of facts, facts in the wrong context, misinformation, opinion, and some type of personal agenda all rolled into one. You appear to argue just to be contrarian. I have no idea where you are coming from.

    That’s just my impression.

  14. GoneWithTheWind says:

    205 lbs and 6’2″ and I am 70 years old. Diet? I eat everything. I even have what I call “forth meal” around 8 pm where I eat chocolate, chips, peanut butter (chunky), nuts, dried fruit or whatever junk food I have lying around, and yes, I’m serious. BS in Computer Science and MBA in Information Systems. Yes indeed I am one of those “lay persons” who has exercised all his life and food and cooking is my hobby. I too, when I was much younger (actually around your age) was sucked into thinking there were good foods and bad foods, that extra vitamins would make me extra healthy and that the food nuts that wrote books and gave out free advice knew something useful but they were really simply sharing their biases. Indeed if you have an illness that requires a special diet then by all means follow it. If you do not then eat a diverse diet, one that doesn’t omit specific foods or food groups or follow fads and you will be eating well. The problem isn’t my “odd set of facts” it is that you disagree with them and you learned the truth in college at your professors knee so you must be right and anyone disagreeing must be wrong. Argue just to be a contrarian? Au contraire mon frère, there are certain things that interest me and food and diet is one of them, The field is full of BS, bias, propaganda and misinformation. I enjoy a healthy discussion with the hope of exposing the truth. I do not care where the truth is, yours or mine, the reward is in the learning.
    Where I am coming from: 1. Diabetes is an inherited disease it is not “caused” by what you eat. 2.There is no miracle food and conversely there is no “bad” food. It is all just food, don’t eat too much of any one thing or food group and don’t avoid foods out of superstition or advice from quacks. 3: Obesity (real obesity) is genetic, pure and simple. A normal person can no more become obese then they can change their eye color. 4. Fast food is not “bad” for you and organic food is not “good” for you it is simply food. Make sure nothing harmful is added and that it is prepared properly and food will not hurt you. 5. I believe drugs, booze and cigarettes are a far worse health hazard then McDonalds or refined flour and sugar.

    • John B., M.D. says:

      I appreciate your feedback. I asked you about your educational background not to diss you, but rather to gain a sense of how I could approach you with some feedback of my own. I disagree with some of your points, though not all. Perhaps I can put things in perspective.

      Your comment, “you learned the truth in college at your professors knee so you must be right and anyone disagreeing must be wrong,” presumes too much. I learned some nutrition and etiology and pathophysiology of obesity in medical school, but for two decades have kept up with the medical literature. I recently got out of practice as a Family Medicine physician and am now looking to do something less stressful. I spend 3-4 hours per week reading my New England Journal of Medicine, as well as a host of medical literature reviews sent to me via emails. And I am not only a climate change skeptic, but also a science skeptic in general. “Trust, but verify.” Early in my career, I got suckered by drug reps selling certain medications, only to find out later the companies hid or spun their data in their financial best interest rather than the patient’s best interest. I am careful to assess if a study has been paid for by Big Pharma or if the researchers are more independent.

      There are many determinants of obesity besides genetics (which does have a huge role in determining weight and energy balance). Environment and lifestyle play a role. I think this link summarizes many things I would agree with:

      I think you would agree with me that genetics play a major role in determining one’s body weight set point:
      But let me make up an example that shows how environment can cause obesity. Suppose you have an athlete at ideal body weight who then has an injury and can no longer exercise. He may get depressed over this, and do some comfort eating, and gain fat weight. Had the injury not occurred, this wouldn’t have happened. Or suppose you acquire a medical condition that requires the use of corticosteroids, and you get fat. My main point is that there are numerous factors that determine energy balance besides genetics.

      BMI is one way to determine obesity, but doesn’t correct for muscle mass (e.g. in an athlete, or at the other extreme, in a bedridden person who has lost muscle mass). Measuring body fat percentage, and establishing healthy normal ranges based on age and sex is one method, but cumbersome and involves specialized training and/or special equipment to measure. Measuring waist circumference is another simple and cheap way to document obesity. It is more formal than my quick and dirty “If you can pinch more than an inch, you should try to lose some weight, irrespective of your BMI and frame size.” However, in my experience, measuring waist circumference rarely influenced my diet and exercise advice for patients. I could take their history and physical and labs and base my advice on that. Part of me thinks that the main use of waist circumference and BMI is for the powers at be to collect population data for analysis.

      Let me make a quick comment about the food pyramid.
      I always hated it. I modified the bottom section that tells people to eat a lot of carbs, and made the pyramid turn into a diamond. Alternatively, can put fresh fruit and veggies on the bottom, since it is near impossible to eat too many kcal by only eating these.

      Another comment to follow below…

      • GoneWithTheWind says:

        “BMI is one way to determine obesity”. But it is inaccurate and unfairly penalized shorter people, muscular or fit people. Looking at the BMI metric for obesity (a BMI above 30) I suspect someone decided quite arbitrarily to stick their finger in the eye of people who are overweight. Let me state clearly that most people who have a BMI of 30 are not obese. While we may not be able to agree on what “obese” is I doubt anyone would disagree that a woman who weighed 350 lbs at 5’2” is obese. On the other hand not everyone would agree that a woman 5’2” weighing 165 lbs is obese. In fact depending on age, distribution of weight and condition that 5’2” woman just might be the most sensual woman you ever met. AND that is NOT the opinion you would have of the 350 lb woman. But yet, both are obese under the BMI measurement. A similar argument could be made about a 5’8” man weighing 350 lbs vs a 5’8” man weighing 200 lbs. If the second man is a weightlifter/body builder it is likely no one would think “obesity” the first time they saw him in a body building competition. So where exactly did these arbitrary cutoff BMI metrics come from? Was there some sort of bias or was it based on science and real life observations? When the U.S. government brought U.S. definitions into line with World Health Organization guidelines, 29 million Americans went overnight from a healthy BMI to overweight. Clearly the BMI categories are arbitrary, inaccurate and reflect a bias. A recent study found “obesity-mortality paradox” as another example of the limitations of BMI. An estimated 24 percent of U.S. adults with normal BMI are “metabolically unhealthy” – bad readings on blood pressure, insulin, cholesterol. Conversely, 10 percent with obese BMI are metabolically healthy.

        Regarding your comments about the food pyramid “I modified the bottom section that tells people to eat a lot of carbs, and made the pyramid turn into a diamond.” By that comment you have confirmed my suspicion that you are a food faddist. Come on! Let’s here it. What is your bias? A vegetarian diet? Mediterranean diet? Paleo diet?

        • John B., M.D. says:

          Your mind is closed. You are stuck on your same talking points. It doesn’t matter what medical literature I cite. I try to teach and respectfully engage in discussion, and you throw it back in my face. I discuss the limitations of using BMI as a metric for muscular or cachectic people, and you go on a BMI tirade, not even listening to my caveats. And you don’t even have a definition or measure for obesity. It is your right to be stubborn. It doesn’t affect me or my health.

          I don’t believe in any particular diet. It is rather lame of you to suspect evil motives or an agenda on my part. Take a breath. My criticism of the food pyramid was that it overemphasized carbs (perhaps because of the agricultural industry lobby). Fruits and veggies are the healthiest. Nuts, whole grains, some diary also good. Don’t eat too much carbs or fat. I eat all types of meat, but don’t seek it out. I like sweets, but I don’t distinguish between sugar (50% glucose, 50% fructose) and high-fructose corn syrup (55% fructose, 45% glucose, and the body can interconvert these anyway). Overall, keep total kcal intake under control. I do consider myself to be in pretty good shape, having broken 3 hours in the marathon twice (2:59 both times), though am slower now. I’m in excellent health, on no medications. Yes, lifestyle is important in addition to genetics.

        • GoneWithTheWind says:

          I was responding to your comments if that is a BMI tirade then so be it. My mind isn’t closed but I certainly have an opinion on some of these issues. In a debate or discussion it is my job to state my position and reasons for my position if that looks to you like a closed mind I can’t help that. It was not my intent to offer any offense and I take no offense by your strong expression of your opinions. I wish you the best.

    • John B., M.D. says:

      Let me offer my opinion on your concluding points. I will be careful not to conflate obesity with other diseases associated with obesity.

      1. “Diabetes is an inherited disease it is not “caused” by what you eat.”
      First, let us restrict our discussion to Type II diabetes, the one associated with obesity. Diabetes etiology is multifactorial. Certainly, diabetes risk is higher the more you eat and the more obese you get. But given the same weight, does the type of food influence diabetes risk? Here are examples of how food choice can influence diabetes risk:
      Also, please be aware that there is no single “diabetes gene.” Diabetes is polygenic, rather than having simple Mendelian inheritance.

      2. “There is no miracle food and conversely there is no “bad” food. It is all just food, don’t eat too much of any one thing or food group and don’t avoid foods out of superstition or advice from quacks.”
      I partially agree. Things are not black and white, nor are all foods the same shade of gray. I can agree with “all things in moderation” only to a point. For example, trans fats are pro-atherogenic: I am sorry this review article from 2006 is behind a pay wall, but here are some excerpts (the numbers indicate the cited reference):

      “Recent evidence indicates that trans fats promote inflammation. In women, greater intake of trans fatty acids was associated with increased activity of the tumor necrosis factor (TNF) system; among those with a higher body-mass index, greater intake of trans fatty acids was also associated with increased levels of interleukin-6 and C-reactive protein.24 In a study of overweight women, greater intake of trans fat was again associated with increased activity of the TNF system and increased levels of interleukin-6 and C-reactive protein.25 In patients with established heart disease, membrane levels of trans fatty acids (a biomarker of the dietary intake of trans fats) were independently associated with activation of systemic inflammatory responses, including substantially increased levels of interleukin-6, TNF-α, TNF receptors, and monocyte chemoattractant protein 1.”


      “Several studies suggest that trans fats cause endothelial dysfunction. After adjustment for other risk factors, greater intake of trans fatty acids was associated with increased levels of several markers of endothelial dysfunction, including soluble intercellular adhesion molecule 1, soluble vascular-cell adhesion molecule 1, and E-selectin.25 This observed increase in E-selectin levels was similar to findings in a randomized trial when oleic acid or carbohydrate was replaced isocalorically with trans fat.28 In another trial, consumption of trans fatty acids impaired endothelial function, as reflected by a reduction in brachial artery flow-mediated vasodilatation by 29 percent, as compared with intake of saturated fat.34”


      “On a per-calorie basis, trans fats appear to increase the risk of CHD more than any other macronutrient, conferring a substantially increased risk at low levels of consumption (1 to 3 percent of total energy intake).22,53-55 In a meta-analysis of four prospective cohort studies involving nearly 140,000 subjects,53-56 including updated analyses from the two largest studies, a 2 percent increase in energy intake from trans fatty acids was associated with a 23 percent increase in the incidence of CHD (pooled relative risk, 1.23; 95 percent confidence interval, 1.11 to 1.37; P<0.001)."

      3. "Obesity (real obesity) is genetic, pure and simple. A normal person can no more become obese then they can change their eye color.
      As per my earlier comment, I would say that the eitiology of obesity, as are practically all ilnesses, related to a combination of genetics plus environment, lifestyle, other illnesses, medications, etc.

      4. "Fast food is not “bad” for you and organic food is not “good” for you it is simply food. Make sure nothing harmful is added and that it is prepared properly and food will not hurt you."

      Well, there are healthy fast foods and unhealthy fast foods. Saturated and trans fats are pro-atherogenic. Aside from the kcal, deep-fried foods are cooked at higher temperatures than, say, microvaved or boiled. These high temperatures can modify food at the molecular level by changing their ultrastructure (e.g. denature proteins – we call this cooking) as well as cause chemical reactions to form different molecules which can then interact with cellular receptors differently than food not cooked in this fashion. I would tend to agree that the purported benefits of "organic" food are overblown, based on the limited medical literature I have seen on the topic.

      5. "I believe drugs, booze and cigarettes are a far worse health hazard then McDonalds or refined flour and sugar."

      Well, this is difficult to quantify. Does one pack of cigarettes equal one Big Mac with medium fries? There is no healthy cigarette dose. There is good evidence one alcoholic drink (12 oz beer, 5 oz wine, 1 ox shot) consumed per day reduces cardiovascular risk. The harm from drugs would be physical but more importantly psychological. Some refined flour and sugar in the diet, so long as total caloric intake is not so high that you get obese from it, is not as bad as smoking a pack a day.

      If you have some specific questions, if I have time I'll try to find some literature for you. Here is one place to look:
      You might find it more informative and less biased/censored than other blogs and websites who may have their agendas.

      • John B., M.D. says:

        Clarification: “CHD” = coronary heart disease.

      • GoneWithTheWind says:

        1. Diabetes is genetic. The problem that science and health care workers have understanding this is they in general point to the symptoms as the disease. We treat the disease to minimize and mitigate the symptoms. In general we cannot cure the disease but we can reduce the worst symptoms and long term effects of the disease. Diabetes also has the distinction of having various levels of symptoms. That is some diabetics can treat their disease with diet and exercise while others must treat it with insulin and constant monitoring. Some diabetics develop very serious and severe symptoms very early and others develop those symptoms late in life or not at all. So although we lump all the type II diabetics together they are not all alike and we do not know why. Another problem this diversity of symptoms creates for us is that about half of the people with diabetes are not diagnosed. At some point the symptoms become serious enough to be obvious to the doctor or the individual and they are deemed to have “caught” the disease and the search begins for a cause. Often this disease is discovered in the patients 20’s to 30’s and the person has gained weight or has a sedentary lifestyle and viola we declare THAT to be the cause. But in fact they had the disease from birth and it was only as they aged and their lifestyle began to be less effective in limiting their symptoms that we discover the disease. So it is easy to see why professional and lay person alike jump to the conclusion that diabetes is caused by lifestyle and equally easy to understand that enormous leap of faith that makes these same professionals and lay people think that EVERYONE would benefit from the same lifestyle and diet that is so essential to the diabetic. It seems logical, it is certainly seductive but it is simply incorrect.

        2. Ahh! Trans fats. OK I’ll bite. Where’s the proof. If I consume trans fats (and I do) when will I die and from what, exactly? But you can’t tell me and you can’t point to any otherwise healthy person who passed away suddenly from trans fats. It is a theory and like so many of the theories about food and supplements etc. it has some basis in fact or logic. Something you can wrap your mind around and conclude that trans fats are bad for you. Show me the body count. All the dead people who consumed trans fats.

        3. Obesity, what I call real obesity not just a BMI above 30, is genetic. I am a big guy and I love food. If anyone could become obese I could. I eat everything and love McDonalds (I proudly say supersize it, which usually gets me a quizzical look). I buy chocolate in bulk and when I eat it (usually about every other day) I eat about 8 ounces of it at once. I eat peanut butter out of the jar with a spoon. I can eat a full 11 oz bag of chips in one sitting. My biggest weakness is cookies which I consume in large numbers with milk until I am full. And yet my weight stays the same. In fact I weighed more in my 40’s (when I was lifting weights everyday) then it is today when I do far less. I can no more become obese then I can change my eye color.

        4. “Well, there are healthy fast foods and unhealthy fast foods.” Maybe! But all you have to support your claim is bias. You have already expressed your bias to carbs and trans fats so presumably you would agree that fast food french fries are bad. But where is the proof? How many fries can I eat before I die or “catch” diabetes? I have to tell you I love McDonalds fries and I have eaten a lot of them over my lifetime and I’m still here and still haven’t caught diabetes. Will the next order of fries break the camel’s back. Or is it really about health problems people are born with and which can be mitigated with specific diet changes. Seriously if you cannot point to specifics what you are really talking about is “faith” in a orthodoxy. I am open to discussing theory and opinion but not blindly accepting a “belief”.

        5. Yes I suspect the theory that a drink or two a day could be good for you. Alcohol is a dangerous drug it causes death destruction of families and dare I say, pregnancies. As for drugs and smoking I have a stronger negative opinion of these things then you do but otherwise we agree. But I cannot agree with you about refined flour or sugar. Yes! If that is what made you overweight then cut it back just exactly as the same advice would apply to an alcoholic. But many people can drink alcohol and not become an alcoholic and many people can eat refined carbs and not become overweight or obese. You are making the mistake of conflating the problems some people have with food to all of humanity. I fall back on my original statement: If you have a health problem that requires a specific diet then by all means follow that diet. If you do not then eat a diverse diet and avoid fad diets or choosing to not eat specific foods or food groups (for example a vegetarian).

  15. beowulftoo says:

    I got our of the Army in ’73. Weighted 175 lbs. I now weight 190. Some has been repositioned. I have more stomach now, less chest. After the Army I picked up an extra 10 lbs. After I retired I picked up the extra 5. I was very fit in ’73. I kept up the exercise until the mid ’90s. Then I went on the road as a consultant. Not much room for exercise but lots of fancy food. My sister is very obese since late teens. She is now losing some weight. I think life style plays a major role in Weight. Everyone in my mother’s family were chubby to very fat. So I am not sure genes play much of a role. (the Doctor tells me I am getting fat, and to stop doing all sorts of things: no rice, no potatoes, no white bread, no fun!

  16. John B., M.D. says:

    Steve, I’m not sure about “80% of US health care costs could be avoided by lifestyle changes,” however:

    “… four common behavioral risk factors (tobacco use, excessive alcohol consumption, poor diet, and lack of physical activity) are associated with four disease clusters (cardiovascular diseases, cancers, chronic pulmonary diseases, and diabetes) that account for about 80% of deaths from noncommunicable diseases.”

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