Genetic Predisposition to Obesity and Medicare Expenditures [pdf]

https://www.gwern.net/docs/genetics/selection/2017-wehby.pdf

by gwern • 8 years ago

47 33 8 years ago

notadoc• 8 years ago

Bad food habits, food choices, culture, and very low activity levels have far more significance to obesity than genetics. This is obvious if you just look at historical obesity rates, it was virtually non-existent a few decades ago.

But yes, the obese consume massive medical resources as any doctor or clinician will tell you. At some point you have to acknowledge this and find a way to adjust for that massive cost increase. Allow insurers to set premiums based on BMI, tax BMI, or have a tax credit for healthy BMI, tax junk food, all of the above, etc. Get creative, but you have to find a way to pay for the cost of being fat. Otherwise, obesity and the myriad related illnesses is going to bankrupt the entire US health system.

GreaterFool• 8 years ago

Also a culture of snacking and telling people they can't go hungry even for a minute.

When I was a kid (not so long ago!) I'd eat breakfast in the morning, something small like a sandwich for lunch at school and then dinner at home with the family. There was nothing in between or nothing in the house to eat in between. Leftovers from previous day maybe? Had to wait until mom prepared the dinner. No candy bars or a bags of nuts or crisps.

Now people just reach out and grab an extremely high-calorie snack at any time. It's a habit, a way of passing time.

ramblenode• 8 years ago

Individuals make an easy target because there's an easy story to tell: that they have bad habits and little willpower. The problem is that this story is incomplete.

The US, at least, is a society which actively incentivizes the preconditions for obesity. The USDA's food pyramid (and now plate) promotes a high carb inflammation diet designed for US agriculture, not citizen health. School food programs (partially based on this) are not healthy and set the stage for later dietary behavior. Grains, meats, and dairy are subsidized by the government making them artificially cheap compared to whole fruits and vegetables. Unhealthy food is enshrined in culture and pushed through advertising. Food deserts are a reality for a large portion of the population.

A better strategy would be to target the problem closer to its source. Incentivize the production of healthier crops and healthier food products. This gives consumers lots of feedback on their choices--each time they go to a supermarket or a restaurant and see prices and nutritional information--as opposed to the occasional doctor visit where they learn just how bad the situation has become.

Ultimately, it's simply unfair the way we treat the sick when we've set them up for failure. Let's create a food-to-health system rather than a system that taunts and then punishes.

tzs• 8 years ago

The general idea of broad lifestyle choices affecting insurance rates might be sound, but the specific idea of using BMI is ridiculous. It's off for tall people, short people, and very fit, athletic people (because it does not distinguish between mass from fat and mass from muscle).

likpok3• 8 years ago

Interestingly enough, I've heard that BMI mostly under-predicts problems. There are a lot more people at a higher body-fat percentage now than when BMI was developed, meaning that BMI assumes that the average person is leaner than they are.

yequalsx• 8 years ago

People are susceptible to suggestion and manipulation. As evidence consider that 40 years ago it would have been considered insane to suggest that k-12 teachers be armed. Opinions, and behaviors can be manipulated and a grand scale. Foods can be designed to increase likelihood of addiction. It is well known that everyone has a limited supply of willpower. Given all this it is not reasonable to put the blame solely on the individual.

merpnderp• 8 years ago

But 40 years before that, it wasn't uncommon or abnormal for teachers to be armed. We need to get back to whatever glued society together 40 years ago.

byproxy• 8 years ago

"It is well known that everyone has a limited supply of willpower."

Not sure about that : http://blogs.discovermagazine.com/neuroskeptic/2016/07/31/en...

but, then again.... : https://digest.bps.org.uk/2017/12/14/strongest-evidence-yet-...

bello2• 8 years ago

I agree that poor lifestyle choices should be somehow disincentivized.

Leaving aside the fact that BMI isn't a great metric (as mentioned in another comment); we can probably come up with a better one.

80% of healthcare costs are driven by 15 conditions, which in turn are mostly affected by 8 behaviors [1]. I bet that the bulk of the cost is due to completely changeable lifestyle behaviors (diet, drinking, smoking, physical activity).

Alcohol and tobacco should be more heavily taxed (fast-food is trickier, as we need to make sure that there's healthy, equally-accessible food options out there). Education around healthy lifestyle choices should be more available, as well as gym memberships/fitness equipment/trainers. Sure they do cost money, but we're already paying so much through non-preventive healthcare.

Any other ideas how to disincentivized unhealthy lifestyle choices?

[1] http://www.aon.com/attachments/human-capital-consulting/2012...

nradov2• 8 years ago

Be careful what you ask for. High taxes on alcohol would be like Prohibition "lite". Smuggling and corruption would increase. Drinkers would go blind from poorly distilled moonshine.

nradov2• 8 years ago

Under the Affordable Care Act (aka Obamacare), employers can already charge employees more for health insurance if they don't meet BMI goals or participate in a weight reduction program.

https://www.healthaffairs.org/do/10.1377/hpb20130516.373854/...

jjeaff4• 8 years ago

Bad food habits, food choices, culture, and very low activity levels

You say that as if you know for certain that none of those things are affected by genetics. Could it be that some people are genetically predisposed to higher levels of activity? It seems very likely to me that different people get varying amounts of endorphin released for similar levels of activity based on genetics.

Same goes for levels of satiation, levels of endorphin release when eating things like sugar.

I grew up in the same household, eating the same food as my brother. Why is it that he just doesn't care for sweet things, never has? And I have a massive sweet tooth. It's been the same since we were both skinny children. It's no wonder he is still skinny and I struggle with weight gain.

ggm• 8 years ago

This feels like a short footstep into bad science-policy outcome. I don't for a minute doubt the science side has good numbers for it's weighted outcome probabilities. I think its going to be widely mis-used, mis-quoted and mis-understood.

Language in this area of health is a poison pen. Intentionality (you chose to drink the coke, you own the diabetes) and de-empathising (you were born fat and poor, I don't have to help you) are the two stand outs I hear a lot from people I know in the USA who have personal struggles with health costs, and consequences and mostly have conquered them. Down here in a world of public health, the genetic exposure risk is pretty directly about aboriginal and islander communities who are drowning in fetal alcohol syndrome, early onset diabetes, other diseases. This kind of report should (I think) help, but I suspect is going to hinder as it becomes a giant baseball bat in the policy debate.

bello2• 8 years ago

the genetic exposure risk is pretty directly about aboriginal and islander communities

Is it, though? Families and communities share much more than genes with each other, including big lifestyle choices. So we can't deduce that easily that genes are to blame.

perlpimp2• 8 years ago

There has been discovered partial link between biome and obesity. Likely it is not based on single gene but rather total sum of factors.

eanzenberg2• 8 years ago

How exacty is obesity genetic when mass obesity is a recent phenomenon? Your bias shows when logic is absent.

strken• 8 years ago

Genetics and environment don't exist in isolation. As a totally made up example, maybe some people are more vulnerable to specific toxins (genetics) that are a by-product of plastic manufacturing (environment), and this causes increased appetite.

jjeaff4• 8 years ago

Simple. Some humans likely were always predisposed to obesity. But as a species, we have never had enough easy calories to get obese.

It doesn't matter if you have a genetic predisposition to alcoholism if you have never even had a chance to taste alcohol.

dilyevsky• 8 years ago

Is Americans' genetic makeup so different from the rest of the developed world? How bout West Virginians vs New Yorkers? I mean ffs WV has 38% obesity rate vs ~25 NY and they are less than 10hr drive from each one another, genetic my ass!

dmichulke• 8 years ago

After reading the first few comments two things stand out:

1. Genetic Predisposition is always a factor (basically for everything) and therefore has an impact on prices and ultimately "fairness" (whatever your definition). One can have basically the same argument about intelligence and salaries.

2. It is also never the only factor.

Once we start to acknowledge the above two facts, we can start discussing percentages

- To what extend does Generic Predisposition affect Obesity?

- What other factors exist that affect it similarly or more? (Gender, smoking, alcohol, white vs blue collar, leisure activities, marital status, salary, age ...)

Only after that we should discuss whether it's fair: It's highly unlikely that anyone is in the worst of all above categories and a simple cap on expenses (or a progressive negative tax) may help to soften the blow to those cases while still incentivizing everyone to live a healthier life.

Genetic Predisposition to Obesity and Medicare Expenditures [pdf]

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