From here
There is a problem with dietary advice in that whilst I am sure that many would agree that obesity is really bad for you and really bad for the heart there are also contradictions.
Let’s say for instance you have a heart problem, not necessarily caused by obesity. In many countries, following a stent you will be put on Warfarin for the rest of your life.
Off topic for moment, as an anticoagulent that is in many countries a no no for pilots.
Back on topic the dose of warfarin needed is checked by a regular INR test. Basically duch a blood test measures the amount of vitamin K in your body. The more vitamin K you have the higher the warfarin dose you need to take.
The problem is that vitamin K is also very good at deterring cancer..
As Brussel sprouts, broccoli, spinach are very high in vitamin K, the more you eat of such foods the more warfarin you would need to keep your arteries free.
So do we eat green vegetables to avoid cancer and die of heart disease.
Take higher doses of Warfarin (rat poison) to avoid a heart attack and give up flying
Or do we continue flying, and die of either heart attack or cancer or a mix of both?
A stent should put you on chlopidogrel for 6-12 months, which is fine for flying. Warfarin may be for a bypass.
Health advice is really hard work these days, due to general social acceptance of obesity.
Also a lot of cultures have their entire social life based around serving large quantities of stodgy food; these people have high levels of obesity as a result, and featured prominently in the “victim profile” of the epidemic. The fact that they mix closely in large numbers would not have helped, either.
gallois wrote:
you will be put on Warfarin for the rest of your life
Yes, warfarin (commonly referred to by the purpose it was originally developed for: raticide) is a problem – but with apixaban (Eliquis), Rivaroxaban (Xarelto), Dabigatran (Pradaxa) we have pretty good alternatives esp. for patients with bypass/stent and no acute AF…
gallois wrote:
There is a problem with dietary advice
Peter wrote:
Health advice is really hard work these days, due to general social acceptance of obesity.
It is – but not due to social acceptance. Problem is that effects can only be seen in mid to long term.
Humans are extremely bad at aligning their behavior based on long term effects. We do not manage to fight poverty. We do not manage to fight obesity and we do not manage to fight climate change. Al of them share the combination of longer term behavioral change with impact that only kicks in over time.
Archer-181 wrote:
What is needed is a proper study which strips out age and comorbidities. Unfortunately nobody will admit the biggest health problem in the UK is people eating a bad diet and eating too much.
Eating too much of the wrong things AND (importantly) almost complete physical inactivity. I suspect this is why the UK has fared so badly with deaths and hospitalisations with COVID compared to many other countries.
To give you an example of how inactive people generally are, our building is on an industrial estate, and if you don’t want a burger from a van from lunch, there’s a sandwich deli about 700m from our building. Nearly everyone drives those 700m. It’s ridiculous. People look at me like I’ve sprouted two heads when I politely decline a lift – it’s a pleasant walk! Especially in this weather! Not to mention it’s quicker to walk (by the time you’ve negotiated a roundabout and a junction where you don’t have the right of way, then circulated around the car park in a vain hope of finding a space, you could have walked it, got your sandwich, and be halfway back).
In the UK (and IOM) people generally have forgotten what the appendages below the waist can provide free, healthy transport. People won’t even cycle 3km to the work place for the most feeble excuses (“It’ll mess up my hair!” “What if it rains?” “There’s hills!”) despite the fact it’ll save money, help them stay healthy longer etc. Cars have made British people so incredibly wimpy. No wonder so many of us died during the COVID outbreaks.
We do not manage to fight poverty. We do not manage to fight obesity and we do not manage to fight climate change.
Well, not every challenge has a solution!
Many engineering problems have not been solved, and social science is largely intractable.
Poverty will never be solved, because wealth correlates with lots of factors, with IQ high up on the list, and nobody has yet found a way to fix that 
Climate change may never be solved. It is not even proven that the current rise in CO2 is due to human activity, let alone anyone knowing what measures will actually work or to what extent. And the field has filled up with people making a living out of it.
Obesity is probably the simplest of these to solve, but still very very hard, due to the evolutionary emotional attachment to food. On a functional MRI scan, the whole brain lights up like an xmas tree when you feed the subject a piece of fat
Re social acceptance, I don’t know about Germany, but the media here has for years been full of programmes like this which – having seen bits of it on TV – I could describe in pretty crude terms, and these drove widespread acceptance that being absolutely massive is really glamorous. Compounding this is “commercial feel good” stuff like you order a “size 8” t-shirt mail order and what arrives is actually size 12. So you squeeze yourself into this thing and message all your followers on twatter that you are now Size 8 and how wonderful this is…
In CV19 times the programme makers have had to be unbelievably careful to avoid this topic, so if someone who was say 1.7m and 150kg died of the virus, but was aged say 30 so probably not yet had the raft of medical issues which you will PROB99 get if you carry on like that into your 50s+, he/she would be described using the standard BBC journalist phrase of “had no pre-existing conditions”.
It makes me really sad to see young people trash their health in this way, because if you are like that when you are young, a) you will find it incredibly hard to get back from it (for a start, we all choose our friends, and your circle of friends will all be huge too because you will look for people who reinforce your self esteem, and if you do grab the bull by the horns and do something and lose a lot of weight, you will lose these friends) and b) you will spend the last few decades (it will be “decades” because the health system will treat you to the maximum possible extent, until you actually die) in poor health. But very little makes me as sad as seeing a child which is about 3x the size he/she should be at that age, which is in that scenario purely a result of having stupid parent(s). That kid has no chance really…
Peter wrote:
Obesity is probably the simplest of these to solve, but still very very hard, due to the evolutionary emotional attachment to food. On a functional MRI scan, the whole brain lights up like an xmas tree when you feed the subject a piece of fat
But it’s not fat that’s caused the problem, it’s an excess of refined sugar (which is found in all sorts of things you wouldn’t expect – e.g. processed meat has added sugar to make poor cuts of meat palatable).
It’s just an unfortunate accident that the word for overweight is the same as the word for the substance in English. Making “low fat foods” by replacing the fat with sugar is a “cure” worse than the disease.
A good line of attack is to eat that weird green stuff Actually a lot of it is not green; it comes in all kinds of funny colours.
alioth wrote:
But it’s not fat that’s caused the problem, it’s an excess of refined sugar
Peter wrote:
A good line of attack is to eat that weird green stuff
That is completely different discussion but one short thought: Most real life studies show that the by orders of magnitude most important effect is the bare number of calory intake – what you actually eat does not really matter. It is just that some diets make it simpler to reduce calories than others.
Reduced sugar (or low carb) diets work because people on such a diet tend to eat significantly lower numbers of calories than people w/o it. Refined sugars are not bad by nature (and do not cause diabetes as many think) but they just make it too easy to ad a couple of 100kcal to every meal that add up.
If you want to eat a daily energy of 2.000kcal by kale only, you need to eat 2kg of kale every day. Even the biggest vegan fanatics would not eat 2kg of kale a day.
Even the “You can eat what you want and as much as you want but you need to list every individual component with weight and energy content in a hand written list” is as effective as other diets.
I thought this was such a great caricature of modern commercial catering
