"Survival Of The Fattest": It's A Fat, Fat World After All

Tyler Durden's picture

Back in March, we first presented a rather stunning finding: by 2020 75% of Americans will be obese or overweight. This was promptly followed up with a post showing just how it is transpired that America became the fattest nation in the world in less than 20 years. What however may not be known, is that America's fatness epidemic is not localized to the country that gave the world the McDonalds burger (and the McMansion): it really is a fat, fat world, after all. 

Behold - survival of the fattest:

It is hardly surprising in this light, then, that the estimate for number of people living with diabetes has been increased, to 371 million - an increase of 11% over 2011.

So with the sensitive issue of what one stuffs in their mouth becoming of paramount importance, primarily due to the avalanche in social costs as a result of escalating morbid obesity, here is a primer on the key facts and figures relating to obesity, domestic as well as foreign, and impacting not just the developed world but also emerging economies, from GS' Mick Ready and Keyur Parekh.

Obesity is a unique phenomenon affecting almost all countries. It is defined as excessively high amount of body fat in relation to lean tissue, and individuals are generally considered overweight if their BMI is over 25, and clinically obese if their body mass index (BMI) is greater than 30.

The 1980s saw a sharp acceleration in BMI in OECD countries. Before 1980, global obesity rates were generally below 10% but today, in almost half of OECD countries, 50% of the population is overweight. Interestingly, data suggests that obesity is a pandemic that is now impacting not just the developed western countries, but also the emerging economies. In BRIC economies, obesity rates are somewhat lower than in their OECD counterparts, but urbanisation and lifestyle changes are driving a significant increase in average BMI. In China, the proportion of the population considered overweight increased from 13.5% in 1991 to 26.7% in 2006; in Brazil between 1975 and 2003, the obesity rate tripled in men and doubled in women; and in Russia 25% of women and 10% of men are now considered obese.

  • Data suggest that at levels of GDP below US$5,000 per capita there is a linear relationship between GDP and mean BMI, and that the only pre-condition for developing an obese population is the ability to afford food.
  • In low income countries, obese individuals are typically middle-aged women from wealthy, urban settings.
  • In countries with GDP of more than US$5,000 per capita pa, obesity is not characterized by gender, or age, but disadvantaged groups typically are at greater risk of becoming obese;
    • 33% of US adults earning over US$15,000 pa are obese, compared with 25% of those earning over US$50,000 pa.
    • 33% of adults who did not graduate high school were obese, compared with 21.5% who graduated from college.

What’s causing this increase?

Obesity is a complex problem, with multiple factors influencing its development within a population. These factors include systemic and environmental drivers, which provide an infrastructure to promote high growth, consumption of transport and recreational factors, which limit the physical activity within a population, and behavioral patterns, where individuals consume high-energy foods and lead sedentary lifestyles.

For an individual, obesity is caused by an energy imbalance: simply put, obese individuals consume more energy than they use. Energy intake is a clear factor in the rise of obesity, and dietary intake is strongly influenced by the kinds of food we eat. Changes in the food system to more mass-produced, processed foods with added salt, fats and sugars, coupled with more effective marketing of these products, especially targeting young children has changed the kind of food we eat which contributes to this energy imbalance.

To summarize, changes in the global food system, which produces readily available, inexpensive, highly processed and well marketed foods, coupled with changes in working patterns, has created an energy imbalance resulting in increased levels of obesity.

Sugary drinks: The choice of a heavy generation

There are multiple factors which are linked to the development of obesity globally, but sugar-sweetened drinks have attracted particular attention in the US. Sugar intake from sugar-sweetened drinks is thought to be the largest single caloric food source in the US, approaching 15% of the daily calorific intake in several population groups.

High-sugar drinks are effectively marketed to children and young adults, and their consumption is often linked to fast food, which is likely to exacerbate the obesity problem. Many sugar-sweetened drinks contain high-fructose corn syrup, and there is evidence to suggest a link between high-fructose corn syrup and the development of insulin resistance (think diabetes). Multiple studies have shown that replacing a sugar-containing drink with a sugar-free equivalent significantly reduced weight gain and fat accumulation in normal weight children, prompting calls from the American Heart Association, the Institute of Medicine, and the Obesity society to reduce consumption of sugar-sweetened beverages.

The consequences of being obese: Shorter, less healthy lives The life expectancy of a person with a BMI of 40-45 is reduced by around 8-10 years, which is similar to the reduction in life expectancy suffered by smokers. An  overweight person of average height increases their risk of death by around 30% for every 15kg of weight. Obesity is a key risk factor in the development of multiple diseases, including diabetes, heart disease, osteoarthritis and

The most direct and obvious impact of obesity is on incidence of diabetes - a severely obese person is around 60 times more likely to develop diabetes than someone with normal weight. High blood pressure and high cholesterol levels are also linked to high BMI.

These combined risk factors make an obese individual more likely to die from heart disease or stroke.

But perhaps a less intuitive link is the one between obesity, physical inactivity and cancer. Obesity and physical inactivity are also a key risk factor in the development of certain cancers; around 9% of colorectal cancers, and 11% of postmenopausal breast cancer in women is linked to obesity. An additional 5kg/m2 in BMI is thought to increase the risk of colorectal cancer by 24% in males, and to increase the risk of postmenopausal breast cancer in women by 12%.

Obesity and cancer – the not so obvious link

According to the American Cancer Society, one-third of cancer deaths are linked to obesity and/or lack of physical activity.

Improvements in cancer diagnosis, treatment and prevention has seen an improvement in death rates for cancer in the US over recent years, but the obesity epidemic within the US puts this trend at risk. Obesity is a known risk factor for multiple different tumour types, including oesophageal, colorectal, endometrial, kidney and certain breast cancers. In addition to increasing the risk of developing certain cancers, obese individuals are less likely to survive their cancer diagnosis; individuals with a BMI above 40 had death rates 52% higher for men and 62% higher for  women when compared to people of normal weigh.

Obese men are at significantly higher risk of developing colorectal cancer; the distribution of body fat appears to be an important fact, with abdominal obesity measured by waist circumference demonstrating a strong correlation with colon cancer risk. Obesity also modestly increases the risk of women developing postmenopausal breast cancer.

The costs of an obese population – direct, but also indirect Obese populations place greater stress upon healthcare systems already struggling to cope with rising expectation on what healthcare systems can deliver, more expensive medical interventions and an increasingly elderly population. The chronic nature of the condition means that obese people consume a greater share of healthcare resources, over a longer period of time.

Medical costs for obese individuals are as much as 30% to 40% higher than those with normal weight. An obese individual will on average visit a physician 27% more frequently than someone with a normal weight, and the annual extra medical costs of obesity in the US were estimated to be US$75 bn in 2003 (BMJ Wang). If current demographic trends continue, obesity-related costs are set to double every ten years, and could account for 16%-18% of US Healthcare expenditure by 2030. In the UK, data point to a similar trend, with £650 mn increased annual costs by 2020, and £2 bn higher costs by 2030 (Wang).

In addition to the direct medical costs for treating obesity, there are indirect costs to society and economies, which include early retirement and lost or lower productivity. US data suggest a direct correlation between obesity and missed work days in men, with males with a BMI above 40 taking almost six additional sick days each year. Swedish data suggest obese individuals are 1.5-1.9 times more likely to take sick leave than their peers with normal weight.

Who provides the solutions?

Before we get to the investing implication of this pandemic, we believe it’s worth spending a minute on the impact that reversal of current trends might have, and the role that various parties have played thus far to resolve this. Perhaps slightly depressingly, we believe that pharma companies alone are unlikely to be able to resolve this. Indeed we believe that a majority of this change message needs to come from government policy and social change (as we saw in the 1970s-80s with smoking).

What are the benefits if trends reverse?

Modest changes can have a dramatic impact on both an individual’s risk profile and society as a whole. A 1% reduction in BMI (approximately losing 1kg of body weight) is estimated to reduce cases of diabetes by around 2 million, and cases of cancer by around 100. However, implementation of these changes will require behavioural changes through health promotion campaigns and policy interventions to address healthy public sector food service policies. But policy and behavioural changes are not easy to implement and take time to take effect.

Pharma industry response – encouraging, but not adequate

Despite numerous attempts, the pharmaceutical industry has had limited success in addressing the primary cause of obesity (energy imbalance). Current treatments combat the consequences of obesity, e.g., through the management of hypertension, or diabetes. [ZH: perhaps the profit potential is far greater in perpetuating the underlying cause and merely treating the symptoms which have a duration that expires with the expiration of the patient?] A large number of companies have tried to develop pharmaceuticals to target energy imbalance, but the vast majority have failed owing to serious toxic effects. For example, Sanofi’s Accomplia was abandoned for suicidal ideation, Fen-Phen was withdrawn for serious cardiovascular concerns, and sibutramine was recently withdrawn following cardiovascular safety concerns.

2012 has seen the FDA approval of two new treatments for obesity, when used in conjunction with reduced calorie diets. Both Belviq (Arena Pharmaceuticals) and Qsymia (Vivus) reduce appetite and in some people can induce a negative energy balance. Both products have demonstrated safety signals which are a cause for concern, and patients receiving these products will require careful monitoring by clinicians. But, the FDA’s willingness to approve agents with clear safety signals illustrates the need for effective intervention for obesity.

One of the more serious efforts to this end was recently demonstrated by the Australian government, which evaluated several measures aimed at combating this epidemic (see exhibit below). Not surprisingly,  nonpharmacological options were found to be more cost-effective in the long term, but are obviously more difficult to implement at a society level.

* * *

Another, even more dramatic health-related recent intervention was that on behalf of Mike Bloomberg and the city of New York banning sugary drinks in 16 oz containers or more.

The problem with government intervention in individual and social level consumption, is that it never works without a proper incentive system. If instead of using negative reinforcement, the government were to use positive reinforcement techniques, and for example offer each American $100/year for every pound kept below the overweight threshold every year, the results would be far more encouraging, and the costs saved in the long run would more than offset initial outlays.

Of course, this being the government, it is absolutely certain that corruption and "unintended side-effects" will intervene, that incentives will be perverted by special interests and lobby groups, and the final outcome would be a far worse one than the base case.

Which is why, sadly, the obesity epidemic will not be "fixed" in any conventional sense, but like so many other aspects of the current unsustainable socio-economic system, will merely go away on its own once the "weakest links" are eliminated by the various forces of natural (and man-made) selection in play today.

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Dealyer Turdin's picture

Guessing you're not real big on fishing.  I'd rather be fat and holding a gun than chasing the fat guy...oh, and  there's this other factor, too... brains.

shovelhead's picture

Got it.

Make mine a double bacon sandwich and hold the bread.

ShortTheUS's picture

Bitch tits... BITCHEZ!!!!!?!!!!!

Kitler's picture

Worlds Largest Abusement Park.

merizobeach's picture

Can I go long on a WLAPs ETF?

Dingleberry's picture

See you at the buffet.....bitchez!

cbxer55's picture

Golden Corral ftw. bitchez

overbet's picture

Down voters, I can only show you the door you have to walk through it. Juicing green vegtables makes you feel 18 when you are 40 after a few weeks and you get used to the taste and actually start craving it if you skip a day.

kekekekekekeke's picture

David Wolfe Daniel Vitalis Dr. MErcola and the health ranger? cool ^_^

A Dollar Short's picture

I will always love my Twinkies.

Peter Pan's picture

What governments and central banks cannot achieve to restore balance, mother nature will impose over time in a very grissly but effective manner.

The truth s that we are in the process of culling ourselves through lifestyle choices which are neither physically nor economically sustainable.

duo's picture

These articles commonly state "since 1980" figures for obesity increase.  What happened then?  HFCS replaced sugar in soft drinks, and in the next decade replaced sugar in just about everything, from salad dressings to pasta sauce.

HFCS is not metabolized the same as sugar.  It is stored as fat first.

GenXer's picture

HFCS is processed by the body the same as sugar. You're correct in saying that the 1980's hearlded huge inflow of HFCS into the market due to government subsidies on corn and food technology breakthroughs making it a far cheaper and therefore more profitable ingredient for the food industry than cane sugar. The real problem since the 80's is not so much HFCS being used but that sugar consumption, rather than declining has stayed very stable, and the new catagory of HFCS has exploded meaning the TOTAL sugar being consumed is skyrocketing.

French Frog's picture

Herein lies the problem when we are dealing with anything that has the backing of one the biggest self-interest lobby groups in the world (the food industry, but the principle is the same with oil, finance....). They have access and sponsor research that will invariably return the results that they are after + many 'innocent looking' websites will be setup and maintained to back up their claims.

I put 'High Fructose Corn Syrup' in Google and on the first pages I found plenty of articles backing the "HFCS is processed by the body the same as sugar" theory and as many that said the opposite, all of them referring to articles from well established and reputable sources.

adr's picture

The body does metabolize HFCS the same way as sugar, but not at the same rate. HFCS takes longer to process leading the body to metabolize other sugars first to get energy. What is not consumed is turned to fat. Far more fat is generated from HFCS in an equal caloric intake of sugar.

True studies are just being done now to show how bad HFCS is for your body. At my local gym the licensed trainer there has been running a study on people who are consuming HFCS and those cutting it out as much as possible. On an equal exercise regimen those trying to cut out HFCS are losing far more weight.

That leads anyone with a brain to come to the conclusion that sugar is metabolized quicker than HFCS. I cut out drinking anything with HFCS and switched to drinks sweetened with pure sugar. I lost ten pounds in a week.

TBT or not TBT's picture

This is retarded.      

Regular table sugar is mainly made of sucrose, a well known molecule, very well understood, which is basically one fructose molecule and one glucose molecule bound together.   So it is 50% fructose and 50% glucose.    It is cleaved into free glucose and free fructose very very quickly by the digestive tract.  

Now, compare to HFCS:

HFCS sugar content is 55% fructose and 45% glucose.

There is no appreciable difference in how these two are metabolized.

HFCS is cheaper, and cheaper for food companies to use because it is sweeter (on the tongue) per unit of cost than cane/table sugar.   Now you know why food companies like to use it rather than cane sugar.   Profit (Duh).

Neither of these is good for you, with HFCS being just slightly worse for you than regular sugar was, because it is cheaper, and because it contains a bit more fructose, which causes LDL cholesterol production, pretty much immediately.   The liver has to process nearly every molecule of fructose we take in, and in that process produces "bad cholesterol".      Most human cells cannot use fructose, aside a few very specialised cells such as sperm cells.

Esso's picture

HFCS is NOT processed the same way by your body as sucrose (cane or beet sugar). The fructose and glucose in HFCS are free sugars where in sucrose they're molecularly bonded requiring an extra metabolic step by your body to make them available for use by your body to be stored as fat.

A 2010 study pretty conclusively proves that HFCS is a primary cause of obesity, diabetes and metabolic syndrome as opposed to sucrose. http://www.princeton.edu/main/news/archive/S26/91/22K07/

It's also a well established fact that excess carbohydrate consumption is the primary cause of high serum colesterol, not the consumption of cholesterol containing foods such as eggs or meats.

adr's picture


It is amazing that people can't accept simple biological concepts as fact. You learn all this stuff in 9th grade Bio, yet it is seemingly impossible to get people to understand it.

I guess that is what billions from ADM and Mosanto can buy you.

TBT or not TBT's picture

The thing is though, HFCS is very nearly the same thing as table sugar.     HFCS is 55/45 fructose/glucose.     Table sugar(sucrose) is 50/50.     The latter breaks in two in the small intestine fast enough that there is little difference, just that 10% extra amount of fructose(which is really bad for us).   But get this, food manufacturers tend to use a little less, or they can use less HFCS, to get the same level of sweetness as with good ol sucrose, because the free fructose renders HFCS sweeter to the tongue.     The perniciouis thing is mainly that HFCS is even cheaper than table sugar.    Both are subsidized by our taxes.   One has more fructose than the other, slightly more.   And fructose is bad stuff our bodies were not designed to take in year around.   Just during seasons where fruits and berries were in season, which isn't very long in most places.   A few weeks.

jimod's picture

sorry, you're wrong. see princeton study.

El Tuco's picture

It's not just HFCS but the grains we eat.


Worth the read..


Cathartes Aura's picture

GMO'd grains, dwarf wheat, etc.   *nods*

Esso's picture

Yes, Dr. Davis' book "Wheat Belly" and his blog are excellent sources.

Another great source is Steve Cooksey's blog Diabetes Warrior. http://www.diabetes-warrior.net/ Cooksey's story is an amazing one.

Mark Sisson really knows his business too. http://www.marksdailyapple.com/

TBT or not TBT's picture

Table sugar is mostly made of one molecule called "sucrose" which is basically one fructose and one glucose(blood sugar molecule) bound together.  It is 50/50 fructose and glucose.

HFCS is 55/45 fructose/glucose, both "free" as I understand it, but that doesn't make much difference metabolically, because the small intestine stage of digestions splits sucrose in two very quickly and easily.

So, no, nothing particularly more diabolical about HFCS than table sugar other than:   It is sweeter, pound for pound, than table sugar.   Costs less to the industry, per dose of sweetness added.   And last but not least. contains more fructose per unit of weight, and fructose is really really bad for heart/circulatory health, as it directlty causes a quick rise in "BAD" LDL cholesterol, in the worst category of such, the small particle LDL.   Fructose does not turn directly into fat.    It cannot.  Very few cells in the body can burn fructose directly, nevermind store it.  Sperm cells are apparently an exception.   Anyway, for the most part the liver, and the liver alone must convert the fructose to usable forms before anything may be made of it by other cells in the body.    The glucose of course can participate pretty instantly in fat creation, or fuel ANY cell in the body.

Disenchanted's picture



So in most 'diet' drinks nowadays aspartame is substituted for HFCS, which is worse?


I keep hearing(people raving about the better flavor) that the soda bottlers in Mexico and points south still use real sugar in their drinks, is this only because HFCS/corn is not subsidized there as it is here? or...Real sugar cheaper for them?


I stopped drinking any sodas, and use the flavor packs(with Truvia) made for bottled water or sweet iced tea with the sugar cut way back and supplemented with Truvia as well.


edit: many of those flavor packs for bottled water also contain aspartame too. read ingredients carefully...

TBT or not TBT's picture

Well now, interesting question.   Answer:   Any sweetness detected by the tongue causes release of insulin.    So drinking a diet soda, particularly on an empty stomach, causes your blood stream to lose glucose, because the insulini increase drives it into fat cells and other cells.  Because no actual glucose arrives in the intestine after drinking an artifically sweetened beverage (on an empty stomach), the glucose in your blood that was mopped up by the insulin spike is not replaced, so you now have low blood sugar, which is also an emergency of sorts.    In response, you get hungry, and eat more, and sooner than you would otherwise.

Which is to say, that diet drinks are, in practice, quite fattening, because of the chain of events they cause.

The solution is not to drink real sugar sodas, however, because the insulin spike from those continues on upward, causing a spike in fat storage of course as the actual glucose is mopped up.   After the glucose spiked is mopped up you are back to having low blood sugar.  

TBT or not TBT's picture

Well, junker, that's the way humans' nervous system is organized, with connections to the endocrine system, evolved over time to maintain homeostasis.   Artificial sweeteners have not been part of the environment we and our predecessors evolved with, or else I guess our bodies' reaction to detecting sweetness at the taste buds would have been more subdued.    As it happens, apparently starting insulin production as a reaction to sweet tastes was advantageous for passing along one's genes, at some point.   Ditto the bodies' reaction to whey proteins, an insulin spike.     Go read some papers, not just the abstracts and conclusions.

Ajas's picture

Yes, but can we cull ourselves fast enough?

This line: "In addition to the direct medical costs for treating obesity, there are indirect costs to society and economies, which include early retirement and lost or lower productivity." is worth an entire article all by itself, particularly in the context of unfunded entitlement liabilities, and a big pharma that knows how to calculate the difference in profits between treating the inevitable symptoms of obesity, vs solving the problem itself.  

And acts accordingly.

Yen Cross's picture

My ass was out of bed /at the crack of dawn!   I'm a human 'financial calendar'...  My ass is out of bed at the European open, like a SKUNK on STINK! every day, until I die!

   I don't have time for "fat, large, ro-tund..."  Fat isn't in my dictionary! bitchez

Rustysilver's picture

Any country with McDonalds is or will have problems. Just look at Central Europe after 1989.


Going Loco's picture

Just look at the incidence of heart disease after margerine was invented.

And don't get me started on transfats.

john39's picture

What most are eating these days is not real food. Even the produce is devoid of vitamins and minerals... And the processed stuff that most live on, designed to cause chronic illness. Eat up sheeple.

toady's picture

I just dropped below morbidly obese to mearly obese, mostly because we're 100% down on the farm now. We're up around producing 80% of what we eat. I still buy beef, I love a good steak, and toiletries I can't figure out how to make.

I like to think of the extra fat as my defense against teotwawki. When everyone else is starving I'll just lose weight.

nmewn's picture

Stay out of my bedroom AND my pantry you fucking creeps.

toady's picture

I'll definitely stay out of your bedroom.

Your pantry on the other hand....

TBT or not TBT's picture

How do you know you wouldn't get along him/her in bed?

Urban Redneck's picture

There are McDonald's in Switzerland, I broke down earlier this year and had one of their $15 "meals" when taking a guest to the airport. But the adult obesity rate here is stable at 8% (and lower than the US childhood obesity rate).

As long as the nominally wealthy developed countries continue to stuff their fat faces with fecal food, the pill pedaling gnomes can make up the revenue lost by the banking gnomes, so we all can buy more thongs for the female gnomes, and everything will be obnoxiously happy-happy-joy-joy tranquil here.


Incubus's picture

gnomes are usually rather likeable.


It's goblins that you're talking about.

TBT or not TBT's picture

McDonalds does very well in France, as does an identical frenchified chain that does the same thing as "MacDoh"   (as the French slang pronounces McDonalds')

Smegley Wanxalot's picture

Dammit!  There needs to be a law!

Kitler's picture

Airfares, busfares, health insurance etc. based on weight.

Call it the Abuser-Pay system

Kitler's picture

Okay... Who's the Fattie who dinged me?

Beam Me Up Scotty's picture

You are exactly right.  If some 350 pounder gets on the airplane, its takes more fuel to fly him somewhere than it does the 175# guy.  Why shouldnt fatty pay more?  Thats the ultimate incentive, financial incentive to lose some weight.  Fat people don't pay a penalty for all the extra resources they consume outside of food.  And they only pay more for food, because they eat more of it.  Once your insurance deductible is met though, party on Wayne, go to the doctor all you want, because you insurance will pay for it all.

knukles's picture

Bullshit.  I didn't get fat all by myself.