"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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toady's picture

You didn't build that!

Disenchanted's picture




I'm not fat, I just built a shed over my tool...

infinity8's picture

I had to have some xrays last week at my local hospital and all the chairs in the waiting room looked fairly new and were like land-of-the-giants double-wides.

Going Loco's picture

Why would the idea of pharma solving obesity occur to anyone other than a twisted conniving industry and the politicians who serve it? Get fat by eating and drinking crap and not exercising enough; then take a pill to try and get thin again? Madness.

Cathartes Aura's picture


there's also the numerous surgical remedies, which are even more profit-able. . .

Harbanger's picture

Profit? You think it will covered by Obamacare?  For the public good, it's easier to ban any behavior that may impact healthcare costs.  Bloomberg is doing test runs to see how people react to his nanny laws.

Cathartes Aura's picture

dunno, I don't do allopathic - but if such things as gastric bypass, perky tits, eyelid lifts, tummy tucks, etc. are considered necessary, who knows?

From 2000 to 2005, there was a whopping 44 percent increase in minimally invasive cosmetic procedures among men, according to the American Society of Plastic Surgeons. While the jump in demand isn't unique to the gender, doctors say it speaks to many men's desire to boost their looks — often through quickie treatments that don't cause a lot of bruising or require lengthy recovery times.

Looking to the future, doctors say they expect tummy tucks and body lifts to show dramatic growth due to the popularity of gastric bypass surgery. Patients can lose hefty amounts of weight following the surgery, leaving them with unattractive, baggy folds of skin.


fatten 'em up, cut 'em down to size - everyone can play, and some make bank!

Parrotile's picture

I often wonder where all the flab removed via liposuction ends up. I've heard the rumours, and trust me they are not nice!


Yen Cross's picture

 My "power nap", is when the rest of IT wakes up!

Caviar Emptor's picture

May the fattest country win! It will soon be a mark of distinction to be fat in tomorrow's global economy. Just like in the days when a chief was worth his weight in gold. Only the few will be able to afford to be fat. 

Long live the corpulent majority!  

lizzy36's picture

Fat is a class issue.

Obesity is seen in twice as as many people in bottom 50% of society versus top 25%.

Applicant A is obese Applicant B isn't, Applicant B gets the job. 

The culling of the herd.

sitenine's picture

"Obesity is seen in twice as as many people in bottom 50% of society versus top 25%"

2 * 100/50 = 4

100/25 = 4

So even chances.  Are you sure that's what you meant to say?

Ginsengbull's picture

Perhaps obesity causes poverty, through lowered energy levels.

Dr Benway's picture

It is rather that what is an accepted 'normal' weight differs between social groups. If it is accepted and normal to be fat in a social group, members are more likely to get fat.

Caviar Emptor's picture

We'll soon return to upper classes being fat, like in feudal times. Fat chiefs and Rubensesque women were considered sexy, cool and desirable

lizzy36's picture


That was when food was scarce, and being fat meant one was in a priviledged class. Now with food plentiful, being a size zero means one is in a priviledged class.

There is a reason many high end designers (think $2500 for a dress) don't produce clothing past size 12 when the average woman's size in the USA is 14.

Kitler's picture

You mean the designers are being paid not to make anything larger by the liposuctionists?

Cathartes Aura's picture

the majority of male "high end fashion designers" are gay.

dressing the Barbies, some with unacknowledged hatred for females (competition), working as intended.

the fashion industry works much the same as any - unattainable goals, and mockery of others, aka hierarchy.

profits in divide 'n' rule.

lotsoffun's picture

lizzy - it also meant that the only people that could afford sit around all day and stuff themselves with joints of this and that and wines and breads were the rich.  everybody else had to walk to work and then work and then maybe purchase a bit of food and then walk home.  even the obamanauts today live royally on snap cards, sitting infront of the t.v. and the driving down to the local supermarket with their snap cards and having a choice of every piece of animal available to eat from about 4 different national producers, loaded with hormones and preservatives and radiation and more junk and take that home and nuke it up and get back infront of the t.v.

sugar was rare.  it was hard to get.  investigate for yourself the slave triangle between nantes in france, the biggest slave port in europe.  sugar drove a big part of the slave history in the americas.  the south of us was about indigo, rice and cotton.  the caribienne was all about the sugar.

and 400 years later, haiti and other places are still a disaster.

cheetahbaby's picture

I doubt it. Not in a society where shopping organic and all that takes a premium and is an indication of class. One does not need to go tt far down on the education ladder to find gross lack of understanding of even the most basic of healty eating facts. And the ignorant are not exactly passing healthy eating on to their offspring. We're not talking twinkies and coke for toddlers here, we're talking prepared foods, chain restaurant eating, Starbucks mocha blah blah blah's etc. The educated top percents will not become obese here any time soon.


TBT or not TBT's picture

Bollocks.  Poor people are fatter because the cheapest food is carbohydrates, laced with cheap modern vegetable oils.   Wealthier people can afford more fat and protein in their diets, and better quality fats, and so are not as fat.   Carbohydrates are uniquely fattening, and their combination with cheap vegetable oils causes body wide inflammator conditions that crop up as all sorts of chronic and degenerative diseases.

BurningFuld's picture

Poor people are fat because they are less active, which is why they are poor. It is simple genetics. Sorry but the truth is sometimes rather harsh.

Interesting how people try to blame things for their problems.  Want to lose weight? Eat less and get off your fat ass and go for a walk. Not only does it save you money but it makes you feel a whole bunch better too.

TBT or not TBT's picture

That doesn't square with observation, BurningFuld.     Gary Taubes kills this one seven ways to Sunday.   The evidence that Sedentary==>Fat is actually very poor, when controlled for carbohydrate intake,    You'd problaby find the same with Sedentary==>Poor as well.   The highest paying jobs are not very physical.   The low paying jobs are quite the opposite.     Because of the low pay, low paid people eat cheaper foods, which are high in carbohydrate content, and high in cheap vegetable oil content, because these are cheap.    You want to lose weight, get OFF the treadmill, go to the kitchen, and collect everything you have that contains sugar or wheat as an additive.   STOP ALL EXCERCISE if you like, and merely stop eating anything with added wheat byproducts, or added sugars.     Insulin causes fat storage.    Lowered insulin levels permit fat to be burned.   This is in fact the only diet plan that succeeds either in the short or long runs.    Same with civilisations.   Fat civilisations eat a lot of carbohydrate.    Lean ones eat more fat and protein, and less far less sugars and grains.

Ginsengbull's picture

Crisco was invented as a candle wax.

TBT or not TBT's picture

A big problem in WWII was how to feed so many troops, and allies troops, and allies populations, half way around the planet.   A centrally planned R&D and manufacturing effort produced preserved foods high in carbohydrates(which are fundamentally easy to preserve), AND hydrogenated fats, which resist going rancid.   NATURAL AND HIGH QUALITY FATS DO NOT PRESERVE WELL, AND SO ARE THE ENEMY OF THE PACKAGED FOODS INDUSTRY.    They paid lots of money over time to be sure these were vilified by governement and government science...you know all of those A&M type universities dependent on government aid and food industry grants.    Newly invented highly processed vegetable oils are a more than a little different, because they are both cheap and designed for stability.    Problem is, together with the high insulin levels caused by all the carbs, these modern vegtable oils get converted at an excessive rate into inflammatory signalling compounds and their toxic precursor, arachidonic acid.

Yen Cross's picture

 Fat is an entitlement issue... Gotta love Lizzy :-)

lizzy36's picture

It is.

Since 2011 obesity is considered a "disability" and entitles one to apply for disability benefits.

Think all those 400lbs who can no longer self propel (walk) and end up on scooters. They don't pay for them out of pocket. NOOOOO! Medicare and your tax dollars, hard at work ;)

knukles's picture

And they are demanding I get a feul efficient electric scooter. 

A Goddamned Pelosi ScooterMobile


(my V12 supercharged handicap scooter runs great on Iranian oil)

nmewn's picture

Ever fat ass round here got ObamaScooter!!!

Disenchanted's picture



There've been ads like this long before Obama came around. Hoveround and the Scooter Store, etc., etc..


 9 out of 10 Hoveround owners got their electric wheelchair at little or no cost.*


Medicare paid most of the wheelchair expense for them.*


Hoveround does all the work for you in getting a mobility scooter!


  • We work with your doctor to fill out all Medicare and
    insurance paperwork for you.

  • We submit the forms on your behalf and follow up as needed.

  • You pay nothing up front if you have qualified supplemental insurance and have met your deductibles. In fact, you may owe nothing at all.


 from: http://www.hoveround.com/home/more-information?PhoneNumber=8008225213&Pa...


 Scooter Store:


(before Bama Care came into effect)



 Hoverounds and Scooters for the Skittle shitting Unicorn environment. Get one today!


Chicks dig guys in wheelchairs(or scooters): http://youtu.be/64Ixzp94ksw



nmewn's picture

Sure. But that wasn't my real point.

If the government is so concerned about obesity, why are they allowing them for fat asses?...for frrrrrrreeeee!

So now, the only exercise a lard ass gets is rolling off their couch into it, in one last desperate search for the now extinct Twinkie...used to be they were reserved for the truely handicapped...you know, people without use of their legs, people on oxygen etc.

Which brings up another pet peeve of mine...those blue handicapped mirror hangers...I don't know how many times I've seen someone slide into a handicapped parking spot , hang one of those on the rear view mirror, only to practically JOG up to the front door of a business. Meanwhile, the parapalegic has to keep circling the parking lot waiting for the asshole who stole her spot to come back out.

People have no fucking shame and government is promoting it.

Harbanger's picture

How do you explain Oprahs rich fat ass lizzy?  It's not that simple, in some jobs you need more qualifications than how hot you look.

lizzy36's picture

Oprah is the boss. 

Interesting, she was not obese before she became the boss. And part of her appeal, is the myth that she is every woman, struggling the same way we all do. Her weight was an outward manifestation of her "every woman" struggle and a major selling point. 

Not merely about hotness. Although that is part of it.

When was the last time there was a fat president? What is going to be Chris Christie's major obstacle to the nomination in 2016?

What i was orginally saying was that all things being equal, the thinner candidate is always going to be first choice. 

Hulk's picture

knukles is drunk...

Hulk's picture

fried okra googles ???

nmewn's picture

Okra Goggles? ;-)


Good stuff. Hardy, easy grow, drought tolerant...old southern favorite.

Maghreb's picture

Not true. Employers love the submissive fatties. Great fun for all the Doms in HR.

Skateboarder's picture

They took away the sanctity from food. Now we have whales on land.

Just because it's made doesn't mean you should put it in your mouth...

blunderdog's picture

What about all those obese folks who aren't fat, though?  What are THEY supposed to do?

Ah, fuck it, let's just start prescribing Adderall off-label.

Money Squid's picture

Im not fat, I just have a lot of junk in my trunk. And, I am big boned.

Carl LaFong's picture

GM "Frankenfoods" are contributing to weight gain as well. There are over 20 crops now in US that are GM. Good luck with that.


MillionDollarBoner_'s picture

No mention of residual growth hormones in the meat, then?

Just how do you grow a chicken to maturity in 13 weeks?


blunderdog's picture

Those are just appropriately-motivated AMERICAN chickens.  Most chickens couldn't hack it in an American factory farm--they'd be on the dole, instead.

Our chickens are firm believers in capitalism, so they intentionally grow faster in order to help maximize shareholder value for Tyson/Perdue/etc.

We achieve this by playing audio-books of Atlas Shrugged in the coops of the layers.

Cathartes Aura's picture

Amrkn Chikkenstm are bred for big breasts, which is interesting given the culture's desire for siliconed tits.


Dr. Sandi's picture

That explains why the breast meat tastes a little off lately.