"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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Incubus's picture

oh, they'll fight, but it'll be awfully vicarious.


Drones will do the work that men used to do.  All 'round the respective countries, you'll have rotund 'soldiers' blowing each other up with remote control toys.


I think we might need to up the megatonnage on our bombs, though.  Need more of that stuff to blow the fatasses away.


Cathartes Aura's picture

no problemo, the MIC is giving out green card residency to anyone who enlists. . .

globalists plan ahead!

unirealist's picture

Fatness is becoming so much the norm that it is hardly noticed.

I grew up in the 50's and 60's.  In my school yearbooks, only 1-2% of the kids are overweight--and NONE of my classmates were obese.  Skinny, skinny, skinny, virtually everyone in the damned school, including staff.  And I don't mean just "normal" weight.  I mean skinny to the point that today would suggest anorexia.

But I don't think it's simply a matter of consumed calories that matters.  There's more to the problem than that.  Nor is it simply a matter of not enough exercise.  Somehow we are collectively altering our metabolisms to accelerate the production of fat cells.

Whether the cause is HF corn syrup, genetically modified foods, antibiotics, or over-processed foods without necessary nutrients, is not clear.  But ending all three of these practices would not be a bad thing at all.  


notadouche's picture

It's all about the activity levels.  Technology has replaced much of the manual labor folks did then.  My southern grandparents ate fried food every day of their life with butter and bacon grease and all the "bad foods" that are getting much scorn today.  They lived into their mid 90's much like their parents did.  They worked hard everyday.  They did not work behind a desk.  Even their leisure time was spent working in the garden they kept.  It's much less about the input than it is the output.  European cities I've been to, the drink wine everyday, eat the "bad foods" but they walk and bike where they need to go.  Don't see the obesity their either.  Active lifestyle is the real secret, not weather or not you drinking a 16 oz. soda.  That's just ridiculous.

lotsoffun's picture

notadouche - forgot to mention one other thing.  portions.


TBT or not TBT's picture

Except that, you basically can't get fat eating principally fats and protein, and going very light on the carbs.   Carbs, uniquely, trigger fat storage, by stimulating the production of insulin.    The 16oz sugary drink causes insulin production, ergo fat storage.   That's science.

surf0766's picture

Imagine a world where the mass production of food stopped or the harvest was cut by 60% because of the need to remove the items suggested in this thread. 98% of the idiots cannot sow a seed.  I don't know if all of the additives are good or bad but one thing is for sure, I'd rather see them eat than watch then riot.

Ginsengbull's picture

Can't sow seeds, but they can make babies.

Aurora Ex Machina's picture

The last American I ate was sickly sweet, and I even chose one of the "healthy option" ones. Couldn't get past the taste, had to grab an East German raised on pickles and sauerkraut to clense my palate.



Aurora Ex Machina's picture

One for sorrow,
Two for luck
Three for a wedding,
Four for death
Five for silver,
Six for gold;
Seven for a secret,
Not to be told;
Eight for heaven,
Nine for hell
And ten for the devil's own sell!


Who said this was about pastries?

Incubus's picture

I wouldn't eat an American.  Too pumped up on chemicals and sickly. 

Maybe a younger one that hasn't succumbed to illness yet, but Americans are poor quality product.

unirealist's picture

By the way, the only reason corn syrups are ubiquitous in the US is because the f*cking anti-Castro-ites in Florida insist we keep up economic sanctions against Cuba.

Which means price supports on US-grown sugar, which makes corn syrup cheaper than white sugar here.

White sugar is cheaper in Central America, so corn syrups are not used.  E.g. "Mexican" Coca-Cola.  E.g. in Nicaragua, where corn syrup is almost non-existent.

nasdaq99's picture

unirealist, that's wrong.  it's Archer Daniels Midland and the midwest farm corn lobby keeping the s american sugar out.

Dr. Sandi's picture

With the subsidies on corn being so profitable, I'm wishing I could develop a way to make cellphones out of corn.

But probably somebody already has.

TBT or not TBT's picture

Hmmm.   Corn prices have been driven up because so much corn...the sugars in corn...go to produce ethanol, to meet federal and local mandates for gasoline ethanol content.    Stupid but true.

autofixer's picture

I have an idea to cut the Federal deficit.  Let's just deny healthcare to anyone who is obese.  Since 75% of Americans are obese, ding!  Deficit fixed!  Ahhh, the wonders of state controlled medical care. Thank you for your vote, suckers!

Antifederalist's picture

Related idea, if you receive benefits from the government you lose your vote.

Cathartes Aura's picture

hmm, will you include CONgress and corporate lobbyists, Wall Street, and all else who receive gov't Bennies?

Antifederalist's picture

Yep. All of them. Sound money, no bailouts. No Citizens United. Money out of politics. My point is how can people who receive benefits vote on the amount they will receive. Once the tipping point is hit (like now) the system collapses because there is no limit to their demands and no political solution. See: gridlock, Federal Deficit.

So, the money becomes worthless.

Antifederalist's picture

Every red arrow is from a STATIST.

Yen Cross's picture

 My best to you all... I need to pick a few " pomegranates" from alongside my fence. They are going to be part of a sweet salsa over "ahi fillets"... I home grow my own 'jalepeno peppers', so I'm going to dice a few up to accent the sweetness.(cilantro,lemon,red bell pepper, sweet corn, and a dash of this and that.

  Then it's Barramundi, Bugs, Lamb,(real bacon) and  papayas & bread Fruit...


Antifederalist's picture

It is almost criminal the way the food lobby has misinformed people.

Go primal. Protein, natural fats , vegatable carbs. No sugar. Thin even without exercise. If it is processed don't eat it.

Unfortunately, less profits in wellness.

The way fat has been demonized pisses me off. We need fat to be satisfied. Bacon, eggs, red meat. I eat them all. Butter is much better for you than margarine but not according to the food industry.

It is sick. Food ignorance is killing people.

BurningFuld's picture

If you really want to stay thin don't cook your food. Cooking greatly aids in the break down of foods. It takes a whole lot more energy from your body to digest uncooked food. Look it up!

BlackholeDivestment's picture

Corruption defines the bottom-line market principle price point paid by poor humans and wealthy humans. Eating the shit of short term gains, that kills more humans quicker, is cheaper and defines the power of the soul-less political voice that has established the global new world order  wealthy client/stake holder price point reality at hand. This is the Moloch market princple. Did you think them occult boys were just fooling around in these woods? Soylent Green is made from people. 

P.S. All those poor and evil fat asses that voted for the 2 Party Mark of the 666 Beast will die sooner, and the individual; that pays the higher cost for the fall, by living longer, lol, will discover the new Rosemary's/Apollyon 2112 Baby Care 666 price point, if they are dumb enough to work for a, lol, ''living''. LMAO.

itstippy's picture

Too much lysergic acid diethylamide is also bad for you.

unirealist's picture

Fatness won't be solved by "eating less" and "exercising more."

What fat people need to do is change their eating habits by returning to a more natural diet.  That means less sugar and less CORN, and no more fast food.

Unfortunately, there are entrenched interest making a LOT of money by feeding us crap, and then treating us medically for what the crap does to us.

Yes, aerobic exercise will help a lot.  Not because it burns calories, but because it changes the way the body processes calories. 

onelight's picture

Yeah, and while it's preaching to the choir at this point, here's Dr Ron Schmid on that very topic -- more power to you:


Dr. Sandi's picture

My grandad said 'Corn was made for drinkin'.

cbxer55's picture

And it's getting near time to start pouring me some. ;-)

Girl Trader's picture

Recent research shows that it is in fact starch and sugary liquids which have caused the obesity.  Our packaged goods industry heavily markets foods which over time cause insulin resistence, and eventually obesity.  Diabetes is the utlimate outcome for some.  A low starch diet has been shown to reduce the risk of cancer as well.

The diet is not strictly low-carb, as was the Atkins diet.  There are a wider range of foods which can be eaten, making it easier to stay on it.  It is a low glycemic load diet.  I feel great and am losing weight steadily on the diet.

The low-fat, high-carb regime the public has been sold for 20+ years is a hoax; it was an invention of a non-doctor who was on a congressional committee, and became gospel.  All scientific attempts to prove the efficacy of such diets for weight loss and maintenance have failed.  The obesity you see today is people faithfully following the inaccurate direction they have been given. 

Please see Rob Thompson, M.D.:

The Glycemic Load Diet

The Glycemic Load Diet Cookbook

The Low-Starch Diabetes Solution

These are all available on Amazon for reasonable prices.

Antifederalist's picture

Bingo. Low fat , high carb is a fraud. Pure and simple.

They want you to be sick folks.

Cathartes Aura's picture


The low-fat, high-carb regime the public has been sold for 20+ years is a hoax; it was an invention of a non-doctor who was on a congressional committee, and became gospel.


gov.t sanctioned "food pyramids" sponsored by ADM, Monsanto, and Corporate Pharma in a cradle-to-grave death-grip on the populace, guaranteed profits from every angle.  and now mandatory pharma-"health"-care will continue the cycle downwards. . .


knukles's picture

Everybody on Wall Street knows that the top of the consumption pyramid is booze, coke and hookers

foxmuldar's picture

Are you going to take me home tonight,

Ah down beside that red firelight,

Ah you gonna let it all hang out?

Fat bottom girls you make the rockin world go round!!!



I was just a skinny lad

Never knew good from bad.

But I knew life before I left my nursery. 


Left alone with a big fat fanny

She was such a naughty nanny

Hey big women you made a bad boy out of me.


I've been singing with my band

Across the wire across the land

I've seen every blue eyed floozy on the way


But their beauty and their style

Went kind of smooth after a while

Take me to them dirty ladies everytime!


Ohhhh! wont you take me home tonight

Ahhhh! down beside your red firelight

Oh and you give it all you got

Fat bottom girls you make the rockin world go round

Fat bottom girls you make the rockin world go round


Hey listen here Now your mortgages and homes

I got stiffness in my bones.

Aint no beauty queen in this locality


Oh but I still get my pleasure

Still got my greatest treasure

Hey big women your gonna make a big man out of me

Now get this.


Oh you gonna take me home tonight

down beside that red firelight

Oh you gonna let it all hang out

Fat bottom girls you make the rockin world go round

Fat botom girls you make the rockin world go round


Get on your bikes and ride you fat asses.


Love this tune. Queen rocks. 



Cathartes Aura's picture

long history of affinity between gay men and fat girls, *nods*

Bear's picture

And all this time I thought the affinity was between gay men and other gay men

knukles's picture

And whooda thunk a toothpick skinny guy named Freddie Mercury wearing a skin tight harlequin one piece jumper with a band named Queen would be gay?

Cathartes Aura's picture

judas priest!!  gay???  not Fredury too??


Papasmurf's picture

Qsymia, not for the faint of heart.




5.2 Valvular Heart Disease
Regurgitant cardiac valvular disease, primarily affecting the mitral and/or aortic valves, has been reported in
patients who took serotonergic drugs with 5-HT2B receptor agonist activity. The etiology of the regurgitant
valvular disease is thought to be activation of 5-HT2B receptors on cardiac interstitial cells. At therapeutic
concentrations, BELVIQ is selective for 5-HT2C receptors as compared to 5-HT2B receptors. In clinical trials of
1-year duration, 2.4% of patients receiving BELVIQ and 2.0% of patients receiving placebo developed
echocardiographic criteria for valvular regurgitation at one year (mild or greater aortic regurgitation and/or
moderate or greater mitral regurgitation): none of these patients was symptomatic [see Adverse Reactions (6.1)
see Clinical Pharmacology (12.1)].



dolph9's picture

Obesity is not complicated.  People are obese because they are greedy, selfish fucks who gladly stuff themselves to give their lives some meaning, long term consequences to themselves and society be damned.

There was once a word for these people (back when human society was still capable of making judgments)....gluttons.

But now, in the modern age, you can't say anything bad about anybody.  In fact it's quite the opposite...the fit people have to work their butts off to provide the food stamps and ambulances and health care for the obese.

I'm fat and beautiful!  I'm fat and I have high self esteem!  I'm fat and I'm worth it!


Dr. Sandi's picture

You're beautiful when you talk bullshit!

zkay's picture



It is becoming known as the "obesity paradox," but this is something of a misnomer. That's because few studies have linked obesity with longer life.

Rather, the studies generally suggest that people with a BMI of 25 to 29.9 -- which is considered overweight but not obese -- have a survival advantage over people with higher or lower BMIs.

BMI, which is a measure of body fat based on a person's height and weight, is used to classify people into weight categories -- underweight, normal weight, overweight, and obese.

Based on BMI scores, a 5-foot, 5-inch adult would be considered:

  •  Underweight at 110 pounds or less (BMI <18.5)
  •  Normal weight at 111 to 149 pounds (BMI = 18.5-24.9)
  •  Overweight at 150 to 179 pounds (BMI = 25-29.9)
  •  Obese at 180 to 210 pounds (BMI = 30-34.9)
  •  Extremely obese at 211 pounds or more (BMI = 35 or greater)
zkay's picture

Compared to people who fell into the normal-weight category:

  • Those classified as underweight were 73% more likely to die.
  • Those classified as extremely obese with BMI of 35 or greater were 36% more likely to die.
  • Those classified as obese with BMI 30-34.9 had about the same risk of death.
  •  Those classified as overweight with BMI 25-29.9 were 17% less likely to die.

The study appears online this week in the journal Obesity.

BurningFuld's picture

That's caus the people at 110 pounds or less are all doing crystal meth. Which unfortunately has it's own inherent set of health pitfalls.

Ginsengbull's picture

The poor man eats, that he may live.


The rich man lives, that he may eat.

backhandtopspinslicer's picture

call me paranoid but maybe they are fattening us up SO THEY CAN EAT US!!

(it aint paranoia if they wash you down with milk)

Aurora Ex Machina's picture

Opposite problem, actually. Fatties taste horrible, and there's an issue with actually getting to the good stuff, smokers (nicotine) are simply inedible, and drinkers lead to being unable to see straight.

Fine dining, those ain't. It's like the Hunger Games, but in reverse.