Obesity tops tobacco as biggest health threat

[Darth Wong]

http://www.healthzone.ca/health/newsfea ... lth-threat

Obesity tops tobacco as biggest health threat
January 6, 2010

Joseph Hall
HEALTH REPORTER

Obesity has surpassed smoking as North America's greatest health risk, a U.S. study and Canadian experts say.

A growing wave of obesity that has rolled across the continent for the past 15 years, coupled with a reduction in smoking, has swept tobacco from its perch as the top contributor to combined death and disease measures in the two nations.

By 2008, the numbers for obesity had caught up to and slightly surpassed smoking, said lead author Haomiao Jia, a Columbia University biostatistics expert. "It's getting worse and worse each year."

The study, which looked at data from more than 3.5 million Americans between 1993 and 2008, was published Wednesday in the American Journal of Preventive Medicine.

The findings are based on U.S. statistics, but top Canadian researchers say they would apply here.

"Our obesity rates have been going up every bit as high as those in the United States," said Canadian Institutes of Health Research scientist Robert Ross.

The study should act as a "wake-up call" for Canadian health officials to begin to address the obesity crisis seriously, he said.

The study used the Quality Adjusted Life Years (QALY) measure to assess the relative impact of obesity and tobacco on physical and mental well-being and life span.

While researchers found smoking still kills far more people than obesity, its toll in terms of life years lost remained relatively stable between 1993 and 2008.

Meanwhile, using the QALY measure, increases in disease rates and accelerated deaths caused by obesity skyrocketed almost 130 per cent over the study period.

Overall health risks caused by obesity have caught up with and slightly surpassed those due to smoking over the study period, Jia said.

In the U.S., smoking rates declined 18.5 per cent over the same period, while obesity increased 85 per cent.

These figures are mirrored in Canada, said Dr. Mark Tremblay, an obesity expert at Ottawa's Children's Hospital of Eastern Ontario.

Ross called for massive anti-obesity strategies, modelled on Canadian and U.S. campaigns that cut smoking rates since the 1960s.

No doubt nutjob fat advocacy groups like NAAFA will scream till they're blue in the face, but it's high time we stopped acting as if obesity is analogous to race. Obesity is a health problem, not an ethnic group. People are dying, they're suffering loss of health and mobility, and they're going to cripple the health care system (not to mention health care workers, who often end up suffering back injuries and other problems as a result of having to work with obese patients; even in our own little circle, Brian Young of Babtech and the old Turbolaser Commentaries had back problems as a result of having to move fat patients, and my sister in law says she simply refuses to help obese people move because of the risk of injury, so she asks for burly male orderlies to help).

[Alferd Packer]

No doubt nutjob fat advocacy groups like NAAFA will scream till they're blue in the face,

So, like thirty seconds, or until someone distracts them with a McDonald's bag or makes them climb a flight of stairs?

But seriously, I fully believe that smoking is on its way out for good. My formative years were really the 90s, we got blasted on all sides about the dangers of smoking at school and in popular media. In fact, we got blasted so much so that despite both my parents smoking throughout my childhood, I never took up the habit. Hell, I never even tried it. My sister did, but she recently and successfully quit. Otherwise, I can't think of a single friend of mine or my wife's that smokes. Hell, my dad's almost fifty-nine, and even he quit after nearly forty years. And when he grew up, everyone smoked everywhere.

I guess a concerted effort needs to be applied in the same way to the obesity problem. That way, even if you have fat parents(which, it would seem, more and more kids will), you're still receiving the correct information about proper diet and regular exercise. Trying for immediate, short-term results probably won't be as effective as a long-term approach.

[Darth Wong]

No doubt nutjob fat advocacy groups like NAAFA will scream till they're blue in the face,

So, like thirty seconds, or until someone distracts them with a McDonald's bag or makes them climb a flight of stairs?

But seriously, I fully believe that smoking is on its way out for good. My formative years were really the 90s, we got blasted on all sides about the dangers of smoking at school and in popular media. In fact, we got blasted so much so that despite both my parents smoking throughout my childhood, I never took up the habit. Hell, I never even tried it. My sister did, but she recently and successfully quit. Otherwise, I can't think of a single friend of mine or my wife's that smokes. Hell, my dad's almost fifty-nine, and even he quit after nearly forty years. And when he grew up, everyone smoked everywhere.

I guess a concerted effort needs to be applied in the same way to the obesity problem. That way, even if you have fat parents(which, it would seem, more and more kids will), you're still receiving the correct information about proper diet and regular exercise. Trying for immediate, short-term results probably won't be as effective as a long-term approach.

We also slapped a lot of taxes on cigarettes, forced them to adopt harsh labeling, and restricted the venues where you could legally sell them (well, that's what we did in Canada; I don't know about Spartafreedomerica). Similar measures would make sense to combat obesity, particularly taxes on foods that contain high levels of bullshit ingredients (particularly if those taxes are used to subsidize healthier foods instead of being used to buy more tanks and fighter planes).

I would honestly have no problem with the idea of a bag of Doritos costing $10 instead of $3, thanks to junk food taxes. It's not as if it will hurt my budget to pay a bit extra when I only buy a bag of Doritos maybe once every month or two anyway. But that's just me; there are a lot of people out there who have shitty diets and who want to aggressively protect that idiotic behaviour for some reason. It reminds me of the people who get angry about seatbelt laws.

[The Kernel]

This is hardly a surprise.

We also slapped a lot of taxes on cigarettes, forced them to adopt harsh labeling, and restricted the venues where you could legally sell them (well, that's what we did in Canada; I don't know about Spartafreedomerica).

It's state by state, but most of them tax the hell out of cigarettes (California for example averages about $6 a pack).

Similar measures would make sense to combat obesity, particularly taxes on foods that contain high levels of bullshit ingredients (particularly if those taxes are used to subsidize healthier foods instead of being used to buy more tanks and fighter planes).

I disagree, I think the current wave of simply mandating healthy ratios of ingredients makes a lot more sense. For example in California we just passed a law to virtually eliminate trans fats which is a much more direct way of addressing the problem rather than taxing them into oblivion. It makes more sense to just legislate these ingredients away as they serve no useful purpose in food.

I would honestly have no problem with the idea of a bag of Doritos costing $10 instead of $3, thanks to junk food taxes. It's not as if it will hurt my budget to pay a bit extra when I only buy a bag of Doritos maybe once every month or two anyway. But that's just me; there are a lot of people out there who have shitty diets and who want to aggressively protect that idiotic behaviour for some reason. It reminds me of the people who get angry about seatbelt laws.

The problem is that the issue with obesity has much more to do with the AMOUNT of food consumed than the type.

Take Doritos for example. A normal sized serving (the small bag which we have at my office for free in the kitchen) is 140 calories and a reasonable quantity of fat. That's really not bad at all for a snack and compares to a snack like an Apple or Pear (the Doritos have more fat but the fruit has more sugar). The problem is that many people don't eat the little bag, they get the giant 600 calorie bag and wash it down with a regular Coke.

The same thing exists with fast food. Sure you can argue about the quality of the food, but consider a meal like this at McDonalds:

5-piece chicken nuggets: 200 Calories
Small Fries: 200 Calories
Large Iced Tea: 0 Calories

Total: 400 Calories

This is sold as a "Mini Meal" and is actually quite balanced. Many fast food restaurants offer similar options like this. The problem is, more people order food like this:

Big Mac: 550 Calories
Medium Fries: 400 Calories
Large Coke: 500 Calories

Total: 1450 Calories

The point I'm making here is that we need to address PORTION size more than anything else.

[The Kernel]

I'd also like to point out that I think a good solution to this problem in the short term is to more heavily promote bariatrics to patients that qualify. It's an extreme solution to the problem and it's not for people who aren't committed to change, but for those that can change themselves it provides a functional cure for obesity and all of the accompanying health issues (Type II Diabetes, high blood pressure, sleep apnea, joint pain, etc).

I personally had the roux-en-y procedure and I can't speak highly enough about it. It may be extreme but after losing huge amounts of weight and gaining it all back with diet programs, it is nice to finally feel like I can eat "normal" amounts without having to feel like I'm starving myself.

[Darth Wong]

I agree about portion size, but it still seems to me like junk food taxes are a reasonable solution. If that greaseburger costs three times more due to taxes, it seems to me we might start reversing this trend over the last 30 years of exploding portion sizes. After all, the cost of a smaller (or healthier) burger will look more reasonable.

[Darth Wong]

I'd also like to point out that I think a good solution to this problem in the short term is to more heavily promote bariatrics to patients that qualify. It's an extreme solution to the problem and it's not for people who aren't committed to change, but for those that can change themselves it provides a functional cure for obesity and all of the accompanying health issues (Type II Diabetes, high blood pressure, sleep apnea, joint pain, etc).

I personally had the roux-en-y procedure and I can't speak highly enough about it. It may be extreme but after losing huge amounts of weight and gaining it all back with diet programs, it is nice to finally feel like I can eat "normal" amounts without having to feel like I'm starving myself.

With a hundred million Americans in the danger group, surgery is not a practical solution, even if it may work for certain individuals.

[The Kernel]

With a hundred million Americans in the danger group, surgery is not a practical solution, even if it may work for certain individuals.

Not for the people in the middle range but for those who are dangerously obese (also the ones with the biggest health problems) it is absolutely practical. You know how I know? Because health insurance providers are willing to cover 95% of the surgery (I paid $500 out of pocket) for people with a BMI of over 40. They wouldn't be willing to do this unless there was a SERIOUS cost return for them later on down the line because of getting rid of the health related effects of obesity.

Seriously, what is a more practical option? A 90 minute operation with two days of hospital stay or life long treatment for high blood pressure, sleep apnea, diabetes, back pain, joint pain, etc?

[The Kernel]

I agree about portion size, but it still seems to me like junk food taxes are a reasonable solution. If that greaseburger costs three times more due to taxes, it seems to me we might start reversing this trend over the last 30 years of exploding portion sizes. After all, the cost of a smaller (or healthier) burger will look more reasonable.

How would you practically define "junk food"? Would it be based on kcals per gram or fat content?

Taxation on high sugar foods that have no real nutritional value (such as candy and soda) makes sense to me, but I think doing the same to foods like burgers would be much less practical.

[Darth Wong]

Not for the people in the middle range but for those who are dangerously obese (also the ones with the biggest health problems) it is absolutely practical. You know how I know? Because health insurance providers are willing to cover 95% of the surgery (I paid $500 out of pocket) for people with a BMI of over 40. They wouldn't be willing to do this unless there was a SERIOUS cost return for them later on down the line because of getting rid of the health related effects of obesity.

Health insurance providers are usually not too stingy about one-time operations. They worry more about long-term care.

Seriously, what is a more practical option? A 90 minute operation with two days of hospital stay or life long treatment for high blood pressure, sleep apnea, diabetes, back pain, joint pain, etc?

Well yes, given those options and only those options, the operation makes more sense. Of course, if the person could, you know, just stop eating so much goddamned food, that would work better than either option.

[Davey]

While I don't think a 'needless junk food' tax is that bad an idea on certain items like potato chips, I think it might be a good idea to offer discounts on raw vegetables and fruit when sold at retail, and the junk food tax or markup be used to subsidize farms and grocers instead to offset the farmers' and grocery stores' losses. Restricting something... diets, habits, etc is hard, replacing is much easier.

And while we're at it, let's get fries and hamburgers and pizza out of school cafeterias.

[The Kernel]

Well yes, given those options and only those options, the operation makes more sense. Of course, if the person could, you know, just stop eating so much goddamned food, that would work better than either option.

It's exactly that sort of attitude which makes it difficult to explore alternate options for combatting obesity.

Do you know what the success rate of dieting is as a factor of changing long-term weight? Less than 2%. I myself did several extreme diets (Optifast for example which consists of eating nothing but 40oz of fortified liquid for six months) which reduced my weight to a healthy level but then like almost everyone who does these kinds of diets, I just gained it all back. Insurance companies know these statistics which is why your insurance isn't going to pay for medical diet programs.

You know why the weight comes back? Because your body floods with ghrelin (a hormone that induces binge eating) because it thinks you are starving. And that hormone will continue to effect you till you have put back on all your weight. Saying that you could simply stop eating is like saying that you could ignore the hormones telling you to have sex and masturbate--sure it's technically true (some religious men manage to do it) but is it really a realistic option?

EDIT: Here's a study on the long term effects of dieting: Diets Don't Work

[Darth Wong]

That's a nice cookie-cutter answer to a standard argument which actually has nothing to do with my position. With conventional dieting, all outside factors remain unchanged: the availability, cheapness, etc. of shitty food. But if food costs much more, people eat less of it. Are you saying that food consumption is immune to economic factors?

[Alferd Packer]

We also slapped a lot of taxes on cigarettes, forced them to adopt harsh labeling, and restricted the venues where you could legally sell them (well, that's what we did in Canada; I don't know about Spartafreedomerica). Similar measures would make sense to combat obesity, particularly taxes on foods that contain high levels of bullshit ingredients (particularly if those taxes are used to subsidize healthier foods instead of being used to buy more tanks and fighter planes).

I would honestly have no problem with the idea of a bag of Doritos costing $10 instead of $3, thanks to junk food taxes. It's not as if it will hurt my budget to pay a bit extra when I only buy a bag of Doritos maybe once every month or two anyway. But that's just me; there are a lot of people out there who have shitty diets and who want to aggressively protect that idiotic behaviour for some reason. It reminds me of the people who get angry about seatbelt laws.

I distinctly remember when I was little kid that my favorite order at McDonald's was $2.99. Similarly, a pack of cigarettes around the time was about the same price (I recall my parents griping that the price went up). Fast forward to 2010: The same thing at McDonald's that I ordered as a kid is about $4.99, and pack of smokes (at least in NJ and NYC) is around $9-$10. There's no doubt in my mind that if the price of a shitty McDonald's burger, fries, and a drink was ten bucks, people would certainly think twice about buying it. I can say with certainty that one of my dad's motivations for quitting smoking was that it got too goddamn expensive.

That's why, even though I drink alcohol, I fully support higher taxes on all alcoholic beverages, like those which were passed recently here in New Jersey. I don't mind paying extra for an indulgence, because I don't drink enough to break the bank.

[The Duchess of Zeon]

Here's a suggestion. Stop dieting and start getting exercise. If you spend four hours a day chopping lumber or running for miles in your neighbourhood, you'd never get that fat in the first place, even if you were slopping yourself full of 3,000 kcal burgers. Also if you want to go to a restaurant and get a burger, order a veggie burger or a turkey burger, there you've just saved yourself at least several hundred kcals. Then get it without mayo and cheese and you've saved yourself a couple hundred more. That right there can be the difference between packing on an extra pound a week and maintaining your current weight. A combination of a couple minor food restrictions and vigorous exercise will prevent obesity in (basically) anyone.

[Terralthra]

Well yes, given those options and only those options, the operation makes more sense. Of course, if the person could, you know, just stop eating so much goddamned food, that would work better than either option.

It's exactly that sort of attitude which makes it difficult to explore alternate options for combatting obesity.

Do you know what the success rate of dieting is as a factor of changing long-term weight? Less than 2%. I myself did several extreme diets (Optifast for example which consists of eating nothing but 40oz of fortified liquid for six months) which reduced my weight to a healthy level but then like almost everyone who does these kinds of diets, I just gained it all back. Insurance companies know these statistics which is why your insurance isn't going to pay for medical diet programs.

You know why the weight comes back? Because your body floods with ghrelin (a hormone that induces binge eating) because it thinks you are starving. And that hormone will continue to effect you till you have put back on all your weight. Saying that you could simply stop eating is like saying that you could ignore the hormones telling you to have sex and masturbate--sure it's technically true (some religious men manage to do it) but is it really a realistic option?

EDIT: Here's a study on the long term effects of dieting: Diets Don't Work

So, all those people who have successfully lost weight with diets have broken endocrine systems? Your study shows nothing that people couldn't tell based on simple physics. If you go on a crash diet (lowering net energy in) your body responds by burning fat and you lose weight. When you go off the diet, you go back to whatever bullshit junk food you ate before, and surprise surprise, you gain the weight back. The height and angle from which you crash ("oooooh, an all-liquid diet!") make no difference on what happen after you stop.

This idea that a "diet" is something you go on to lose weight and then stop is the source of your problem. Successful long-term weight change is accomplished by, surprise surprise, long-term diet change. Even positing this "binge-eating hormone" (mentioned nowhere in the study you linked, and a cursory search indicates that the stomach naturally secretes it at all times, with plasma levels increasing before a meal and decreasing afterward), your hormones don't put food in your mouth, your hands do. Unless you are proposing some sort of fugue state, it's a matter of self-control.

If you want to lose weight, net energy in < net energy out. If you want to maintain weight, net energy in = net energy out. It's really that simple.

[Phantasee]

I've heard something about how a person who is overweight or obese when they hit puberty will pretty much stay that way without a big effort on their part, relative to people who are healthy weights when they hit puberty.
EDIT: My question, of course: is there any substance to this?

[The Grim Squeaker]

Here's a suggestion. Stop dieting and start getting exercise. If you spend four hours a day chopping lumber or running for miles in your neighbourhood, you'd never get that fat in the first place, even if you were slopping yourself full of 3,000 kcal burgers. Also if you want to go to a restaurant and get a burger, order a veggie burger or a turkey burger, there you've just saved yourself at least several hundred kcals. Then get it without mayo and cheese and you've saved yourself a couple hundred more. That right there can be the difference between packing on an extra pound a week and maintaining your current weight. A combination of a couple minor food restrictions and vigorous exercise will prevent obesity in (basically) anyone.

Actually, it's been shown that exercise doesn't help with dieting on average. In many cases, people gain weight due to increased caloric intake due to exercising.

But Kernel, while dieting is fucking hard, it's not something that's possible only for statistic outliers - yeah it's hard unpleasant shit, but if I managed to do it, so should most people.
(Background: I weighed about 80kilos at age 10-11 after moving to ISrael. I now weigh about 72 at age 21, and my fat percentage is way less than it was then. I lost most of the weight as a late teen in fact, and that was before I had physical motivators (I.E wanting to get laid)).
Exercise is good, not buying junk food and having healthy food or low calory snacks (salads, fruits, watermelons, soup) around the house is better.

[The Duchess of Zeon]

Actually, it's been shown that exercise doesn't help with dieting on average. In many cases, people gain weight due to increased caloric intake due to exercising.

Don't eat a second hamburger, then. Clearly you see exactly what the problem is--"increased caloric intake". It isn't exercise being ineffective, it's people choosing to eat more now that they think they can burn it off, instead of understanding that they're working to burn off what they already eat.

[The Grim Squeaker]

Actually, it's been shown that exercise doesn't help with dieting on average. In many cases, people gain weight due to increased caloric intake due to exercising.

Don't eat a second hamburger, then. Clearly you see exactly what the problem is--"increased caloric intake". It isn't exercise being ineffective, it's people choosing to eat more now that they think they can burn it off, instead of understanding that they're working to burn off what they already eat.

I'm not talking about jogging to McDonalds, more on the lines of eating another apple and a bigger meal portion after exercising, maybe drinking a fruit juice because you just got back from the gym, etc'.
Exercise makes you hungry. It's not that hard to eat more than you burn over an hour, especially since most people don't know what exactly burns what. (protip - aerobics barely burns calories, it's muscle mass buiding exercises that burn calories overall).

[AMT]

I have to side with those who think increasing taxes would be a good solution. Regulation is slowly strangling Cigarette consumption (except of course for the core smokers who will likely continue with the habit until the bitter end despite how much it costs. Hell, as an aside I remember when my mom would hunt for pennies so she could get a fresh pack, and smoke used ones from ashtrays because she couldnt afford "fresh" ones. Anyway...).

However, regulation is a dirty word here in America, and by god you're not a patriot! if you don't eat way too much for you.

There just isn't enough political will for this to be done, and any politician who makes a concentrated effort will be decimated by the public, perhaps even without lobbyists slinging shit at them (which of course they will).

[ThomasP]

Do you know what the success rate of dieting is as a factor of changing long-term weight? Less than 2%. I myself did several extreme diets (Optifast for example which consists of eating nothing but 40oz of fortified liquid for six months) which reduced my weight to a healthy level but then like almost everyone who does these kinds of diets, I just gained it all back. Insurance companies know these statistics which is why your insurance isn't going to pay for medical diet programs.

You know why the weight comes back? Because your body floods with ghrelin (a hormone that induces binge eating) because it thinks you are starving. And that hormone will continue to effect you till you have put back on all your weight. Saying that you could simply stop eating is like saying that you could ignore the hormones telling you to have sex and masturbate--sure it's technically true (some religious men manage to do it) but is it really a realistic option?

As you mention here, there are very massive psychological and behavioral hang-ups that are largely mediated by physiological causes. Put simply, human bodies are designed to get fat and tend not to want to let go of that fat without extreme conditions. The physiological changes on a diet lead to psychological changes, with the net result being hunger - and most people will just go eat. There's a lot more to that regulatory system than just ghrelin, but that is the gist of it.

That's a big part of why there are so many fat people around, honestly. Information is not and really never has been the problem; informing people is easy. Getting them to modify their behaviors, when their bodies are giving them the exact opposite signals, is not.

Taxing "junk" food would maybe help that problem; then again, it might not for a variety of reasons. Having access to cheap, good-tasting (well...) and very calorie dense foods has certainly not helped the problem, in the sense that it's much easier to over-eat with much smaller portions of food. Whether or not that would succeed in making people change their habits I don't know; they might just find other ways to keep overeating. It's not as if there's anything particularly special about junk food - if you consistently eat more calories than you use up in a day, they're stored as fat.

Any solution is going to have to focus on the psychological and behavior-changing aspects of weight-reduction, because left to their own, the average human will eat him/herself to at least a condition of being overweight, if not outright obese. True obesity does seem to have some genetic components to it, just because not everyone eats themselves to that size, but the equilibrium condition (the settling point) for most everyone (without conscious intervention) is "fat".

Unfortunately even obesity researchers haven't figured out a complete solution to this one. Any way you cut it, it's always going to be easier (physiologically and psychologically) to get fat than it will to lose weight. Weight-reduction involves will power and doing things that your body is not wanting you to do. If there's not a sufficient incentive and motivational structure in place for the person, they're almost certainly going to fail.

How you'd create that kind of system across an entire society I have no idea.

[The Kernel]

That's a nice cookie-cutter answer to a standard argument which actually has nothing to do with my position. With conventional dieting, all outside factors remain unchanged: the availability, cheapness, etc. of shitty food. But if food costs much more, people eat less of it. Are you saying that food consumption is immune to economic factors?

Not immune to economic factors, but certainly in the US most people have enough money to afford as much food as they want, and you yourself have pointed out a correlation between lower economic classes and obesity. You'd have to tax foods pretty heavily to overcome this barrier.

Besides, I actually agree with you, I just think that legislation to force companies to sell food that has better ingredients makes more sense as it has already proven effective in reducing things like trans fats.

So, all those people who have successfully lost weight with diets have broken endocrine systems?

Are you saying that people who manage to be abstinent through sheer force of will have broken endocrine systems as well? Ridiculous, this is not a black/white issue and there are varying degrees of hormones in different people's bodies.

Your study shows nothing that people couldn't tell based on simple physics. If you go on a crash diet (lowering net energy in) your body responds by burning fat and you lose weight. When you go off the diet, you go back to whatever bullshit junk food you ate before, and surprise surprise, you gain the weight back. The height and angle from which you crash ("oooooh, an all-liquid diet!") make no difference on what happen after you stop.

This idea that a "diet" is something you go on to lose weight and then stop is the source of your problem. Successful long-term weight change is accomplished by, surprise surprise, long-term diet change. Even positing this "binge-eating hormone" (mentioned nowhere in the study you linked, and a cursory search indicates that the stomach naturally secretes it at all times, with plasma levels increasing before a meal and decreasing afterward), your hormones don't put food in your mouth, your hands do. Unless you are proposing some sort of fugue state, it's a matter of self-control.

If you want to lose weight, net energy in < net energy out. If you want to maintain weight, net energy in = net energy out. It's really that simple.

By that logic all you need to do to get teens to stop having sex is to tell them "All you have to do to stop having sex is not give into your natural urges!". Good luck making that a reality.

But Kernel, while dieting is fucking hard, it's not something that's possible only for statistic outliers - yeah it's hard unpleasant shit, but if I managed to do it, so should most people.
(Background: I weighed about 80kilos at age 10-11 after moving to ISrael. I now weigh about 72 at age 21, and my fat percentage is way less than it was then. I lost most of the weight as a late teen in fact, and that was before I had physical motivators (I.E wanting to get laid)).
Exercise is good, not buying junk food and having healthy food or low calory snacks (salads, fruits, watermelons, soup) around the house is better.

The clinical studies disagree with you and are quite clear that the success rate of dieting and exercise to change your weight over the long term has very low success rates.

[The Kernel]

I have to side with those who think increasing taxes would be a good solution. Regulation is slowly strangling Cigarette consumption (except of course for the core smokers who will likely continue with the habit until the bitter end despite how much it costs. Hell, as an aside I remember when my mom would hunt for pennies so she could get a fresh pack, and smoke used ones from ashtrays because she couldnt afford "fresh" ones. Anyway...).

Regulation is part of it, but I think social evolution plays a bigger factor. People don't smoke anymore not because they can't afford to but because it isn't "cool" anymore. I'm not sure how we could apply this to obesity though.

[The Kernel]

I distinctly remember when I was little kid that my favorite order at McDonald's was $2.99. Similarly, a pack of cigarettes around the time was about the same price (I recall my parents griping that the price went up). Fast forward to 2010: The same thing at McDonald's that I ordered as a kid is about $4.99, and pack of smokes (at least in NJ and NYC) is around $9-$10. There's no doubt in my mind that if the price of a shitty McDonald's burger, fries, and a drink was ten bucks, people would certainly think twice about buying it. I can say with certainty that one of my dad's motivations for quitting smoking was that it got too goddamn expensive.

As an aside, why does everyone rip on McDonalds? They are actually one of the best fast food options nutrition wise these days as even their flagship burger (the Big Mac) is relatively small by burger standards and is only 550 calories whereas flagship burgers at other restaurants can run into the 1500 calorie range.

I'm not going to argue the quality of McDonalds food but the whole "Super Size Me" thing hit them hard and they decided to take a very responsible route of removing all trans fats and cutting down their portion sizes and they deserve a lot of credit for that. Don't take my word for it, compare their menu to other fast food restaurants and it blows away pretty much everything except some of the better Taco Bell offerings.