Dieting changes the calories expended part of the equation. If you lose a significant amount of weight, your resting calorie usage goes way down. Way way down. Your body thinks it’s starving, and informs your brain and your appetite of that. If you were obese, and then go down to “normal” weight, to maintain that weight you have to lower your calorie level to a ridiculously small amount. You have to eat many fewer calories than someone who was already at that weight and never had been obese would need to ingest.
Any discussion of eating habits has to deal with the fact that many people live in food deserts. If you are middle and upper class living in an area with ready access to supermarkets and reasonable food prices, consider yourself fortunate. Food policy in our country is a nightmare. The whole food/obesity issue is beyond the scope of this thread however which is about healthcare access, affordability, ACA and alternatives.
So you can fix it on the exercise side. Exercise such as walking, running, biking, and weight training all consume a well understood set of calories.And the last one is independent of your own weight, so it will not decrease as your weight does.
Bunsen and I could have some rousing discussions about “calories in vs calories out” :). At its most basic level, that’s what it’s all about. However, it becomes more nuanced than pure energy balance concepts. What we eat has metabolic impacts that effect hunger, satiation and resultant eating behavior. Empty calories leave our bodies in nutrient deficits that result in eating compensations. Eating too little can result in metabolic changes affectionately coined as starvation syndrome. The list could go on about why it is more complicated than the arithmetic of calories in vs calories out but at the end of the day, once you account for all these other factors that influence eating patterns, it does boil down to calories in vs calories out and thermogenics. The biggest problem is that 1) most people have no idea of what energy balance is all about and how much they really need to eat to be in balance and 2) most people really don’t know how much they are eating.
You can’t fix it! The person who weighs the same as I do, but who used to be obese, needs fewer calories than I do. If they are as active as I am (pretty active), they will need fewer calories than I do. No matter what they do, they will need fewer calories than I do when I do that thing, and they will constantly be thinking about food because they will constantly be ravenous.
Sample size of one
My friend lives in Canada, her husband experience.a recurrence of cancer which had been treated 5 years previously. At the time of the original cancer there was no internet, by the time of the recurrence they could do tons of research. She vehemently asserted that he was treated initially with protocols 10-20 years behind US treatment standards
They had the wherewithal to come to the states and he participated in three different experiments before finding the one that worked. That was nearly 15 years ago and he is still ok. They would say that using cutting edge treatments made the difference and they could not get those in Canada.
By the same token, another Canadian friend’s three year old was diagnosed with cancer and quickly treated with no fear of bankruptcy.
In reading this thread people mention the exchange being underfunded. Remember, if the consumer is paying a discounted price, the government is paying the remainder, the company is receiving 100% of charged premiums.
It’s not that low premiums are paid by low income people, it’s that those full premiums are still not enough to make the maths work
“They had the wherewithal to come to the states and he participated in three different experiments before finding the one that worked. That was nearly 15 years ago and he is still ok. They would say that using cutting edge treatments made the difference and they could not get those in Canada.”
It looks like the friend benefitted from clinical trials not from mainstream, approved therapies. Fifteen years ago the standard treatment in the US would not have been cutting edge either.
We could believe the exchange was underfunded in the sense that some people who make a little over four times the poverty line find that insurance is truly unaffordable. The benchmark plan for someone my age in my area is something like $11K a year. Four times the poverty line is a bit less than $50K per year. If you make $48,000 a year, $11,000 looks unaffordable. To be sure, that person would be exempt from the requirement to buy health insurance, but if they didn’t buy health insurance, they wouldn’t have health insurance. So there’s a good case to be made that the subsidies aren’t big enough, for some people. Not that it’s relevant to the current political climate, but it’s still true, or at least arguably true.
@bunsenburner:
Thank you, that was my thought when I read the original post. Saying Canada was 15-20 years behind when comparing it to a cutting edge clinical trial or experiment is comparing apples and oranges, among other things, with clinical trials, there is no insurance involved, the cost is born by the company doing the trials as far as I know.
The problem with the health exchanges is why they put penalties in for not having insurance, insurance pools only work if they have a wide cross section of people in them who have many who are relatively healthy and they subsidize those not so healthy. The problem with the exchanges is they have had a hard time getting people on them who are healthy, a lot of people would rather pay the tax penalty than get insurance it seems, and another problem is that a lot of the people who are joining the exchanges are people who didn’t have insurance before, in many cases couldn’t get it (remember ACA forbid denying coverage to pre-existing conditions, many of those who got on the ACA exchanges were already sick with something), and people without insurance tend not to get medical treatment, so start out more sick than a typical person would. The rates for premiums were charged based on assumptions about how many relatively healthy people would be on the plan, and those people make it economically feasible to run them, when you have a lot of sick people the premiums will be too low to cover the illness. This is a classic no win situation for the health exchanges, in that a lot of the people coming on board had no insurance for a long time, are sick because of the sad state of health insurance in this country, yet they become the reason why ACA doesn’t work because they finally are able to deal with their conditions and illnesses. I suspect the penalties for not getting insurance were much,much too low to get more healthy people in the insurance pools, had we done that they likely would have worked a lot better.
My one kid has only one choice of individual health insurance…at all…in his country in his state. NO choice at all. It’s that plan…or no plan. Well…he can go bronze or silver…but it’s the same plan…and the cost differential is about $10 a month.
And the cost really did go up $200 a month…from a low $175 per month to $375 a month. More than double.
Which will drive even more healthy people out of the system, while those that are sick will hang on for dear life (sometimes literally). This is how a death spiral begins, and it was painfully obvious for many people.
@NoVADad99
Don’t confuse people with facts…talk radio proclaimed obamacare caused rates to go through the roof, and according to them, no one ever died or went bankrupt because they didn’t have health insurance or had insurance that didn’t cover much sigh. Problem is, the people who didn’t have health insurance pre ACA were invisible to the many now complaining about the cost of health insurance so it is very easy to claim there wasn’t a problem, and it is also very easy to forget how much health insurance premiums were going up before ACA because most people A)get it from work and B) don’t really pay attention to how much they and their employer are paying, so to them, it was better before ACA.
Part of the problem is overuse. Just today, my mother woke up a little slowly in her assisted living facility. And because she can’t see well, she misidentified the person who came to see her. Instead of waiting a little bit to see, an ambulance was called immediately. So unnecessary.
^Agreed which is probably caused by litigation concerns in a lot of cases. Better order the tests so we cover our butts.
I was watching a movie today and one of the characters spent gobs of time in the hospital after an operation, something that was the norm back in the day when the movie was set. For our own births, many of our mothers were in the hospital for 8 or so days for healthy, normal delivers, yet healthcare costs were manageable back then. What you didn’t have back then was the concerns over litigation and the high costs of malpractice insurance.
TatinG, come on over to the Parents Helping Parents thread. We have a lot of experience helping each other save our parents from unnecessary treatment. You can tell your mother’s assisted living facility not to have her transported to the emergency room, although in your mother’s case that might be overly broad. But anyway, come on over.
Yes, but she’s 2,000 miles away. They did call me but only AFTER the ambulance had taken her away. My dad was out somewhere. He doesn’t have a cell phone.