Report from Singapore

The government has been working with food stall owners to cut the amount of oil and salt used in cooking and persuade them to use brown rice, considered healthier than polished white rice.

Here is more.


So, Singapore is acting like a paternal state?

Is this a test to see how many people don't know what is blindingly apparent about other places?

But consider this strange case - there was a country where the authorities used all the tools at their disposal, from propaganda to laws, to stop people from spitting.

The reason was that before the discovery of antibiotics, the best method to help stop the spread of tuberculosis was to keep those infected from spreading the disease. And of course, the country that did this was the U.S. of a century ago.

'During the nineteenth and early twentieth centuries, tuberculosis (TB) was the leading cause of death in the United States and one of the most dreaded diseases known to mankind.


The National Association for the Study and Prevention of Tuberculosis was formed in 1904 to unify and expand the country's regional anti-tuberculosis programs. Inspired by the identification of the tuberculosis bacteria in sputum, its mission included an aggressive campaign against public spitting. The amazing discovery that bacteria could survive in spit for an entire day even convinced many women to stop wearing their long, trailing dresses into town for fear they might pick up sputum and drag it into their homes.'

Fascinating reading - some societies actually try their best to use all the tools at their disposal to keep their citizens dying from diseases that can be prevented, including blatant propaganda directed at changing how their citizens live, infringing their freedoms - in the case of the article linked above, from spitting where ever one desired, just like they always had before. Strangely, it is now rare to hear anyone to defend the formerly commonplace practice of spitting essentially everywhere in public - government propaganda can have a deep effect on a culture, no question. Or maybe the decline in TB led to a decline in spitting, showing how government propaganda can have a deep effect on stopping a disease vector.

Other societies are more focussed on other things. Such as consistently ridiculing the idea that obesity is not a massive public health concern, easily on the scale of tuberculosis, even as that society's demographers predict that this generation of Americans will have a shorter lifespan than their parents, in major part due to the impact of diabetes among the obese currently under the age of 20.

I didn't realize that one could catch obesity from other people eating fatty foods.

Nope - but someone is going to be paying for all the problems related to obesity. Including a fascinating perspective that the number of young people requiring dedicated medical care in their 20s for problems that are normally seen in people over 60 (severe joint problems leading to severely impaired mobility, for example) will create serious funding needs to take care of such people.

But why talk about things concerning the future - let's look at the past, at the fun facts from this almost decade old report -
'Increasing the average weight estimates impacts airlines because they can’t exceed the weight limits of a plane. That means less luggage or fewer passengers or some combination to get the weight down.

So enjoy those big hamburgers and supersized colas. The FAA is trying to make sure we don’t bring down too many planes because the machines can’t handle the load.'

Or the refitting of seats because Americans, in aggregate, no longer fit in them.

The costs are increasing, and Americans will continue to pay them. Obesity may not be a contagious disease - but its demands on American infrastructure and health care are just beginning.

aircraft having to be recertified because the FAA passenger weight limits are too low

Indeed. If I were European, I would take enormous comfort from the alarming increase in obesity, this peculiarly American trend that allows me to ignore than somewhat less alarming obesity trends in Europe.

Europeans merely substitute a depression epidemic; they don't have succor from tubs of ice cream nor super size potato chips.

"Nope – but someone is going to be paying for all the problems related to obesity. "
Yes, government turns private goods into tragedies of the commons.

I wouldn't dismiss that so quickly

Ha. Nice. So, when the "beautiful people" only hang out with each other, they're not being snobby, just health conscious. And, since obesity is "socially contagious", we should teach our children to shun fat people, lest those fat people cause a "change of norms", to use the authors' phrase, right? Of course not, because that's not a pre-determined outcome that we're trying to justify or rationalize.

Hence, when obesity is asserted to increase everyone else's healthcare costs or airfares, the solution is not to allow insurance companies to charge the obese higher premiums or to allow airlines to charge the obese higher airfares, the solution is to ban or tax soda, even for the non-obese. When the problem, as in the original post, is that fatty foods contribute to (own, not "socially contagious") obesity, the solution is not to recognize that one can simply avoid fatty foods oneself, the solution is to restrict advertisement.

There seems to be a pattern to these food police nanny-state "solutions": they are rarely narrowly targeted to directly solve the asserted problem. Instead, they seem to be deliberately crafted to be *indirectly* and only peripherally related to the asserted problem, so that they can punish some politically disfavored group in the process. "Big Food" and the stereotypical, pop-culture-loving, non-socially-conscious American seem to be the preferred targets.

I had been asking for brown rice at the food stall where I eat regularly but till now they have refused to serve any ("no one else wants brown rice"). Maybe things will change now but I doubt it.

In a vegetable rich diet (Singapore) I don't see brown rice as a big value add. That and white rice tastes so good with curry

Indeed. You need minerals and vitamins, but brown rice is a poor source of them compared to fresh vegetables.

Most of the toxins increasingly found in rice are contained in the hull, much as the agricultural toxins in potatoes are found contained in the skin. Brown rice therefore contains more arsenic, for example. Brown rice isn't a win for health. Less fat and refined carbs is a win. Less rice and more vegetables and lean meat might help.

It's too bad that this paternalism is using outdated, discredited ideas about the root causes of obesity. A rice-and-bread tax would be more useful

Also salt is only shown to significantly increase blood pressure in a population of African-Americans, which are in short supply in Singapore. (That's why different medications are used for AA hypertensives vs. whites, as dramatized in an old House episode.)

Your factoid is based on a Black-White world. Did your study consider the effect on any Asians?

"A rice-and-bread tax would be more useful"

Right, because eating all that rice caused runaway obesity in Japan and China. And all those potatoes made the Irish super-fatties in the 19th century. And those Zulus with the highest carb density diet in the world? Fatties all of them! #not

Low carb is ridiculous on its face. The entire population of the world (other than Eskimos and Masai) lived on a diet that was primarily carbohydrate-based for the last 5,000 years without a significant obesity problem.

You're right that historical experiments are few. Carbohydrates are an inferior good, so most carb-heavy peasant diets were also calorie-poor. Which is causal? Your knee-jerk "ridiculous" is ignorant, but there is certainly some uncertainty here which more mature commenters can appreciate.

However, the few clinical trials of diet have shown low-carbohydrate diets to be superior over the long term for weight loss. And the epidemic of diabetes and metabolic syndrome is suggestive that sugar and simple carbohydrates are a causal factor.

Ultimately more research is needed (and is being performed! In the meantime, diet science is fairly weak and we must make a best guess with regards to our own diets. (Have a donut on me, Brock!) Regardless, the case for state intervention is weak, and the Singapore intervention appears to be based on old biases rather than a best-guess based on the evidence.

"Carbohydrates are an inferior good, so most carb-heavy peasant diets were also calorie-poor."

This is an historically inaccurate statement. There were periods of famine, but generally there was enough for people to eat. That's why populations grew under the Malthusian model - surplus calories. Hunter gathers did not enjoy a calorie surplus relative to agrarian populations, according to the estimates I've seen. (And those estimates were based on modern-day and recent-day hunter gatherer groups in South America, African and the Pacific Islands - not speculative models.)

"And the epidemic of diabetes and metabolic syndrome is suggestive that sugar and simple carbohydrates are a causal factor."

Correlation does not prove causation, but negative-correlation looks really bad for causation. A number of Doctors (such as Joel Fuhrman) use high-carb diets to reverse Type 2 Diabetes.

I agree that diet science is weak, but one thing I'm sure of is that Taubes' "carbohydrate hypothesis" is just as misguided as the lipid hypothesis.

I hadn't heard of Joel Fuhrman before, but according to a summary of his suggested diet ( he recommends only a limited portion of starchy vegetables or grains, and says to "avoid breads and cereals as much as possible." And no fruit juice or sugar. Sounds pretty low-carb to me.

the few clinical trials of diet have shown low-carbohydrate diets to be superior over the long term for weight loss

Could you cite these trials? I haven't seen any longer than a year, which is not long-term. And the advantage at a year is a lot less than the advantage at six months.

What I find ridiculous is to argue what was right in another age and civilization also applies to us.

Ceteris paribus?

Did the Eskimos, Masai, Irish, Zulus etc. lead a sedentary lifestyle substantially similar to us?

Good point, but who is this "us" you refer to?

We just had a discussion on this blog about lactase persistence among Indo-European peoples and its absence in East Asia.

If raising cows and other livestock for milk led to such a rapid spread of a mutation for lactose tolerance, it's extremely likely that populations like ethnic Chinese which have been eating domesticated rice for over 8,000 years are also better equipped for a high-carb, rice rich diet. So, what's good for Singapore may not be good for the U.S. and Europe.

"Right, because eating all that rice caused runaway obesity in Japan and China. And all those potatoes made the Irish super-fatties in the 19th century. And those Zulus with the highest carb density diet in the world? Fatties all of them!"

There's actually an epidemic of diabetes in India and China. It's largely a myth that diabetes is a rich-world disease that afflicts fat American couch potatoes.

This is what is particularly American -

'Diabetes and pre-diabetes have skyrocketed among the nation's young people, jumping from 9% of the adolescent population in 2000 to 23% in 2008, a study reports today.

The findings, reported in the journal Pediatrics, are "very concerning," says lead author Ashleigh May, an epidemiologist with the Centers for Disease Control and Prevention.

"To get ahead of this problem, we have to be incredibly aggressive and look at children and adolescents and say you have to make time for physical activity," says pediatric endocrinologist Larry Deeb, former president of medicine and science for the American Diabetes Association.'

And do note, again, that though this article itself is new, the data is five years out of date. Does anyone seriously think that the problem has declined in the meantime? There is some relevant information about the measurements in the article, and true, diabetes is not exclusively a disease of the overweight. But here is the real kicker -

'Deeb says other research suggests there will be "a 64% increase in diabetes in the next decade," which is even higher than the predicted increase in obesity, "because stress on the pancreas and insulin resistance catches up with people. We are truly in deep trouble. Diabetes threatens to destroy the health care system."

The Pediatrics report also found that overall, half of overweight teens and almost two-thirds of obese adolescents have one or more risk factors for heart disease, such as diabetes, high blood pressure or high levels of bad cholesterol. By comparison, about one-third of normal-weight adolescents have at least one risk factor.'


Salt is absolutely essential to life. You will die without salt in your diet. Drinking too much water isn't the only way to induce hypnoatremia.

There's an amount of salt you need in your system at all times. People with salt levels too high should cut back; people with salt levels too low should add it. There's no way a one-size government solution could ever fit-all, especially since whether an individual is too high or too low in salt can vary from day to day.

What fraction of the general population suffers from "salt-too-low-diet" versus "salt-too-high-diet"? You are falling into the trap of artificial symmetry.

"What fraction of the general population suffers from “salt-too-low-diet” versus “salt-too-high-diet”?"

More than you'd think. I'm good friends with a guy who consults on metabolic conditions professionally, with a focus on diet and lifestyle as both the cause and the cure of their problems. And for many, many people part of the solution is to add salt to their diet. This is especially true of people who have tried to "eat healthy".

"You are falling into the trap of artificial symmetry."

No, I'm not. Even if 80% of the population was too-high in salt, this Singapore policy would be a bad idea for 20% of the population.

The only excuse for this policy is the idea that it's easier to add salt to your soup than remove it. Someone who's regularly hyponatremic can always carry salt around with them, I guess.

We ought to be clear if we object on ideological grounds or utilitarian ones.

If one is ideologically against the government interfering, it might be justified to object to the intervention even a low-salt diet benefited 99% of the population.

OTOH, if the objection is utilitarian I don't see why not change the status quo from a state that favors 20% of the population to one that favors 80%?

What was the _policy_ that favored the 20% again?



Not having a policy is a policy.


Normally, I would reply with something meaningful, but for this one, just listen to yourself for a minute. Would I have gotten anything different if I used the word _law_ instead?

I cook without salt and eat out maybe twice a month. You would have to really concentrate to get a salt deficiency,

I cook with salt and eat out maybe twice a month. You would have to really concentrate to get a salt excess.

Both of you are probably healthy. The body has systems that manage the concentrations of salt. A person with a healthy metabolism can handle fairly wide dosage levels, because the body will just adjust other factors to compensate (such as thirst or water retention).

Which is another reason that this policy is misguided.

The government of Singapore should consult with private corporations in the food industry and do whatever they recommend. The manufacturers have extensive expertise in nutrition and want their customers to live longer so they buy more stuff. The hidden had will look after consumers' health, right? Right?

Well, thats how the US food pyramid and modern dietary recommendations where established.

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