Eat healthy, exercise, don't smoke, stay a good weight.. you will do better than average, on average. I think this is all just a trend of our not healthy culture. If over 10 years everyone gains 10 pounds, your life expectancy is not going to do awesome things.
Anecdotally I notice that a lot more younger people seem to be eating healthy and exercising regularly (although it seems to be two extremes with the other younger people being particularly unhealthy and a lack of people in the middle). Maybe the problem is that the push for healthy eating and exercise in culture has come too late for some people who are now at the age where their bad habits are leading to early death.
I see that too, among the relatively wealthy, well-educated people that make up most of my friend groups and family. However, as a primary care doctor, I can tell you that obesity and type II diabetes seem to be affecting people at a younger and younger age amongst the poor. I'll look for actual data later this afternoon, but that's been my experience and those docs who have been practicing decades longer than me tend to agree.
I've noticed this but left if out of my comment. The reason being that young children generally aren't in control of their diet and exercise so it's probably a result of the parents and where they fit in on the two extremes I've mentioned.
Is there evidence that our culture is becoming less healthy?
A trip to any U. S. major theme park ought to do the trick, preferably one of the ones around Orlando.
It seemed to me that we, meaning the US as a whole, have been building better habits.
I hesitate to pull the "you live in a bubble" card, but I think it applies here. If I looked around me here in Seattle, I might agree with you. Buncha fit hiker/snowboarder types driving Subarus on their way to the xTREME Mudfest This Is Sparta Run Sponsored by Rockstar Energy Drink. You have nothing in your profile for me to go on, so I'll go with assuming you're a 20/30-something bro living around SV who's into running/biking/whatever like all of your friends. You look around and go, "obesity problem? What obesity problem?"
Then I hop on a plane to visit my parents in Florida, and the bubble pops. O...M...G, when did children turn into such butterballs? Oh, that explains it: look at their parents. Pictures of friends in the Midwest? Same thing: when did my classmates get so fat? Again, I don't know your background, but if you're basing your opinion on what you've seen on the west coast, you're doing it wrong.
If you think Florida is bad, try Appalachia. I moved from Orlando to Seattle and earlier this year took a trip to Gatlinburg. The obesity there was just insane.
Good point; sadly it's been a good ten years since I've been near the NC mountains and I've forgotten. I have no reason to think it has improved. Though the fact that the wife and I lost weight when we moved from NC to Seattle ought to tell you something.
Living in urban Northern Virginia (NoVa), I had a similar culture-shock when I moved to NortheEastern North Carolina, a very rural area. All of my coworkers and neighbors were obese, I quickly became known around town as the weird guy who walked everywhere, and at restaurants my friends would make fun of me for eating salads while taking pride in showing off how much food they could eat at one sitting. I once made the mistake of making a critical comment about McDonald's and was accused of "pushing a liberal agenda."
Back in NoVa years later, and the mindset down there still baffles me. Heart disease and diabetes are just kind of accepted as inevitable natural outcomes of aging, and are not seen as the consequences of overindulgence.
Perhaps, changing demographics is also a likely contributor. We have more poor people these days, both through immigration and growing income inequality/stagflation. Poor people can't invest are much time/money/energy into their health. And yes poorer individuals often make bad choices, usually through prioritizing the short-term to the detriment of the long-term, but it's hard to place too much blame on them given the circumstances they find themselves in.
This might be pedantic, but stagflation doesn't describe our economy. Stagflation would indicate stagnant growth and too high inflation. Inflation is currently at 1.6% according to the BLS for the past 12 mo. If anything, that is a little too low due as the Fed's target is about 2%. Growth is also going the correct direction as the Fed is forecasting growth for 2016 of around 1.6-2%.
Does that mean the economy is perfect? Of course not, but stagflation probably isn't the right word either.
You're right, I was using it as a catch-all term which I really shouldn't do.
What I was trying to get at was the trend of rising costs of living with stagnant wages which a lot of people have been seeing for the past couple decades. Need to come up with a good portmanteau for that :)
"life expectancy fell by one-tenth of a year, from 78.9 in 2014 to 78.8 in 2015, according to the latest data. The last time U.S. life expectancy at birth declined was in 1993, when it dropped from 75.6 to 75.4"
"Experts cautioned against interpreting too much from a single year of data; the numbers could reverse themselves next year, they said."
I'd be more suspicious of a completely monotonic data set. "For the first time since 1993" sounds dramatic in a headline but it also means it's only a single data point.
Hard to say but baby boomer obesity is a probably factor. Boomers are reaching end of life ages and their obesity issues are contributing to early mortality. The boomer population is so large that even a small uptick in obesity related mortality will show up in the national average.
Obesity is still a big problem and shaves off years of our lives. I think having an anti-obesity agenda is a wonderful thing and shouldn't be trivialized.
A lot of boomers are reaching end of life ages and dying off, raising mortality. Their obesity issues and the vast number of boomers out there are raising the rate.
You would expect the number of deaths to rise due to demographics, but just the distribution alone should not affect the rate. Now because a group is demographically together, that group of peers may have collectively had a significantly different integrated set of life experiences than previous groups - different food and food habits, different environmental exposures, work environments, etc. (all of which could add up to more obesity). So the dip could be the first sign that those integrated differences add up to a shift.
Though, re: obesity, aren't there a number of papers that seem to say that some extra weight in your latter years may be an indicator of better survivability for some medical events?
It's not very clear, but I think the article discusses that. It says the death rate above 65 is unaffected, so this is not coming from the aging boomers dying off. It's middle-aged people.
I suppose I assume a commentator on hn should have a basic idea of how to interpret statistics.
Of course it's not a matter that last year things were good, this year things are bad.
What this signals is a "tipping point", where the continuous medical and public health improvements that have added to life expectancy (usually for those 60+)can no longer keep up with the various factors causing increased death at a young and especially middle age (how important obesity is among these is another issue).
Well, without mentioning an agenda, stress causes heart disease. Obviously if we could do something so that people could stress less, exercise more, and eat fresh food more often rather than processed food, heart disease would drop and people would die less.
There are quite a few things we could do in this direction.
For example, we could provide mandatory calisthenics classes for people on medicaid - think some sort of watered down military PT class. If you need medicaid, you need to show up daily and do jumping jacks.
Similarly, we could replace food stamps/welfare/etc with a government-issued basket of healthy vegetables, complete with printed instructions on how to cook them.
Utah has been having great success helping the poor with (secularized) Mormon style paternalism. Perhaps the rest of us can learn from them.
>Similarly, we could replace food stamps/welfare/etc with a government-issued basket of healthy vegetables, complete with printed instructions on how to cook them.
While many people don't have good cooking instruments where they live, I do think making at least part of food aid into a direct provision of healthy fruits and veggies, including those which can be eaten raw-at-worst, would be a large improvement. Honestly, at this stage, government-run cafeterias serving healthy food for free to anyone in need would be a massive improvement.
It's a pity that people have such negative feelings about "paternalism" that they'd rather give out food stamps for buying rice and beans at inflated convenience-store prices than actually let the government provide healthy food directly.
One would have hoped Obamacare would have caused an increase in longevity, what with the dramatic decrease in the uninsured. Particularly, the expansion of Medicaid which allowed the poor to gain treatment for chronic conditions like diabetes which they had not had previous access to. But I suppose for that to show up in death statistics would play out over a much longer time scale.
It did, however, affect various subjective measures. People feel good about going to the doctor and having an insurance card even if it doesn't help them.
It's possible there is a long term, small, hard to measure effect, but we have little evidence of it.
Well, "Medicaid substantially reduced the prevalence of depression", which IS a health effect.
It also helped people treat their conditions and illnesses (the increased visits, etc).
What it didn't no is have lifestyle-level health effects ("had no statistically significant effects on blood pressure, cholesterol, or cardiovascular risk") which I don't see why anyone would expect it to have. For one, they just checked after 2 years -- not a significant time unless somebody starts dedicated and determined lifestyle changes.
Those people remained poor and retained their lifestyle habits regarding exercise, food etc (which is what accounts for blood pressure, cholesterol, etc). They just get better access to healthcare.
If Medicare gave them leisure time, a private chef or high end restaurant gift cards, and a personal trainer it would be a different story...
Does that study examine the impact of access to healthcare or the impact of access to healthcare for a group of people that are relatively healthy?
The expansion would have been to people that were earning too much to qualify for Medicaid. That's going to mean they were relatively healthy.
I'm also not real sure that increasing quality of life and financial security is fairly described by the doesn't help them in People feel good about going to the doctor and having an insurance card even if it doesn't help them. I realize you are carefully talking about effects on objective measures of health, but maybe that isn't the only goal of such programs?
It studies the impact on the exact group of people that Obamacare expanded medicaid to.
I agree with you that making people healthier was not the real goal of Obamacare. If it was we'd have passed the "Affordable Gym Memberships and Vegetables Act" (aka "Michelle Obamacare") instead.
Probably just random variance. In particular, that most categories of cause of death increased seems to point at random chance, since they should not correlated strongly. (But this is probably something to watch next year.)
Shouldn't this be exactly the contrary? If you have 10 independent coin flips, the chance of getting 10 heads is < 0.1%, while if they are perfectly correlated, then it simply becomes 50%.
Having 10 independent causes of death going up simultaneously is very unlikely to be caused by random chance. Rather it's an indication of an external phenomenon influencing all causes simultaneously.
The argument is the other way round, they should not be correlated, or if they are correlated they should be correlated in an obvious way, therefore it is likely random chance compared to the situation were suddenly there is a spike in violent death because of nuclear war or something.
Widespread obesity, poor diet, sedentary lifestyles, the uniquely inefficient health care system, wealth inequality, etc, will likely cause overall expectancy to drop further.
Related and interesting:
> "As of 2010, the average, upper-income 50-year-old man was expected to live to 89. But the same man, if he's lower income, would live to just 76, according to the report."
Unimproving: Infrastructure in the US is falling apart, often literally. Nobody wants to pay for bridges, roads, sewers, or flood protection. It's like a return to the 1800s before any of this stuff existed.
Uneducating: The "fake news" problem is the tip of the iceberg. People are celebrating their ignorance as if it's a good thing, that being educated is to lose touch with the real world. It's telling that the flat-earth community, filled with offensive levels of pride in stupidity, thrives in the US.
Unearning: Children are often earning far less than their parents because they're forced into crappy part-time jobs or minimum wage temp work. Those lifetime jobs that parents got in a union or a big enterprise are all but extinct.
>While life expectancy is strongly correlated with income, it's actually uncorrelated with inequality and access to health care.
Or so says one published study, but scientific consensus develops across many studies, responses to them, meta-studies, and over a long period. Here is a counter result for example: https://www.ncbi.nlm.nih.gov/pubmed/15650149
It's difficult to interpret this because the paper defines income throughout the text in terms of income quantile (not absolute, COL-adjusted levels).
And oddly, in the FT, they show a significant negative correlation b/t Gini index and life expectancy in the upper quartile, and not the lower quartile (you'd expect the opposite). In the lower quartile, it is p=0.11, r=0.2; i.e., a nonsignificant positive association between income inequality and income quartile. This suggests the effects of income inequality might actually affect LE in different directions for high and low earners. This would explain why they say in the abstract they don't see a LE-Gini correlation for the distribution as a whole.
The story I would spin is that, within one geographic region, a high Gini actually means that rich and poor are living in proximity and sharing social structures. If you have low Gini in a compact region it likely means everyone there is (uniformly) poor.
IOW, they very likely have a correlation b/t Gini and income levels they aren't controlling for. This is why we use multivariate regression with interactions, not just run a Pearson between every pair of variables. The statistics in this article are really bad. JAMA strikes again.
one interesting note is that life expectancy at 65 years of age did not change, Indicating that the diseases behind the lower life expectancy occur in middle age or younger.
The reasons behind the decrease. [deaths per 100K population]
The heart disease went up from 167 to 168.5
Also'Unintentional Injuries' went up from 40.5 to 43.2.
On the positive side, the contribution of cancer has come down.
It's an imperfect proxy for how well a population is doing. But, yes, yours is a question we should peer into to know whether the presumption of longer life = unqualified good.
That said, in this case, it's believed self-kill and opioid overdosing are contributing to this trend and those are not good contributors.
The quality of available food in the US is a big part of the problem. A recent TED speaker postulates 74% of food in the average US grocery store is spiked with added sugar [1]. We also eat too few vegetables and too much meat in our diets. And those foods are often raised with harmful pesticides and hormones respectively.
I am a discerning shopper, avoid fast food and still get surprised by food that is not good for me. For instance, I put a tiny amount of unflavored, low-fat half & half in my coffee in the morning. I checked the label today and see that it contains corn syrup. In my head, it was just skim milk and cream. Silly me.
Could you post a link to/picture of said half & half? I have a very hard time believing it's legal to call something with corn syrup in it "half & half" (as opposed to "creamer" or something similar).
It's commonly found in "fat-free" or "skim" half & half, along with thickening agents. You're right, it's pretty awful that this crap is labeled as "half & half".
Interesting point that we eat too much sugar (which in turn makes us over eat at meals, and thus become obese). It's like a cultural thing though, maybe we can change it slowly somehow...
I was kind of wondering how this didnt happen earlier.
I have been to US 3 times. NYC, Vegas, San Fran, Los angeles etc. and one thing I noticed was how unhealthy alot of americans lived compared to europe.
Obsese parents together with children as small as 6 years old were all dining at fast-food restaurants eating massive amount of food. The kids were very obese too.
The entire culture seemed for _me_ as its rather normal to eat your dinner at kfc or mcdonalds than making food at home. When we took the flight fra NYC to Vegas we noticed there were more obese people than "regular sized". But when we took fra SF to London it was opposite.
And whats up with the size of the meals served in restaurants? its huuge. alot food for little money. Sometimes we split one dish in between us because it was too much for a single person. The same when we went to movies, we got to choose size of coke and popcorn. So we picked medium coke. Medium is like extra-large in europe.
I think its sad because americans are missing out on really great food. It is the food you cook yourself thats not only healthy but tastes so much better and authentic.
I hope nobody is offended my post but I just felt its an area to improve on.
I agree with most of your post as I am fortunate to have been exposed to food cultures outside the US, but I disagree with this point. Many people either can't or won't cook food that is "authentic" to any reasonable standard especially if it is, to them, a foreign cuisine. This applies in basically every country around the world. That being said, I don't think the goal of good food is to be "authentic" if restaurant critiques are any indication.
I think I left it open to misunderstanding, but what I meant by authentic in this context was "shortest and less-tampered path from nature to ingestion".
Foe example, in restaurants they may have frozen meat for long time or in bad condition. Vegetables and sauces maybe be re-used. Unknown ingredients may be mixed to enhance taste, color or smell.
By authentic you kinda go to your local fishmarket, buy the fish (in here we got fresh non-frozen), buy groceries and make that food the same day. By making the food yourself you know what you are putting inside your mouth :)
sorry for any misunderstanding, English is not my first language.
> And whats up with the size of the meals served in restaurants?
Two things. If you have a (non-fast food) restaurant and want to increase revenue, there aren't too many options. One approach is to increase the size of the meal (eg serve 10% more food but charge 25% more money).
The other is the doggy bag (taking away leftovers with you). You can then reheat that to make another meal.
When I lived in the UK, going to eat at a restaurant was a rare thing (maybe once every few months). On moving to the US I found my colleagues would often eat out three or four times a week, and have leftovers for many of the other meals.
The movies really get you in america. It'll cost you something like $4 for a small and $5.50 for a large (where the large is quite literally 3 times bigger than the small). Of course if you're with an SO you can share the large but when people go alone they just buy the large and plan to drink it the entire day. Same for popcorn. I think you get something like 6-8 times more (because the free refill) when ordering a large compared to small and the cost is less than double.
I noticed that the "top ten cause" chart doesn't have an "other" column, but it looks like that can be computed from the total rates for top ten causes and the total for all causes. If my math is correct, we went from 191.3 (2014) to 191.1 (2015). So I guess the good news is the death rate from unpopular or unexplained causes went down a little. :|
It's another in a long line of examples underscoring massive inequality, but it's about to be made moot by the 100's to 1000's of gigatons of methane (5 GT in the air right now) from just the ESAS going to push global warming into the +4C to +6C range within a decade. Global famines, wars, mass migrations and so on. If a person today doesn't have a completely self-sufficient, off-the-grid refuge in the far north or south, that person is suicidal or a Christian fundamentalist praying for rain.
73 comments
[ 3.3 ms ] story [ 133 ms ] threadI feel that this is an economic issue more than anything else.
How long has it been since you visited a school? It's very depressing to see how many elementary aged children are 20+ lbs overweight.
Obesity is widespread and extreme.
A trip to any U. S. major theme park ought to do the trick, preferably one of the ones around Orlando.
It seemed to me that we, meaning the US as a whole, have been building better habits.
I hesitate to pull the "you live in a bubble" card, but I think it applies here. If I looked around me here in Seattle, I might agree with you. Buncha fit hiker/snowboarder types driving Subarus on their way to the xTREME Mudfest This Is Sparta Run Sponsored by Rockstar Energy Drink. You have nothing in your profile for me to go on, so I'll go with assuming you're a 20/30-something bro living around SV who's into running/biking/whatever like all of your friends. You look around and go, "obesity problem? What obesity problem?"
Then I hop on a plane to visit my parents in Florida, and the bubble pops. O...M...G, when did children turn into such butterballs? Oh, that explains it: look at their parents. Pictures of friends in the Midwest? Same thing: when did my classmates get so fat? Again, I don't know your background, but if you're basing your opinion on what you've seen on the west coast, you're doing it wrong.
Back in NoVa years later, and the mindset down there still baffles me. Heart disease and diabetes are just kind of accepted as inevitable natural outcomes of aging, and are not seen as the consequences of overindulgence.
Does that mean the economy is perfect? Of course not, but stagflation probably isn't the right word either.
What I was trying to get at was the trend of rising costs of living with stagnant wages which a lot of people have been seeing for the past couple decades. Need to come up with a good portmanteau for that :)
"Experts cautioned against interpreting too much from a single year of data; the numbers could reverse themselves next year, they said."
I'd be more suspicious of a completely monotonic data set. "For the first time since 1993" sounds dramatic in a headline but it also means it's only a single data point.
http://www.nejm.org/doi/full/10.1056/NEJMoa055643#t=article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831354/
> Life expectancy at age 65 did not fall, another indication that the diseases behind the lower life expectancy occur in middle age or younger.
http://stateofobesity.org/rates/
Obesity is still a big problem and shaves off years of our lives. I think having an anti-obesity agenda is a wonderful thing and shouldn't be trivialized.
Some data:
http://www.nejm.org/doi/full/10.1056/NEJMoa055643#t=article
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2831354/
Though, re: obesity, aren't there a number of papers that seem to say that some extra weight in your latter years may be an indicator of better survivability for some medical events?
Of course it's not a matter that last year things were good, this year things are bad.
What this signals is a "tipping point", where the continuous medical and public health improvements that have added to life expectancy (usually for those 60+)can no longer keep up with the various factors causing increased death at a young and especially middle age (how important obesity is among these is another issue).
Stress impairs the body's ability to function optimally - think "fight or flight response" vs. "relaxation response" [1].
[1] https://en.wikipedia.org/wiki/The_Relaxation_Response#Fight-...
I think it's probably more accurate to hypothesize that inflammation causes heart disease.
For example, we could provide mandatory calisthenics classes for people on medicaid - think some sort of watered down military PT class. If you need medicaid, you need to show up daily and do jumping jacks.
Similarly, we could replace food stamps/welfare/etc with a government-issued basket of healthy vegetables, complete with printed instructions on how to cook them.
Utah has been having great success helping the poor with (secularized) Mormon style paternalism. Perhaps the rest of us can learn from them.
http://www.npr.org/2015/12/10/459100751/utah-reduced-chronic...
While many people don't have good cooking instruments where they live, I do think making at least part of food aid into a direct provision of healthy fruits and veggies, including those which can be eaten raw-at-worst, would be a large improvement. Honestly, at this stage, government-run cafeterias serving healthy food for free to anyone in need would be a massive improvement.
It's a pity that people have such negative feelings about "paternalism" that they'd rather give out food stamps for buying rice and beans at inflated convenience-store prices than actually let the government provide healthy food directly.
https://www.nber.org/oregon/
It did, however, affect various subjective measures. People feel good about going to the doctor and having an insurance card even if it doesn't help them.
It's possible there is a long term, small, hard to measure effect, but we have little evidence of it.
It also helped people treat their conditions and illnesses (the increased visits, etc).
What it didn't no is have lifestyle-level health effects ("had no statistically significant effects on blood pressure, cholesterol, or cardiovascular risk") which I don't see why anyone would expect it to have. For one, they just checked after 2 years -- not a significant time unless somebody starts dedicated and determined lifestyle changes.
Those people remained poor and retained their lifestyle habits regarding exercise, food etc (which is what accounts for blood pressure, cholesterol, etc). They just get better access to healthcare.
If Medicare gave them leisure time, a private chef or high end restaurant gift cards, and a personal trainer it would be a different story...
Increased visits is a cost (about $1200/recipient), not a benefit.
I agree that we should have run the Oregon experiment a lot longer and tied the implementation of Obamacare to the outcome.
The expansion would have been to people that were earning too much to qualify for Medicaid. That's going to mean they were relatively healthy.
I'm also not real sure that increasing quality of life and financial security is fairly described by the doesn't help them in People feel good about going to the doctor and having an insurance card even if it doesn't help them. I realize you are carefully talking about effects on objective measures of health, but maybe that isn't the only goal of such programs?
I agree with you that making people healthier was not the real goal of Obamacare. If it was we'd have passed the "Affordable Gym Memberships and Vegetables Act" (aka "Michelle Obamacare") instead.
Having 10 independent causes of death going up simultaneously is very unlikely to be caused by random chance. Rather it's an indication of an external phenomenon influencing all causes simultaneously.
Widespread obesity, poor diet, sedentary lifestyles, the uniquely inefficient health care system, wealth inequality, etc, will likely cause overall expectancy to drop further.
Related and interesting:
> "As of 2010, the average, upper-income 50-year-old man was expected to live to 89. But the same man, if he's lower income, would live to just 76, according to the report."
https://www.washingtonpost.com/news/wonk/wp/2015/09/18/the-g...
Uneducating: The "fake news" problem is the tip of the iceberg. People are celebrating their ignorance as if it's a good thing, that being educated is to lose touch with the real world. It's telling that the flat-earth community, filled with offensive levels of pride in stupidity, thrives in the US.
Unearning: Children are often earning far less than their parents because they're forced into crappy part-time jobs or minimum wage temp work. Those lifetime jobs that parents got in a union or a big enterprise are all but extinct.
https://jamanetwork.com/journals/jama/article-abstract/25135...
Or so says one published study, but scientific consensus develops across many studies, responses to them, meta-studies, and over a long period. Here is a counter result for example: https://www.ncbi.nlm.nih.gov/pubmed/15650149
And oddly, in the FT, they show a significant negative correlation b/t Gini index and life expectancy in the upper quartile, and not the lower quartile (you'd expect the opposite). In the lower quartile, it is p=0.11, r=0.2; i.e., a nonsignificant positive association between income inequality and income quartile. This suggests the effects of income inequality might actually affect LE in different directions for high and low earners. This would explain why they say in the abstract they don't see a LE-Gini correlation for the distribution as a whole.
The story I would spin is that, within one geographic region, a high Gini actually means that rich and poor are living in proximity and sharing social structures. If you have low Gini in a compact region it likely means everyone there is (uniformly) poor.
IOW, they very likely have a correlation b/t Gini and income levels they aren't controlling for. This is why we use multivariate regression with interactions, not just run a Pearson between every pair of variables. The statistics in this article are really bad. JAMA strikes again.
On the positive side, the contribution of cancer has come down.
That said, in this case, it's believed self-kill and opioid overdosing are contributing to this trend and those are not good contributors.
I am a discerning shopper, avoid fast food and still get surprised by food that is not good for me. For instance, I put a tiny amount of unflavored, low-fat half & half in my coffee in the morning. I checked the label today and see that it contains corn syrup. In my head, it was just skim milk and cream. Silly me.
[1] http://www.npr.org/2016/11/18/502171330/how-worried-should-w...
Here's an example: https://www.landolakes.com/products/half-half-and-whipping-c...
Obsese parents together with children as small as 6 years old were all dining at fast-food restaurants eating massive amount of food. The kids were very obese too.
The entire culture seemed for _me_ as its rather normal to eat your dinner at kfc or mcdonalds than making food at home. When we took the flight fra NYC to Vegas we noticed there were more obese people than "regular sized". But when we took fra SF to London it was opposite.
And whats up with the size of the meals served in restaurants? its huuge. alot food for little money. Sometimes we split one dish in between us because it was too much for a single person. The same when we went to movies, we got to choose size of coke and popcorn. So we picked medium coke. Medium is like extra-large in europe.
I think its sad because americans are missing out on really great food. It is the food you cook yourself thats not only healthy but tastes so much better and authentic.
I hope nobody is offended my post but I just felt its an area to improve on.
I agree with most of your post as I am fortunate to have been exposed to food cultures outside the US, but I disagree with this point. Many people either can't or won't cook food that is "authentic" to any reasonable standard especially if it is, to them, a foreign cuisine. This applies in basically every country around the world. That being said, I don't think the goal of good food is to be "authentic" if restaurant critiques are any indication.
Foe example, in restaurants they may have frozen meat for long time or in bad condition. Vegetables and sauces maybe be re-used. Unknown ingredients may be mixed to enhance taste, color or smell.
By authentic you kinda go to your local fishmarket, buy the fish (in here we got fresh non-frozen), buy groceries and make that food the same day. By making the food yourself you know what you are putting inside your mouth :)
sorry for any misunderstanding, English is not my first language.
Two things. If you have a (non-fast food) restaurant and want to increase revenue, there aren't too many options. One approach is to increase the size of the meal (eg serve 10% more food but charge 25% more money).
The other is the doggy bag (taking away leftovers with you). You can then reheat that to make another meal.
When I lived in the UK, going to eat at a restaurant was a rare thing (maybe once every few months). On moving to the US I found my colleagues would often eat out three or four times a week, and have leftovers for many of the other meals.
I noticed that the "top ten cause" chart doesn't have an "other" column, but it looks like that can be computed from the total rates for top ten causes and the total for all causes. If my math is correct, we went from 191.3 (2014) to 191.1 (2015). So I guess the good news is the death rate from unpopular or unexplained causes went down a little. :|