pork never goes bad posted:

Discendo Vox posted:

caloric intake reduction while sustaining burn 100% reduces weight. I'm not going to dig through all your cites but you essentially shouldn't cite a Kevin Hall article for anything; I was in the room for his ASN keynote in 2019, the man's an embarrassment to the entire field.

pork never goes bad posted:

Do you have evidence for the bolded part, here? You call it obvious but it's definitely not obvious to me given that it's been the predominant cultural position in the West for centuries and a cornerstone of public health advice for just as long but has not made any dent in obesity rates. In fact, given that no population has sustainably reduced average weight as a result of policy efforts, I'd suggest that anything we view as obvious in this debate should be viewed with a great deal of skepticism.

I'd like to argue for a reexamination of our attitudes towards obesity and dieting more broadly, as well as respond to this part of your post. Not everything I say is specifically aimed at you, but since you've been sharing these weight loss drug articles I'm using it as a jumping off point.

Let me first quickly discuss calories in and calories out, the old trope that is usually thrown around in these discussions. If you wish to defend this paradigm, it seems to me that you're trying to say something useful rather than just repeat a truism. That this advice is supposed to be actionable. Thermodynamics is no real help - the human body is not a closed system. If the point is just that if you starve someone long enough, eventually they'll waste away and die, then sure. But I suspect that what you mean by your "obviously," because of your inclusion of willpower, is that calorie restriction is a plausible mechanism for healthy weight loss. It is this point to which I initially respond. Subsequently I will develop a few more points about how we treat overweight in the doctor's office and in public policy, and how we view fat bodies in society.

Starvation response to calorie restriction tends to adjust the calories out side of the balance more than the calorie restriction does in the long term, with no meaningful studies on the long term efficacy of calorie restriction showing sustained and sustainable weight loss but many showing sustained damage to the metabolism. Furthermore, even when dieting does reduce weight, there's not good evidence that it improves attendant health outcomes. Obese people on calorie restrictive diets can present with all the symptoms of anorexia, including heart arrhythmias, amenorrhea, hypokalemia, and severe complications from malnutrition in all major organs of the body. In fact, so called "atypical anorexia nervosa" which can be diagnosed in normal and overweight people is somewhere between 3 and 10 times more common than the stereotypical abnormally thin anorexia nervosa presentations. Calorie restriction is not an effective intervention in obesity, it is not good advice for a doctor to give, and in fact it causes substantial concrete harms.

Overweight and mildly obese people have no lower life expectancy than normal weight people when controlling for confounders like smoking. Overweight people with healthy biomarkers have lower all cause mortality than underweight people with similar biomarkers and lower all cause mortality than "normal" weight people with unhealthy biomarkers. Though this remains contentious, our best epidemiological studies suggest a mild protective effect of overweight on mortality risk. More specifically, though obesity is a risk factor for all kinds of negative health outcomes, in the medical setting every one of these outcomes has more predictive biomarkers which can be directly measured (ldl-c and apoB for heart disease, a1c for diabetes, crp for certain metabolic disorders and cancers, mobility and strength can be directly measured, etc) and which show a far stronger correlation with the outcomes than weight. These are no harder to build public health campaigns around, and unlike obesity there is good evidence that people can affect these biomarkers positively with lifestyle changes. For mobility or cholesterol, for example, increasing exercise improves these markers and their associated health outcomes irrespective of whether weight change. Focusing on weight makes it less likely that we are able to positively improve health.

Weight stigma in the doctor's office contributes to significant avoidance of care by overweight and obese people, resulting in later diagnosis of many chronic and acute conditions including those unrelated to weight. Obese and overweight people are often denied care for unrelated conditions until they lose weight. Anesthesiologists often refuse to work with overweight patients because of systemic and individual anti-fat bias. We have systematically understudied how to provide care for larger bodies and so anesthesiologists are ill equipped to safely sedate larger patients for routine surgeries. Overweight and obese people often have symptoms of physical injuries such as fractures, broken bones, and soft tissue damage from injury blamed on their weight and the underlying physical injury is left untreated. How much all this affects all cause mortality rates and life expectancy is poorly understood and understudied. Weight stigma in the doctor's office also results in chronic over prescription of statins, fibrates, and t2 diabetes drugs to overweight and obese people who do not have biomarker results suggesting their need and for whom studies of these drugs have shown no medical benefit, with resultant side effects and complications of medication contributing to mortality and life expectancy in ways that are also as yet poorly understood. And weight stigma in the doctor's office is the primary reason that eating disorders are both more common and under diagnosed in overweight populations. Finally, weight loss drugs have historically been greeted with fanfare and hailed as being game changing, but there's a reason that we don't have any right now. They all caused far more harm than benefit in the long run. With healthy weight people requesting this new set, I fully expect this story to play out again.

Fundamentally, our cultural paradigm that being fat is unhealthy is, at best, a well meaning oversimplification. We no longer need to measure weight to manage almost any major health condition, telling patients to lose weight is an ineffective intervention that has concrete and measurable harms, and it is my belief that the continued focus on weight and weight loss reflects unjustifiable animus towards the fat body and societal shame about appearance.

Contrastingly, public health campaigns which focus on dietary improvement or exercise have been shown to have meaningfully positive effects on both biomarkers of chronic disease, health outcomes, and life satisfaction in overweight populations. If we care about health, let's talk about health, and let's design interventions that improve health rather than target weight. We are so locked into our fat-phobic paradigm that I will never judge any overweight or obese person for their efforts to lose weight or encourage any specific action by any individual trying to improve their lot in our broken society, but I do mourn a little every time I hear weight discussed in these terms.

I will not cite every point I've made here in detail, though I'm happy to cite any specific point if asked. To get started, here are a few broad citations, though.

On the Energy Balance Model of obesity, showing the paucity of a "calories in, calories out" paradigm for weight loss (though, this model does support the notion that energy balance does determine obesity, it just shows how the naive conception of how this is so is incorrect): https://academic.oup.com/ajcn/article/115/5/1243/6522166

On public policy wrt obesity, this piece by Katherine Mayer should end the debate: https://www.proquest.com/openview/4150738197df3b369a81012fa250b3c9/1?pq-origsite=gscholar&cbl=37325

On weight and health outcomes, https://pubmed.ncbi.nlm.nih.gov/19680230/
https://onlinelibrary.wiley.com/doi/10.1002/jcsm.12378

On the lack of efficacy of diets and calorie restriction, this review by Traci Mann et al is clear: https://pubmed.ncbi.nlm.nih.gov/17469900/

On eating disorders in fat people, Erin Nicole Harrop is a relatively approachable authority: https://scholar.google.com/citations?hl=en&user=ABaxAMgAAAAJ&view_op=list_works&sortby=pubdate

Bar Ran Dun posted:

I was “overweight” by BMI when I was an athlete (I was a captain of the swim team at a service academy). During the training trip, one day I ran ten miles, had four hours of practice in the water(so like a marathon’s worth ) and lifted and was like just one day that week.

We had one guy on the team who was there because he wanted to be a seal. He was built like brick shithouse. I remember later hearing a radio program about him getting to kick box in a prison match in Thailand.

BMI really isn’t any good for looking at athletes weight ratios. Now that I’m old and fat, yeah it accurately reflects my health.

Failed Imagineer posted:

BMI is a population statistic which gets frequently misused as a personal health metric.

PharmerBoy posted:

Something I had never considered until the proximity of the Fox settlement and now the Disney/Florida lawsuit: the state doesn't have the option of settling in something like this do they?

If FL officials are really turning against DeSantis (or say even in a separate hypothetical of a law passed by a previous opposite administration) the state can't just say the other side is right and remove the law without an additional act of congress & executive. Best they can do is just fail to fund a defense and let the other side run the case where they want, which is its own set of dangers.

Discendo Vox posted:

caloric intake reduction while sustaining burn 100% reduces weight. I'm not going to dig through all your cites but you essentially shouldn't cite a Kevin Hall article for anything; I was in the room for his ASN keynote in 2019, the man's an embarrassment to the entire field.

cat botherer posted:

BMI is a good population-level measure, and is accurate on a personal level for the vast majority of people - there's not that many college athletes or people who have unusual muscle mass. There's a lot of people who think BMI doesn't apply to them, because they're totally jacked from using Nautilus machines at the Y a couple times a week so they don't have to stop eating at McDonald's (no shame to anybody, but self-delusion isn't healthy either).

Mellow Seas posted:

I don't know anything about Hall, but I don't think anybody is disputing that. The point is that maintaining 100% burn requires an increase - sometimes a dramatic increase - in activity levels, if you are under caloric restriction. Reducing calories in, all else being equal, also reduces calories out.

pork never goes bad posted:

Can you cite the bolded part showing that this is true in humans who restrict calories as part of a diet? Either you are making a trivially true point that is useless in the discussion of obesity management and public policy related to obesity or you are making a false point.

Re the Hall citation, to make the same point, see this study on Biggest Loser participants.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4989512/

Or see the review by Traci Mann that I cited on the effectiveness of diets.

pork never goes bad posted:

pork never goes bad posted:

Can you cite the bolded part showing that this is true in humans who restrict calories as part of a diet? Either you are making a trivially true point that is useless in the discussion of obesity management and public policy related to obesity or you are making a false point.

Discendo Vox posted:

Not remotely to the same proportion, and caloric reduction remains the actual causal mechanism of weight reduction.

pork never goes bad posted:

Do you have evidence for the bolded part, here? You call it obvious but it's definitely not obvious to me given that it's been the predominant cultural position in the West for centuries and a cornerstone of public health advice for just as long but has not made any dent in obesity rates. In fact, given that no population has sustainably reduced average weight as a result of policy efforts, I'd suggest that anything we view as obvious in this debate should be viewed with a great deal of skepticism.

I'd like to argue for a reexamination of our attitudes towards obesity and dieting more broadly, as well as respond to this part of your post. Not everything I say is specifically aimed at you, but since you've been sharing these weight loss drug articles I'm using it as a jumping off point....

Mellow Seas posted:

The metabolic effects ... seem to increase in severity the more one "yo-yos" - I don't have data on that, I'll see if I can find anything and would be interested in what you know.

Discendo Vox posted:

Weight stigma and mistreatment in a clinical setting is a profound problem, and one that doesn't appear to be consistently addressed in more recent and otherwise beneficial reforms to medical education. While not quite as bad as it was a generation or two ago, most clinicians and treatment guidelines still rely on BMI due to its availability, and instruction on how to address different weight and health scenarios are inconsistent, at best. The scenario Mirotic describes should be less common in younger doctors who have had training around eating disorders, but the other end of the spectrum, on addressing and responding to individuals with higher weight, is really poor.

pork never goes bad posted:

I'm certainly not beginning from Hall's work. I'm beginning from the observation that the dominant paradigms have failed repeatedly and over a pretty long timescale to make a dent in the problem they purport to address. When people talk about the obesity epidemic, the usual reason given for addressing it is the health impacts it has and the costs of those health impacts for society. My fundamental point is that if we want to improve health outcomes, we should use better proxies for health than weight. We have those proxies.

The secondary point I make is that the continued focus on weight causes concrete harms which those who purport to care about obesity fail to account for or adequately study.

Our approach does not work and it does cause harm. We should change our approach. It's fair enough to quibble with the details and citations I provide or tell me that my certainty mismatches the evidence, Discendo Vox, do you disagree with the prior two sentences?

Leon - Try searching "weight stigma and eating disorders" or look at the Tracy Harrop link I posted. She has a lot of work on this. Some clarifications - I said that weight stigma in the doctor's office was the main driver for EDs in overweight people. This was an overstatement. Firstly, I should not have said that it's the main driver. It's a major driver. Weight stigma out of the doctor's office is also a major driver. There may be other drivers. Secondly, weight stigma is also a major driver of eating disorders in non-overweight people.

Mellow Seas posted:

I think the main contributor is cable TV, video games and PCs making sitting on your rear end way, way, way more fun than it ever was in the past. There are a lot of other things about the food supply, increase in sedentary work, etc, that contribute, and yeah maybe even water contaminants or viruses, but I really do think it's mostly all the super awesome cool stuff we can now do with our brains while, physically, doing pretty much nothing.

Like, what would a "couch potato" even look like before the advent of those forms of entertainment? The term wasn't even coined until the '70s before catching on in the '80s. Now the term is barely even used anymore because the behavior it describes is near-ubiquitous.

Mellow Seas posted:

I don't know anything about Hall, but I don't think anybody is disputing that. The point is that maintaining 100% burn requires an increase - sometimes a dramatic increase - in activity levels, if you are under caloric restriction. Reducing calories in, all else being equal, also reduces calories out.

Mellow Seas posted:

I think that as neuroscience advances we will ultimately find that almost nothing anybody does is ever actually their fault. Like, including things that we would all consider inexcusable and indefensible with our current understanding of the brain.

Levitate posted:

Reading books? Not quite as addictive in many ways but when I was younger and had more time I definitely have "wasted" almost entire days sitting on the couch reading. I don't think that was/is quite as common as TV or video game marathons though, people tend to get a bit tired of reading after a bit and get up to move around.

How's that?

just to throw around made up numbers, if you're living a fairly sedentary lifestyle and eating 3k calories per day, and you cut that by I dunno 700 calories per day but don't change your routine (no more exercise, no less activity) how is calories out also being reduced? Is the claim that metabolism slows down and so you don't go anywhere with that? Is there a legitimate source that can be cited about this? e: like I'm actually curious, people say a lot of stuff about "metabolism changes!" but it seems like something incredibly hard to quantify but is used very commonly in all things weight related.

Anecdotally I've always found calories in/out and exercise incredibly effective at losing or maintaining weight. It's often more about finding how to maintain a level of calorie intake and avoiding cravings and such, and tracking every single thing you eat/drink so that you have accurate information. That sucks and is hard for a lot of people and can lead to bad places mentally for some, which is part of why it's all hard to do. I feel like the addictive quality of most snack food etc these days, with high salty and sugary content, is incredibly hard to ignore or eat in moderation. A serving size of crackers or chips or something 1 oz and like 150 calories, but how many people do you think just eat 1 handful and leave it at that?
On top of that you can't think of it as a "diet" where you're doing it for a bit to lose weight and then you can ignore it. It's 100% about changing how and what you eat and developing new habits, not things that you do for a little while. I think that's why a ton of people lose weight and then gain it back...the pressure and lure to overeat is very high with the kind of foods that are common these days and changing your overall diet to stay within a range conducive to weight loss or management at a lower weight is really tough.

Mizaq posted:

How many calories are excreted out of a diet? If you consume 3k calories per day but excrete 800 of them, could you then reduce your caloric intake to say 2.5k calories daily and your body goes into panic and excretes only 300 instead and thus netting you nothing but hunger pangs? Does weight lose research methodically count calories out via excretion like it does via exercise/physical and mental activity? Heck, is mental activity measured?

Edit: semi-beaten by Levitate

quote:

That means during a typical day, a person uses about 320 calories just to think.

Different mental states and tasks can subtly affect the way the brain consumes energy. “If we were to put you in a scanner and we looked at what’s going on [in your brain] while in front of the TV or doing a crossword, your brain’s activity would change if we gave you a demanding task, and it would use more energy,” he says.

quote:

But if you’re hoping to think yourself slim, Raichle says you’re out of luck. While the brain burns a lot of energy, any changes in brain activity and energy use during a tough mental task are minute: “maybe a 5% change against the backdrop of all brain activity,” he says.

Even if you were to keep your brain immersed in difficult mental pursuits all day long, this 5% change wouldn’t add up to much. “Calorie-wise it would be very modest,” Raichle says, adding that you would expend more energy pacing back and forth.

Mellow Seas posted:

I think that as neuroscience advances we will ultimately find that almost nothing anybody does is ever actually their fault. Like, including things that we would all consider inexcusable and indefensible with our current understanding of the brain.

Space Cadet Omoly posted:

As a counselor I don't think this is true. Obviously some things are chemically based which is why I take meds for my ADHD because I can't produce the chemicals my neurotransmitters need for that on my own anymore than a diabetic can produce insulin. However, there's a lot of things that people can change through developing things like better coping mechanisms and emotional regulation. I know this because I've both done it myself and helped others do it.

Levitate posted:

Is the claim that metabolism slows down and so you don't go anywhere with that? Is there a legitimate source that can be cited about this? e: like I'm actually curious, people say a lot of stuff about "metabolism changes!" but it seems like something incredibly hard to quantify but is used very commonly in all things to stay within a range conducive to weight loss or management at a lower weight is really tough.

University of Alabama Researchers posted:

In premenopausal women with overweight, metabolic adaptation after a 16% weight loss increases the length of time necessary to achieve weight loss goals.

Discendo Vox posted:

The claim can be true in a fundamental and broad sense based on external causality, but that's more a question of whether the concept of free will exists. Maybe we should bring some philosophy thread users in here to talk about the problems of compatibilism.

Mellow Seas posted:

Here's a recent study I found, it's limited in scope but supports the principle: https://www.uab.edu/news/research/item/12593-weight-loss-may-take-longer-than-expected-due-to-metabolic-adaptation

For what it's worth, it also matches up well with my anecdotal experience, and that of many others, of maintaining a certain level calorie restriction - yes, really - and yet having my weight loss not stop, but slow down significantly.

quote:

But a middle-aged Republican man from Kentucky described being woke as “an excuse to run rampant and do what you please under a false pretense that you are for a righteous cause.” And an older independent woman from Wisconsin described it as “newfangled gobbledygook” and “a bunch of B.S.”

quote:

‘A country on fire’: New poll finds America polarized over culture, race and ‘woke’

The country’s cultural divides and political divides have become one and the same, according to a new national NBC News poll.

The poll finds stark partisan differences on major cultural issues — racism, accepting LGBTQ people, the term “woke,” and even the fundamental goals of American society.

Half of Americans — 50% — believe society should be promoting greater respect for traditional social and moral values, while 42% say society should be encouraging greater tolerance of people with different lifestyles and backgrounds. That perspective has stayed almost completely stagnant since the poll asked the same question in 2013.

Digging into those numbers reveals a deep partisan divide.

Three in four Republicans say the country should promote traditional social and moral values, while 67% of Democrats want greater tolerance of diverse lifestyles and backgrounds. Independents are split, with 49% picking traditional values and 41% siding with greater tolerance.

“The survey revealed a country on fire, seething with anger at our political leaders and too often at each other,” said Democratic pollster Jeff Horwitt of Hart Research, who conducted the poll along with GOP pollster Bill McInturff of Public Opinion Strategies.

The poll “revealed a country sharply divided on these questions politically, and often ethnicity and generation,” he added.

Americans are also divided on whether their country judges by the content of their character rather than the content of their skin. Significant majorities of Black adults (79%) and Latinos (61%) disagree with that statement, while a slight majority of white adults (53%) agree with it.

Overall, 52% of Americans disagree that the country judges people by the content of their character rather than their skin color, while 47% agree.

While this divide is within the poll’s margin of error, it’s the first time since 2008 the majority of respondents have disagreed with the statement, which evokes the famous declaration by civil rights icon Rev. Dr. Martin Luther King Jr. during his “I Have a Dream” speech.

Asked if American society is racist, 59% of adults agree, with a whopping 79% of Black adults and 69% of Latino adults saying society is racist.

Defining ‘woke’

These partisan divides come as Republican presidential hopefuls have been leaning into the culture wars as they appeal to the GOP base — the field of candidates (and likely candidates) have largely rallied around rejecting “woke” perspectives and promoting restrictions on transgender people, particularly in schools or for gender-affirming care for minors.

Florida GOP Gov. Ron DeSantis, who is widely expected to run for president, often says that his state is “where woke goes to die.” And former President Donald Trump said he’d block any federal agency from trying to “promote the concept of sex and gender transition at any age.”

The poll finds that the term “woke” is well known, with 76% of Americans saying they are familiar with the term, while 22% were not familiar with it. But the country is again divided along partisan lines over what exactly “woke” means, and if it is a positive or negative concept.

Open-ended interviews with those polled show that partisans also differ on how to define “woke.” Democrats describe it as a personal view that expresses empathy and awareness of systemic injustices, while Republicans, and some independents, were more likely to describe wokeness as an agenda promoting far-left priorities.

Being woke means being “filled with empathy and trying to understand other people,” said one older Democratic man from California. A younger female Democrat from the District of Columbia said it means being “mindful of historical inequities.”

But a middle-aged Republican man from Kentucky described being woke as “an excuse to run rampant and do what you please under a false pretense that you are for a righteous cause.” And an older independent woman from Wisconsin described it as “newfangled gobbledygook” and “a bunch of B.S.”

Divides on transgender acceptance

The poll also finds 48% of Americans believe the country has gone “too far” in accepting transgender people. A slightly smaller share of Americans — 43% — believe the country has “not gone far enough in ending discrimination against transgender people.” It’s a divide within the poll’s margin of error.

Again, respondents fell along party lines with 79% of Republicans saying the country has gone too far and 76% of Democrats saying the country has not gone far enough. Fifty percent of independents say society has gone too far, and 36% say it hasn’t gone far enough.

The survey finds that most Americans do not personally know someone who identifies as transgender — just 28% say they themselves, a friend, a family member or a coworker are transgender. Those who fall in that category are more likely to be younger, Democrats and highly educated.

And those relationships, or lack thereof, appear to make a big difference in views on society’s acceptance of transgender people.

Among those who say they know a transgender person, 67% say society hasn’t gone far enough in accepting transgender people and 25% say society has gone too far.

Among those who say they do not know a transgender person, 57% say society has gone too far, while 34% say it hasn’t gone far enough.

quote:

‘A country on fire’: New poll finds America polarized over culture, race and ‘woke’

quote:

NEW YORK (AP) — The first years of the pandemic saw a huge decline in high school students having sex, according to a government survey.

Teen sex was already becoming less and less common before COVID-19.

About three decades ago, more than half of teens said they’d had sex, according to a large government survey conducted every two years. By 2019, the share was 38%. In 2021, 30% of teens said they had ever had sex. That was the sharpest drop ever recorded by the survey.

The Centers for Disease Control and Prevention on Thursday released reports analyzing the latest findings from the survey that looks into risky youth behaviors, including smoking, drinking, having sex and carrying guns.

More than 17,000 students at 152 public and private high schools responded to the 2021 survey. Participation was voluntary and required parental permission, but responses were anonymous.

The CDC also noted declines in students who said they were currently having sex or who’d had at least four sex partners.

The declines clearly had a lot to do with the pandemic that kept kids isolated at home for long stretches and, often, under extended adult supervision, experts said.

“I think these together paint a picture of high school students building fewer strong interpersonal connections that can be protective of good mental health,” said Laura Lindberg, a Rutgers University researcher who studies adolescent sexual behavior.

“This is an opportunity to say maybe teens are having too little sex,” said Lindberg, who was not involved in the reports.

The CDC’s Kathleen Ethier said the decline may be a good thing if it reflects more young people making healthy decisions to delay sex and reduce their number of partners.

“But what concerns me is this is potentially a reflection of social isolation,” said Ethier, director of the CDC’s division of adolescent and school health.

Health officials generally like to see trends that result in fewer teen pregnancies and sexually transmitted infections, but the decline in teen sex coincided with increased reports of social isolation and poor mental health.

The 2023 survey, which will show if the decline was temporary, is currently underway.

Another finding: The proportion of high school kids who identify as heterosexual dropped to about 75%, down from about 89% as recently as 2015. Meanwhile, the share who identified as lesbian, gay or bisexual rose to 15%, up from 8% in 2015, when the survey began asking about sexual orientation.

There were also increases in the proportion who said “other” or that they were questioning or uncertain, the CDC found. The changes may be at least partly related to social changes that have reduced the stigma about identifying as not heterosexual, Lindberg said.

Leon Trotsky 2012 posted:

The youth of today are sexually open chewing tobacco and vaping enthusiast virgins.

pork never goes bad posted:

Can you cite the bolded part showing that this is true in humans who restrict calories as part of a diet? Either you are making a trivially true point that is useless in the discussion of obesity management and public policy related to obesity or you are making a false point.

Mellow Seas posted:

Here's a recent study I found, it's limited in scope but supports the principle: https://www.uab.edu/news/research/item/12593-weight-loss-may-take-longer-than-expected-due-to-metabolic-adaptation

Bar Ran Dun posted:

Frequently is underselling it. They put one on the fat list with extra PT and a diet at the academy based on BMI alone, unless you were an athlete. The pinch fat test and things like neck / chest / waist measurements were the far secondary metric. Most doctors use it first too.

Leon Trotsky 2012 posted:

The youth of today are sexually open chewing tobacco and vaping enthusiast virgins.

Jaxyon posted:

Insurers literally use personal BMI as a cutoff for covering bariatric surgery

Edgar Allen Ho posted:

In no world are you so hard pressed that drive thru at rush hour is saving you time or money compared to a million slow cooker dishes or even slapping together a sandwich at home. HFCS is easily avoidable without paying extra at fancy places, it’s at walmart for store brand prices.