Health Insights: Tackling Obesity, Unraveling Healthcare Ownership, and Embracing Time-Restricted Eating

Obesity is a common, serious, and costly disease.

• According to the latest data from the National Health and Nutrition Examination Survey (NHANES), more than 2 in 5 adults (42.4%) have obesity, and about 1 in 11 adults (9.2%) have severe obesity¹. Obesity is also becoming more common in children and adolescents, with nearly 20% of those aged 2 to 18 years having obesity.
• Obesity-related conditions include heart disease, stroke, type 2 diabetes and certain types of cancer. These are among the leading causes of preventable, premature death.
• The estimated annual medical cost of obesity in the United States was nearly $173 billion in 2019 dollars. Medical costs for adults who had obesity were $1,861 higher than medical costs for people with healthy weight.
• Now, 25% or 100 million Americans, have Non-alcoholic Fatty Liver Disease (NAFLD). Non-alcoholic fatty liver disease (NAFLD) is a condition where fat accumulates in the liver. It can cause inflammation and damage to the liver cells, leading to life changing complications:
  • Non alcoholic steatohepatitis (NASH): This is a more severe form of NAFLD, where the liver becomes swollen and scarred. NASH can progress to cirrhosis, which is irreversible and can cause liver failure or liver cancer¹.
  • Cirrhosis: This is a condition where the liver tissue is replaced by scar tissue, reducing the liver’s ability to function. Cirrhosis can cause complications such as bleeding, fluid accumulation, infections, and mental confusion².
  • Metabolic syndrome: This is a cluster of risk factors that increase the chance of developing heart disease, diabetes, and stroke. These risk factors include obesity, high blood pressure, high blood sugar, and abnormal cholesterol levels. People with NAFLD are more likely to have metabolic syndrome³.
  • Cardiovascular disease: This is a term that covers diseases that affect the heart and blood vessels, such as heart attack, stroke, and peripheral artery disease. NAFLD is associated with increased inflammation and oxidative stress, which can damage the blood vessels and increase the risk of cardiovascular disease⁴.

• While you may have heard a lot about the new GLP-1 agonist weight loss medications Ozempic, Wegovy, and Zepbound, these medications are very expensive, averaging $1000/month, and they have significant side effects.  
• A better, cheaper, and more sustainable solution for treating obesity is eating better and getting moving. The timing of our eating (and exercise) may be beneficial as well. See below.

Who Owns Your Doctor?

• Have you noticed that it is hard to get in to see your doctor? Does your doctor’s office seem to have changed a bit? Is it as responsive or personable as it used to be?
• Since the Affordable Care Act of 2009, AKA Obamacare, there has been a transformation of ownership of physician practices in the US.
• According to a recent analysis by the American Medical Association (AMA), the percentage of doctors in the US who were employed was 50.2% in 2020, up from 47.4% in 2018 and 41.8% in 2012¹. In contrast, the percentage of doctors who were self-employed was 44% in 2020, down from 45.9% in 2018 and 53.2% in 2012¹. The remaining 5.8% of doctors worked as independent contractors¹. The AMA attributed the shifts in practice arrangements to factors such as mergers and acquisitions, practice closures, physician job changes, and the preferences of younger and retiring physicians¹. ¹: AMA analysis shows most physicians work outside of private practice
• The above numbers reflect all doctors, including surgeons and specialists, many of whom are the last of the independent holdouts. It is now estimated that 60-80% of Primary Care practices are now owned by another entity, like a hospital, health system, insurance company, or private equity.
• Prior to 2009, most doctor practices were independent where the doctor was the primary owner-stakeholder. Back then, the doctor-owner had an entrepreneurial mindset and the relationship between the doctor and us patients was more directly aligned. These doctor-owners advocated exclusively for us.
• Are todays employed doctors working for you or their employer? What are their incentives?
• It may be helpful to ask who your doctor works for and if that has changed.
• In a later newsletter, I will discuss innovative care models like Direct Primary Care and Advanced Primary Care that likely will be the future of Primary Care.

Take Action: Eat Like Your Ancestors. Eons ago, when we didn't have the modern conveniences of refrigeration and electricity and the 24/7/365 access to food, our ancestors would have to get up and hunt or gather their meals. This took time (and effort) and their first meal likely wasn't until mid-day. A type of intermittent fasting called Time Restricted Eating (TRE) copies this eating schedule. TRE limits your food intake to a certain number of hours each day, such as 8 to 10 hours. Conveniently, most of your fasting period is when you are asleep which makes it easy. Personally, I eat only between 11-8. The benefits of TRE are significant:

• Weight loss: TRE may help you eat fewer calories and lose weight by reducing the time window for eating.
• Improved blood sugar levels: TRE may improve insulin sensitivity and lower blood glucose levels, especially in people with prediabetes or diabetes.
• Better heart health: TRE may lower blood pressure, cholesterol, and inflammation, which are risk factors for heart disease.
• Enhanced gut health: TRE may alter the composition of the gut microbiota, which may affect metabolism and immunity.
• Anti-aging and anti-cancer effects: TRE may activate cellular pathways that protect against oxidative stress, DNA damage, and inflammation, which are involved in aging and cancer.
• It gives your liver and pancreas a rest and may put you in ketosis each day where you burn fat for energy and not glucose. 

Here are some beginners tips for TRE:

• Start with a longer eating window, such as 12 hours, and gradually reduce it to 8 or 10 hours as you feel comfortable.
• Choose a time window that suits your lifestyle and preferences. For example, if you are a morning person, you may prefer to eat from 7 a.m. to 3 p.m. If you are a night owl, you may prefer to eat from 12 p.m. to 8 p.m.
• Drink plenty of water and calorie-free beverages during your fasting period to stay hydrated and prevent hunger. Hot drinks, like black coffee or tea, fills the stomach. 
• Eat balanced and nutritious meals and snacks during your eating window to meet your energy and nutrient needs.
• Avoid overeating or bingeing during your eating window, as this may negate the benefits of TRE and cause digestive issues.
• Listen to your body and adjust your TRE plan as needed. If you experience any negative side effects, such as fatigue, headache, or mood swings, you may need to increase your eating window or stop TRE altogether.
• If you are a diabetic, seek a doctor's advice prior to starting..

Matt McCord, MD Founder, Benesan

Disclaimer: I am not your doctor. We don’t have that kind of a relationship. The information shared here should not be viewed as medical advice. For that matter, no newsletter should ever be viewed as medical advice!