Featured article in the Winter 2015 Issue of Nutrition Close-Up; written by John La Puma, MD
Recent approvals of obesity drugs Qsymia (Vivus) and Belviq (Arena) may help clinicians seeking solutions for their overweight patients. But many physicians still remember Phen-Fen with a shudder: heart valve abnormalities in young women put a stop to that off label combo in 1997. Other available diet drugs1 have not performed well enough to help doctors overcome their fear of liability, or help enough patients overcome their fear of failure.
But neither Qsymia nor Belviq take the right direction, and not necessarily because there are concerns about their adverse effects, or their $100-plus monthly cost. Even under the best circumstances, Qsymia produces about a 10% weight loss over one year; Belviq only 5%.
Instead, it’s because prescription drugs for weight loss fall short in more fundamental ways. Seventy percent of cases involving heart disease, stroke, diabetes, memory loss, premature wrinkling and impotence are preventable.2 Sixty percent of cancers and many asthma and other lung-related diseases likely due to environmental causes such as toxin exposure, as well as diet and lifestyle, are preventable too.3,4
Food is the most underutilized weapon we have against chronic disease. Knowing more about what’s in your food, and how it got there, can help you take your health into your own hands. You can stock your kitchen medicine cabinet, save money, and provide joy and energy for you and those you love.
Culinary medicine is a new evidence based field that blends the art of food and cooking with the science of medicine, and is aimed at helping people reach good personal medical decisions about accessing and eating high quality meals that can prevent and treat disease and enhance well-being. Dietitians, physician assistants (PAs), and physicians have special roles to play in the field. Physicians should refer more to dietitians and PAs; all should have training in culinary medicine. Two recent culinary medicine publications: a randomized controlled trial on the effects of oral olive oil on healing time,5 and a review of plant-based diets for those with Crohn’s Disease.6
As we know, too much food has downsides. Obesity-related illness in the U.S. alone now costs more than $190 billion annually, about 21% of annual medical spending. By 2050, 60% of men, 50% of women and 25% of children are predicted to be obese.7 The fastest rate of growth worldwide: Africa. The greatest number of obese adults: China. Some European countries (UK and Ireland) are catching up with America (70% overweight) and Mexico (71% overweight). Australia is already over 60%.
These data are scary, but one solution is not. How well you sleep, how intensely you exercise, how your mindset affects your metabolism, and which foods you use as fuel and which get stored as fat, can all now be beamed to you (and to your friends or coach, if you choose). You can now see, in real time, what you are doing to make yourself healthy and, conversely, what you’re doing to make yourself sick.
The obesity solution I like best is one that makes wellness fun. Mobile technology, tracking companies, and game creators are coming together to do this. The most innovative companies today are developing ways to send to your mobile device your most relevant data—food and beverage intake, activity, weight, sleep, stress response—and combine it with game-like managed competition.8 The objective, of course, is to entice you to compete with your social network for the healthiest lifestyle, and be rewarded along the way with ongoing coaching and other incentives.
Programs such as Apple’s HealthKit, Google Fit and Samsung S Health are ready for take-off. Devices like Fitbit (wristwatch) and wifi smart scales (body comp analysis), and apps like myfitnesspal and runkeeper automatically upload activity data and provide feedback. Heart rate, blood pressure, and glucose levels will soon follow. Devices and apps are changing the landscape of how people can get healthy, and helping them achieve sequential personal bests.
Clinicians should be able to recommend trusted apps, devices and websites, write culinary medicine prescriptions, and know how food, like medicine, works in the body. Clinicians should be able to offer conditionspecific food and lifestyle measures, with tech-enabled tracking support if desired, before recommending prescription medication for most chronic conditions.
Diet drugs have their place, but not first place. A new consciousness about the power of food and cooking, combined with ever-advancing mobile technology, can put care back where it belongs: in the patient’s own hands.
A culinary medicine prescription coupled with technology for an obese nation is new, and potentially profitable. Companies that see obesity as the economic threat that it is—and get it under control in their workforce—will have a powerful tool to increase productivity. The time to fill that prescription is now.
John La Puma, MD, is a board certified practicing internist, professionally trained chef, and New York Times bestselling author. His latest book is REFUEL®, an eating plan for men to boost low T, strength and stamina. Dr. La Puma also hosts a cooking and food shopping nutrition series on PBS, “ChefMD® Shorts.” He is based and sees patients in Santa Barbara, Calif. Visit him online at www.drjohnlapuma.com.
1. Weight-Control Information Network. Internet: http://www.win.niddk.nih.gov/publications/prescription. htm
2. http://www.euro.who.int/en/health-topics/noncommunicable-diseases/cardiovascular-diseases/dataand-statistics (Accessed 12/7/14)
3. Schottenfeld D, Beebe-Dimmer JL, Buffler PA, Omenn GS. Current perspective on the global and United States cancer burden attributable to lifestyle and environmental risk factors. Annu Rev Public Health. 2013;34:97-117.
4. Wright LS1, Phipatanakul W. Environmental remediation in the treatment of allergy and asthma: latest updates. Curr Allergy Asthma Rep. 2014;14:419.
5. Najmi M, Vahdat Shariatpanahi Z, Tolouei M, Amiri Z. Effect of oral olive oil on healing of 10-20% total body surface area burn wounds in hospitalized patients. Burns. 2014 [Epub ahead of print].
6. Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J 2013;17:61-6.
7. Organisation for Economic Co operation and Development (OECD). Obesity Update 2014. http://www. oecd.org/els/health-systems/Obesity-Update-2014.pdf (Accessed 12/07/14)
8. Topol E. The creative destruction of medicine. Internet: http://creativedestructionofmedicine.com/