Americans have become the unhealthiest people in the world. They are taking more drugs than ever before, more are obese, and lifespans are shortening. In 1900, the average life expectancy for Americans was 47 years, and by 2019 it reached 79 years. But in 2020, U.S. life expectancy dropped to 77 years and in 2021, further dropped to 76.4 years, according to the CDC. (Murphy SL, Kochanek KD, Xu J, Arias E. Mortality in the United States) In fact, life expectancy in countries like Columbia is higher than in the U.S. (Lauren Irwin. US trailed dozens of developed nations for average life expectancy: research. The Hill November 7 2023 https://thehill.com/policy/healthcare/4298072-us-trails-developed-nations-average-life-expectancy/#:~:text=The%20U.S.%20ranked%20in%20the,around%20the%20world%20fell%20by%20 )
One of the major contributors to this downhill trend is the abandonment of personal responsibility for health, and the search for quick fixes like drugs and supplements and diets that lead to fast weight loss. Here’s what the quick fixes have in common: They don’t work, and they often make things worse. Take GLP-1 inhibitors for weight loss, for example. Wellness Forum Health has advised against these drugs since they were first approved in 2014, stating that they would lead to worsened health and even increased obesity in the long term. They were right. Recent evidence shows that while short-term weight loss is significant, changes in body composition while taking the drugs lowers metabolism and leads to other concerning health issues.
You might have seen Sharon Osborne in the news lately, sharing about her health situation due to taking this drug for weight loss. She knew nothing, nor was informed of, the terrible risks and side effects. Ozempic is a Type 2 diabetes drug, not to be used for weight loss.
According to trial results published in the New England Journal of Medicine, about 40% of the weight lost while taking GLP-1 inhibitors is muscle mass. Muscle burns more calories than fat – 14 calories per pound per day vs 3 calories per pound respectively. (Zurlo F, Larson K, Bogardus C, Ravussin E. "Skeletal muscle metabolism is a major determinant of resting energy expenditure." J Clin Invest 1990 Nov;86(5):1423-1427)
Loss of muscle mass can lead to physical instability and weakness, which can lead to disability and an inability to live independently. Frailty is one of the most common reasons for ending up in nursing homes. No one aspires to spend their final years in one of these places, but if you are not physically capable of living on your own, this is where you will end up.
When patients stop taking GLP-1 inhibitors, either due to economic factors, side effects or both – the rebound weight gain is fast and significant, and the person is even worse off than before taking the drug.
Maintaining a lean body is advantageous for health for several reasons, including:
People who have muscular bodies have a higher basal metabolic rate, which results in higher calorie burn, as mentioned before.
Muscles use glucose for energy, which helps with glucose control, which is particularly important since most obese people are diabetic or on their way to becoming diabetic.
Skeletal muscle serves as an endocrine organ, regulating hormones including those that enhance energy expenditure.
When patients stop taking GLP-1 inhibitors, either due to economic factors, side effects or both – the rebound weight gain is fast and significant, and the person is even worse off than before taking the drug.
Maintaining a lean body is advantageous for health for several reasons, including:
People who have muscular bodies have a higher basal metabolic rate, which results in higher calorie burn, as mentioned before.
Muscles use glucose for energy, which helps with glucose control, which is particularly important since most obese people are diabetic or on their way to becoming diabetic.
Skeletal muscle serves as an endocrine organ, regulating hormones including those that enhance energy expenditure.
The bottom line is that we can expect that the new weight loss drugs are going to create to a bigger problem than the mess created by opiates. Millions of people are taking them, and their weight loss is temporary at best. At some point, both the cost and the side effects will result in discontinuation for many, if not most. Companies with self-funded health plans are already starting to exclude coverage for them due to the expense. And multiple lawsuits have already been filed for injuries and deaths related to the drugs. In the future, doctors and medical centers may refuse to prescribe them due to liability concerns. What will happen to people who opted for this quick fix? They won’t just be back to where they started from, but worse off – because it will be even harder for them to lose the excess weight they’ve carried for a very long time.
The quick fix is never a real fix. It just postpones doing the things that have been proven to improve health – changing thinking patterns, adopting new diet and lifestyle habits, and taking responsibility for self. (Pam Popper, Wellness Forum Health)
TORTILLA SOUP
Whether it is Cinco De Mayo or not, this uncomplicated and easy to make soup hits the spot even in warm weather
Ingredients
8 cups Veggie broth, I cup cooked rice, 1 can black beans, 1 can Ranchero beans, 1 can crushed fire roasted tomatoes.
1/2 red onion, 4 cloves garlic, 2 carrots sliced
Spices: Cumin, Tumeric, Chile powder, salt, pepper
Sweat the chopped onions and garlic in a little veggie broth. Add the spices (I used about a teaspoon each of the Cumin, Tumeric and Chile powder. You can add more later after tasting.)
Add the broth and let simmer about 20 minutes. Drain the black beans and add to broth. Add the ranchero beans with sauce included. (I use the 365 brand from Whole Foods. It’s cheap) Add the tomatoes. Simmer another 20 minutes.
Add as much of the cooked rice as you like. Less rice makes it more “brothy.” Top with fresh cilantro, a toasted tortilla, and avocado if you like!
According to a systematic review and meta-analysis that included 42 studies and almost 47,000 patients, cancer patients with high levels of muscle strength and cardiorespiratory fitness (CRF) had a lower risk from death from any cause. This relationship held true even for patients with advanced-stage cancers. All-cause mortality decreased by as much as 46% for patients who were fit, when compared with patients who were weaker and had lower CRF.
The authors wrote: "Assessing physical fitness, particularly muscle strength and CRF, is crucial for predicting mortality in cancer patients. Implementing tailored exercise prescriptions to enhance these physical fitness components throughout the cancer continuum may contribute to reducing cancer-related mortality."[1]
An even larger systematic review and meta-analysis included 12 studies with 1.3 million cancer patients and examined the relationship between muscle strength, CRF and cancer mortality. This review showed that muscle strengthening activities were associated with a 13% lower risk of mortality, and that mortality was even lower - 28% - when aerobic activity was included.
The authors wrote that this was likely based on several mechanisms:
Changes in body composition which lowered body fat. Excessive body fat is a risk factor for cancer.
Higher body fat also contributes to insulin resistance, which in turn leads to higher levels of insulin-like growth factor (IGF-1). Insulin and IGF-1 can increase cell proliferation and reduce cellular apoptosis.
Weight loss: obesity is correlated with negative changes to the intestinal microbiome, which results in increased production of pro-inflammatory molecules and hormones including estrogen.
Strength training increases muscle mass, which improves glucose control and improves immune function.
Physical activity improves circulation which reduces hypoxic environments in which tumors can thrive.[2]
A large body of evidence from many sources supports exercise as an integral part of a strategy for surviving cancer. Kelly Turner is the author of Radical Remission : Surviving Cancer Against All Odds. The book resulted from her interviews with almost one thousand patients with advanced cancer who survived. While they collectively used dozens of strategies, they all used nine, which were described in detail in the book. She subsequently started the Radical Remission Project to train coaches, conduct research, and gather even more survival stories. After she and her team worked with cancer patients for a few years, she added exercise and movement as the tenth important strategy that increases survival.
Many cancer patients are unhealthy and lack fitness at the time of diagnosis. Instead of encouraging them to improve their health and become fit, oncologists often insist that diet has nothing to do with cancer risk or survival, and many discourage physical activity, instead advising patients to rest. Friends and family often agree.
This was the case for Ruth Heidrich, one of the reality patients who appeared in the hit film Forks Over Knives. Ruth was diagnosed with metastasized breast cancer in her 40s. She not only survived, but thrived thanks to adopting a plant-based diet as recommended by Dr. John McDougall, and vigorous exercise. She said in the film that her friends were telling her, "Ruth, you’re a cancer patient, you should be resting." She responded, "I just knew that if I built a strong body, I could beat this." And she did, going on to compete in triathlons and run marathons well into her 80s.
Pam Popper, President
Wellness Forum Health
[1] Bettariga F, Galvao D, Taaffe D et al. "Association of muscle strength and cardiorespiratory fitness with all-cause and cancer-specific mortality in patients diagnosed with cancer: a systematic review and meta-analysis." Br J Sports Med 2025 Jan; published online ahead of print
[2] Nascimento W, Ferrari G, Martins CB et al. "Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies." Int J Behav Nutr Phys Act 2021 May;18:69
An article posted on Medscape compared the results of plant-based eating, bariatric surgery, and drugs like GLP-1 inhibitors for weight loss to determine which option led to the most long-lasting results. The clear winner: plant-based eating.[1] The article included data from several studies to support this conclusion. A systematic review and meta-analysis showed that 49% of patients who underwent bariatric surgery regained at least some of the weight they lost, and many patients regained a significant amount of weight. Those who were the worst off had Roux-en-Y bypass surgery, with 64% of those patients regaining weight.[2] I’ve written before about the dismal results for GLP-1 inhibitors, and the author of the Medscape article shares my concerns. One trial showed that patients taking the drugs lost weight, but one year after discontinuation, participants regained 2/3 of their weight back.[3] This is not surprising. Permanent weight loss can only take place when people commit to changing their habits, when they learn to make time for self-maintenance, and when they develop a normal relationship with food. Obviously, drugs cannot and do not result in these types of changes. Additionally, the side effects are heinous. Side effects include low blood sugar, nausea, heartburn, vomiting, stomach pain, diarrhea, constipation, sore throat, symptoms of stomach flu, dizziness, thoughts about self-harm, signs of thyroid tumor-like swelling or lump in the neck or trouble swallowing, symptoms of pancreatitis, gall bladder disease, kidney disease, and stomach paralysis.[4] The meds increase the risk for vision loss, which is not usually regained after discontinuation.[5] All of this sounds dismal, but there is a much better way to lose weight – plant-based eating, as the Medscape author concludes. A five-year study led by Dean Ornish, and published in 1998 compared a group of patients who consumed a plant-based diet, engaged in aerobic exercise, received training in stress management, and who had group support with a usual-care control group. The plant-based group lost almost 24 pounds at the end of one year and kept over half of it off 5 years after the intervention. The control group experienced worsening health with continued progression of coronary atherosclerosis.[6] Another study compared outcomes for patients who were obese or overweight with at least one comorbidity. One group consumed a low-fat whole food plant-based diet while the other received standard care. At 6 months, BMI reduction for the plant-based group was 4.4 vs 0.4 for the standard care group.[7] Other studies have shown similar results,[8] [9] and many report not only weight loss, but lower plasma cholesterol, lower blood pressure, reduced fasting glucose levels and other improvements in markers of health. These studies are over 20 years old, and none of them included portion control, which people do not like and almost never maintain. We don’t need more research; rather we just need to pay more attention to the existing body of evidence for guidance on how to help patients lose weight and improve their health. A major impediment is that there is so much less money to be made teaching people how to eat plants than there is in making, distributing and prescribing drugs. This can be changed, however, by forcing medical institutions and health professionals to follow informed consent laws. There are two ways to accomplish this; one is to teach patients to demand objective information from their providers BEFORE making any health-related decisions in non-emergency situations. We teach our members to do this on their own since real INFORMED discussions rarely take place in medical offices. The other option is lawsuits against health professionals and institutions that do not do this. If failure to make informed consent an integral part of medical care becomes expensive enough, providers and institutions likely will change. In the meantime, here is what a doctor SHOULD tell an overweight or obese patient about his/her situation and choices. "I’m concerned about your weight, because it places you at significantly higher risk of coronary artery disease, cancer, diabetes, musculoskeletal disorders, and premature death. I strongly encourage you to do something about this before it gets worse. There are three options. I’ll tell you about each and then send you home with some written material to study. #1: Bariatric surgery. There are significant side effects, and you will likely gain back some or all of the weight you lose. You will suffer from severe nutritional deficiencies that cannot be resolved with supplements. You will eat tiny amounts of food for the rest of your life and if you revert to eating larger portions you will feel sick for a while, stretch out the stomach again, and end up back where you started from. #2 Weight loss drugs, like GLP-1 inhibitors. Side effects include low blood sugar, nausea, heartburn, vomiting, stomach pain, diarrhea, constipation, sore throat, symptoms of stomach flu, dizziness, thoughts about self-harm, signs of thyroid tumor-like swelling or lump in the neck or trouble swallowing, symptoms of pancreatitis, gall bladder disease, kidney disease, and stomach paralysis. If you stop taking the drugs, you’ll likely regain most if not all of the weight you lost, and the side effects may not go away. #3 I can teach you how to eat delicious, low-fat plant food 3-6 times per day – as much as you want of it. You’ll need to invest some time in learning how to do it right, and how to shop and cook. You’ll have to change your mindset about food, and perhaps address psychological issues that cause you to overeat. But if you do this and stick with it, you’ll achieve normal weight, and if you are taking drugs for conditions like blood pressure and type 2 diabetes, you will probably be able to discontinue them. Which would you like to do?" I think most people would choose option three. From Pam Popper, President Wellness Forum Health [1] Betya Swift Yasgur. Nutrition, Drugs, or Bariatric Surgery: What’s the Best Approach for Sustained Weight Loss? Medscape Jan 10 2025 https://www.medscape.com/ [2] Reis MG, Guimaraes LF, Moreira G et al. "Weight regain after bariatric surgery: A systematic review and meta-analysis of observational studies." Obesity Med 2024 Jan;45:100528 [3] Wilding JPH, Batterham RL, Davies M et al. "Weight regain and cardiometabolic effects after withdrawal of semaglutude." Diab, Obes, Metab 2022 Apr;24(8):1553-1564 [4] https://www.drugs.com/ozempic. [5] Hathaway JT, Shah MP, Hathaway DB. Et al. "Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglitude." JAMA Ophthalmol 2024 Jul;142(8):732-739 [6] Ornish D, Scherwitz LW, Billings JH et al. "Intensive Lifestyle Changes for Reversal of Coronary Heart Disease." JAMA 1998;280(23):2001-2007 [7] Wright N, Wilson L, Smith M, Duncan B, McHugh P. "The BROAD study: A randomised controlled trial using a whole food plant-based diet in the community for obesity, ischaemic heart disease or diabetes." Nutr Diabetes 2017 Mar;7(3):e256 [8] Barnard N, Scialli A, Turner-McGrievy G, Lanou A, Glass J. "The effects of a low-fat, plant-based dietary intervention on body weight, metabolism and insulin sensitivity." Am J Med Sept 2005;118(9):991-997 [9] Barnard N, Scialli A, Turner-McGrievy G, Lanou A, Glass J. "The effects of a low-fat, plant-based dietary intervention on body weight, metabolism and insulin sensitivity." Am J Med Sept 2005;118(9):991-997 |
The Centers for Medicare and Medicaid Services (CMS) 2022 National Quality Strategy is described as an "ambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals." This sounds great, and it would be if there were any possible way for this initiative to fulfill its promise. But, as with many programs operated by the government, high-quality outcomes are not likely to occur..
Most doctors and most patients know that diet, exercise, hydration, sleep, and other lifestyle factors are important determinants of health. Clinical practice guidelines for many conditions include recommendations that diet and lifestyle intervention should be the first and is the best treatment. Many studies have shown that type-2 diabetes can be reversed with a whole food plant-based diet (WFPB).[1] [2] Long-term adherence to a WFPB diet has been shown to result in atherosclerotic regression, reduction in angina and reduced risk of cardiac events, even in people who have been diagnosed with severe coronary artery disease.[3] [4]
So why aren’t more doctors spending more time during office visits to discuss these types of health improvement strategies with their patients? The answer might surprise you. Quality measures used to evaluate the performance of doctors and reimbursement schedules do not take into consideration issues such as improved health outcomes and reduced costs of care. For example, adherence to medication is rewarded, even if the patient does not experience any health improvement at all. Diet and lifestyle education requires more time than most medical institutions allocate for patient visits, which further incentivizes prescribing instead of engaging in meaningful discussions about health.
Thus, in most cases, patients are not informed about diet and lifestyle change as an option or an alternative to medication. A commonly held misconception is that most Americans would rather just take a pill than change their diet and increase their exercise. But the reality is that this choice, along with the risks and benefits of both options, is not presented to most patients most of the time.
Lifestyle medicine is now a medical specialty, and since certification began in 2017, 2500 physicians have become board-certified. In addition to the limitations already mentioned, a survey found that over half of lifestyle medicine clinicians receive no reimbursement for offering such services. And some programs that are eligible for reimbursement offer so little money that clinicians cannot afford to spend time on them.[5]
One program that is reimbursed adequately is intensive cardiac rehabilitation. It’s underutilized and one of the reasons may be that patients are required to co-pay for visits. For the program to work, visits need to be scheduled frequently, increasing the expense to patients, and creating yet another barrier to real health improvement.
One of the best illustrations of just how dysfunctional the current system has become is what happened to a lifestyle medicine family practice physician who prescribed lifestyle change instead of a statin drug to a patient with hyperlipidemia. Within just three weeks, total cholesterol dropped from 226 mg/dl to 171 mg/dl and triglycerides dropped from 132 mg/dl to 75 mg/dl. This was obviously a great outcome for the patient. But the CMS 5-Star Rating System assigned the physician a Grade C, which placed the doctor’s previous 5-star rating at risk. The reason was that scores are largely based on medication compliance. The physician was penalized even though the outcome was much better than would be expected from treatment with a statin.[6]
There are other ways the system can punish doctors for curing people. The sicker the patient, the higher the reimbursement rate from Medicare, because it is assumed that care will cost more. The physician who reverses type 2 diabetes with diet is penalized because diabetes is no longer listed as a condition the patient has, so Medicare pays the doctor less money. In other words, Medicare pays doctors to manage, not reverse disease.[7]
There are now over 2500 quality measures for doctors to pay attention to, and curing people is not one of them. This sad state of affairs reinforces our advice that consumers must take responsibility for their health and should not outsource decisions about treatment to their doctors.
[1] Anderson JW. "Dietary fiber in nutrition management of diabetes." In: G. Vahouny, V and D Kritchevsky (eds), Dietary Fiber: Basic and Clinical Aspects." Pp.343-360. New York: Plenum Press,1986.
[2] De Natale C, Annuzzi G, Bozzetto L et al. "Effects of a Plant-Based High-Carbohydrate/High-Fiber Diet Versus High–Monounsaturated Fat/Low-Carbohydrate Diet on Postprandial Lipids in Type 2 Diabetic Patients." Diabetes Care 2009 Dec;32(12):2168-2173
[3] Ornish D, Scherwitz LW, Billings JH et al. "Intensive lifestyle changes for reversal of coronary heart disease." JAMA 1998 Dec;280(23):2001-2007
[4] Esselstyn CB, Ellis SG, Mendendorp SV, Crowe TD. "A strategy to arrest and reverse coronary artery disease: a 5-year longitudinal study of a single physicians’ practice." J Fam Practice 1995 Dec;41(6):560-568
[5] Padmaja Patel MD. How PCPs Are Penalized for Positive Outcomes From Lifestyle Change. Medscape October 13 2023
[6] IBID
[7] IBID
Pam Popper Wellness Forum Health
