How to Outsmart Your Hungry Inner Couch Potato
This week I am talking to Dr. Tim Church, Chief Medical Officer for Wondr Health (@WondrHealth) a company focused on Digital Behavior change especially focused on the obesity epidemic. Tim has spent a large part of his career focused on this area and as he puts it “bringing the most good for the most people” and he Unveils the Top-Secret Weight Loss Potion, It’s Called Sweat and Tears
We spend a little time looking at the history of the rise in obesity and the important fact that there is no one defining cause or problem. Like me, he views genetics and years of Darwin-based evolution as a big element as our genetic makeup and evolutionary history have programmed our bodies to hold onto weight as a survival mechanism in times of food scarcity.
Unfortunately, as Tim explains our bodies have a natural tendency to defend a certain weight, and as we gain weight, our body adjusts to that new weight as the new normal. This makes it increasingly difficult to lose weight and move back down the scale. The good news is we are having our “iPhone moment” for prevention with new drugs bringing significant effects and our focus will shift from simply losing weight to achieving a specific goal of 15% weight loss which comes with some remarkable health benefits
We discuss the need for more healthcare providers trained in obesity medicine and behavioral health and the importance of leveraging technology and offering scalable solutions to reach and assist a larger number of individuals. But he notes the need for caution with a large presence of fraudulent solutions in the market making it important to advises seek reputable and transparent professionals for guidance
Listen in to hear Tim’s optimism about the future, with the right tools and strategies emerging to help individuals with weight management and how they can be applied to reverse decades of declining health and increasing waistlines.
Listen live at 4:00 AM, 12:00 Noon, or 8:00 PM ET, Monday through Friday for the next week at HealthcareNOW Radio. After that, you can listen on demand (See podcast information below.) Join the conversation on Twitter at #TheIncrementalist.
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Raw Transcript
Nick van Terheyden
And today, I’m delighted to be welcoming Dr. Tim church. He’s the Chief Medical Officer of Wonder health. Tim, thanks for joining me today.
Tim Church
Thank you so much. It’s a great pleasure.
Nick van Terheyden
So if you would set the listeners, on your background, give us a little bit of context of your story to this point, because it bears a lot of relevance to the discussion we’re going to have,
Tim Church
it doesn’t thank you for letting me let me talk about that I am a physician trained in public health and preventive medicine. So my whole view is most good for the most people, I spent most of my career in academic research, I ran a massive research shop, looking at healthy aging, a lot, a lot of things around exercise and everything you can name, and of course, weight loss, everything from behavioral programs, to medications to the mechanisms of weight loss to the role that exercise plays in weight loss and keeping weight off. And, you know, it was through that, that I really got involved kind of with, with corporate America and ways that you can impact lives in a really large level.
Nick van Terheyden
So it feels like almost an inflection point, although I don’t think it is, when we’re talking about obesity. I think that inflection point actually occurred a number of years ago, but it’s almost as if there’s another one because of these new drugs that are on the scene. But before we get into some of that, let’s talk a little bit about the history. I mean, we’ve seen this sort of steady, well, I’m gonna say steady, but at some point, it feels like it’s a hockey stick of increase. You know, I think there were some notable things for me in part of the history, one that stood out because I traveled a lot was when the airline said, right, the average weight is now going from 190 to 200. Because we’ve got to account for this additional weight. What do you think has been happening to cause that and give us a little bit of context of what’s happened in terms of trying to address it over that period of time? Today, starting
Tim Church
off with an easy question. For you, you want to you you want to start a fight amongst researchers throw out there what caused the obesity epidemic. There’s a website that actually lists things that have been considered contributors to the obesity website. Last time I checked it, they’re like 270, I’m going to tell you a fun story. I’m from Salinas, California, I grew up working in a lettuce fields. And so one day, it dawned on me, how does physical labor play into the obesity epidemic. So we actually pulled all the US employment data that we have remarkable data on what Americans do for a living. And in 1950, in 1950, or 1961, added two Americans, their job, they worked, they did physical labor. And if you add up the calories, it was a lot of calories, they’re burning every day. And if you watch from from from from 1960, all the way into the 2000s, the amount of work at work goes down, down, down, down, down, down, and we can calculate how many calories had been removed from the workday. And then we said, alright, well, what does that mean in terms of weight, and we took those calories, and we extrapolated what that would do to weight gain. And it exactly matched the weight gain trends in the US. And so we were able to say, look, you know, we said a little tongue in cheek, but, you know, the obesity epidemic is because no one works at work anymore. We all sit down for lunch. I don’t believe that’s the only cause. But it’s a great example how the environment is changed clearly the food supply has changed. Clearly the components of the food supply has changed. And and in you, to me, it’s a fun debate. But it doesn’t help anybody because we haven’t found kind of the smoking gun so to speak, when it comes to helping people, you know, the other way.
Nick van Terheyden
So I I’m gonna push back a little just because I guess it’s a personal aspect to me when when you talk about smoking gun, but I feel like there is and maybe that, you know, this is part of my bias in terms of answering
Tim Church
say the word,
Nick van Terheyden
right sugar, right,
Tim Church
you’re gonna say is a player is a player, I don’t debate that. You got to remember though, you know, we’re all so different. We all have such different genetics, especially when it comes
Nick van Terheyden
sorry, but if you’ve seen the Life of Brian, you know, we’re not all different.
Tim Church
So, it’s funny, I was telling someone the other day they’re like, you’re like why did they used to focus on fat now that focus on sugar? Because 30 years ago, like the number one predictor of your weight and the number one predictor keeping weight off was the amount of fat Ewing so at that time, like fat was the thing. And then because of carbs coming into into the food supply and sugar coming into the food supply, there was this massive shift, where no, actually sugar content became kind of one of the better predictors of of weight gain and in success when it comes to weight loss. So I agree with you, for a lot of people, carbs are the answer, but not for everybody. And I get this all the time, I cut a bunch of carbs out of my diet, and I’m still gaining weight, what’s going on? I’m like, Well, you’re not a carb sensitive person, you know, you’re actually a fat sensitive person, you need to focus on getting fat out of your diet. So why green fever? For a lot of people? That’s true. I do think it is more complicated than that. And we’ve totally engineered activity out of out of our lives. And it gets worse every year,
Nick van Terheyden
I think, fair points. And, you know, again, it’s partially it’s bias playing in and, you know, some of this is about the SAD diet, you know, the that, you
Tim Church
know, just this is so important, because you can’t, you can’t, when you talk about weight, it’s somewhere around religion and politics and money. And I don’t care what you’re talking about, it comes into play. I like to challenge doctors, I’m like, tell me if your topic arthritis, heart disease, whatever it is, is on the supermarket magazines, as you check out. It’s not mine is yours isn’t it complicates all this, and these these phones and social media, it just makes it worse? Because you know, you spent so much time debulking myths, rather than helping people to get at the truth, which can actually help themselves.
Nick van Terheyden
So could we agree that the causative agents in this case are carbohydrates, fat, protein and exercise? Yes, of course. He says covering all the bases are slippery, but well, so that we can move on to your point. Yeah. And rather than looking at that, thinking about what do we do about it? Well, let’s be clear. You look at the stats, we’ve clearly been an ineffective, you’ve been involved in this for a long period of time? Why is that what’s going on?
Tim Church
Because we’re not meant to lose weight and keep it off. You know, we you look at incretins, these these molecules produced by by the the intestines, and the GI tract. I mean, we incretins didn’t exist when we trained, we didn’t know what GLP one, we didn’t know what amlan was, it didn’t exist, we didn’t understand that these things are actually probably more important than the insulins of the world, the glucagon in the world. And, and so, you know, you’ve that studies have been done. And these are New England Journal studies. And you know, these people lose a lot of weight. And they track them over a year, and they watch what happens to their incretins. And the incretins, that suppress hunger, well, guess what, those go away, and he does a promote hunger, those increase, so the whole setpoint thing, and it kind of, don’t love setpoint, but it’s generally true, your body wants to go back to whatever weight it was at, and you have lots of redundant systems in your brain to make sure you do. And that’s where these medications come in. Now, that’s large amounts of weight, if you’re talking three to 5%, so it’s a 10 pounds, your body doesn’t kick back as much, you know, people can be very, very successful with behavioral strategies, losing 1015 20 pounds and keep that off, it’s when you get up into the 40s 50s 60s 80s. That type of stuff, the body doesn’t like that the body is going to respond. Really good news here, though, is the benefits of weight loss begin at 3% weight loss. It’s remarkable. I mean, you cut your risk of diabetes, you know, by probably close to 50%, which is 3% weight loss, so six pounds of weight loss. And that’s good from a health perspective. But people don’t want to hear that because they don’t want to six pounds of weight loss. You get the point here, there’s a little bit of behavior that results in some weight loss has tremendous health benefits.
Nick van Terheyden
So let’s talk just a little bit about the setpoint. Because I think this is one of the things that I want to be sure that my understanding and the listeners understanding is correct around this, which is as you gain weight each time you reach this new, whatever and it doesn’t matter what the increments are, they’re whatever they are, your body says okay, this is perfect. And any attempt to move off that is actually fought very hard. So it as you gain more and more weight, it becomes increasingly hard to move back down the scale is that
Tim Church
the cement dries, the cement dries as you gain that weight that wet cement dries and that’s the new foundation your body wants to be at. It makes sense from an evolution perspective from an evolution perspective. It would make absolutely no No sense for us to ever want to give up weight. You know, through the centuries, there hasn’t been enough calories. So a body desperately holds on to weight, it would not make sense. If we, you wouldn’t survive, you would pass on your genes if your body was constantly giving up its energy supply for no reason. So it makes sense,
Nick van Terheyden
right? So our makeup and you know, I’m gonna say 1000s, hundreds of 1000s millennia of genomics is pushing us into this feast or famine environment, we’re no longer in it. We’re now surrounded all sorts of contributory factors. And we’ve had very little success to date. Before we get into some of the latest innovations. What is there anything that you’ve learned, small steps, things that have really helped people to benefit and get off that cement to crack the cement at this point, using your analogy,
Tim Church
and you’re not going to believe what I’m gonna say? Give yourself a break. The vicious cycle of shame, the vicious cycle of beating yourself up the vicious cycle of self judgment, it is the number one thing that sabotages people’s attempt at changing their behaviors.
Nick van Terheyden
To say I’m, I’m truly surprised by that, that this is, you know, I’m not gonna call that simple. It’s not really it’s all about, you know, attitude behavior. And, you know, it’s all in the brain, which is where everything starts and finishes. So I’m gonna be a little bit edgy here and say, well, we’ve solved that problem now, because we’ve got some new drugs that are really effects. We do we do. So Game over, man.
Tim Church
Kinda, but not really, in a way the game is just beginning. And let me let me jump into that. Not only do we have new drugs, but by the way, there was three more publications yesterday in New England Journal about new drugs in the pipeline. So So I want to do a few things. One is forget about weight, let’s stop talking about the scale is top talking about your weight. This isn’t about weight anymore, the weight is a given, the new medications are going to produce weight loss. And what you’re going to start seeing is this new magic number of 15% weight loss. That’s it, you’re going to see all the clinical guidelines get rewritten, and they’re all going to say the goal is 15% weight loss. And then this is where it gets staggering at 15% weight loss, say goodbye to hypertension, and 15% weight loss, for getting new cases of diabetes at 50% weight loss and you’re going to reverse slash remission, diabetes at a rate of about 70%. There’s going to be a paper coming out showing a 15% weight loss, you reduced the risk of strokes and heart attacks. By 30%. It’s never been shown. So this isn’t about weight loss anymore, which you talked about earlier. You know, this is I call this the iPhone moment. And people think I’m exaggerating. We’re about to see prevention change in a way we’ve only dreamed about. We I didn’t see it coming in this form. But these medications have to be used, right? And I’ll go with the big three, right medication.
Nick van Terheyden
No, so for those of you just joining, I’m Dr. Nick the incrementalist today I’m talking to Dr. Tim church. He’s the Chief Medical Officer of Wonder health. And we had dived right into the medications and you know, the inflection point or as you call it, the iPhone moment, you know, truly significant. But it’s not as simple as that. And I interrupted you and I want you to hit your three points. So I missed
Tim Church
my cue and I’m embarrassed. No, so the big three, and he starts with there’s simply not enough health care providers trained in doing this. There’s there’s 6700 in the US physicians who are board certified in obesity medicine, that’s nothing There’s 22,000 oncologist so there’s not enough people trained and doing this in which leads to point number one, right medication, right person, right reason, just everybody writing the same GLP one that you see advertised is bad medicine. Because if you’re an emotional eater, that’s not the right medicine for you. There are other medicines for that. You know that we have multiple weight loss medications that are approved out there that produce phenomenal weight loss. Everybody is so fixated with the Olympics and the way gobies right now. They and those are great medicines, but they’re not for everyone. So right medication, right person, right reason. Guess what better outcomes and lower costs. And x number one, number two, you have to have a behavioral program attached to these, you have to just it’s that simple. And it’s not like other medications where it’s kind of nice. This is a mandatory thing. And I’ll give you a few reasons. One is the obvious one, you get more weight loss, and you get longer term weight loss. So that’s good. But you’ve got to address the issue, what is the person’s true challenge to why they there’s different challenges we all face, you know, I’m an emotional eater. I’m a stress eater. I’m a rigid eater, I struggle with sugar. You know, I’m somebody who, who who always has physiological hunger, you have to match the right medication to the right, the right challenges, but you also need to be giving the bullet behavioral strategies for those challenges severe emotional eater, you need to be working on your triggers and why you got there and healthier ways to address that. So you got to get at the root cause. This is really cool, move, move, move move, it is a one plus one equals five, when it comes to movement, and these and these, these medications while you sleep better, you know, you feel better. And the other thing is because these medications are taking care of the calories in, you don’t have to get these obnoxious doses of exercise we used to prescribe, just go and get 100 minutes when we go walking, and everything will be better. The last one is gonna sound a little weird, but stick with me, when you’re losing this much weight. When you’re doing weight loss through a medication that exceeds bariatric surgery, it changes your life and you have to be ready for that. Because we all have expectations about our weight. If I lose this weight, my sister is going to like me more. If I lose this weight, I’m going to get that job promotion. If I lose this weight, fill in the blank, they’re not connected. We’ve learned this with bariatric surgery, if you don’t help people set realistic expectations about what weight means in their life, you’re setting them up for failure, you’re setting them up for really bad things. Another thing people don’t think about. Not everybody in your circles are going to be supportive. They’re called Saba tours. saboteur is very, very common part of weight loss that unless you are in this business you don’t think about, it could come from your best friend, it could come from someone at work it come from a bowling buddy, because you’re threatening, what they perceive is your relationship and their way of life with them. You know, you’re boring buddies might not be happy, because now you’re not eating as much pizza with them as you used to your lunch buddy might feel weird, because you’re not eating the way you used to. So helping people recognize saboteurs, normalized saboteurs. And then giving them strategies for taking the saboteurs and getting them to engage with them and understand their journey. It’s usually not that difficult, it’s really important, but it can be very distressful. If no one’s explained to you what a saboteur is. And somebody somebody in your life is making, you know, your journey real difficult. And the last thing in this is really for employers, unique data. I mean, right now, if you’re, if you local doctor prescribing these things, and you think that your carrier is going to give you usable data, you got nothing, you know, you just don’t I see these reports every day, only thing you get is a price tag. And so you need data, what are people being prescribed? How long? are they sticking to it? Are they doing the behavioral program? Are you getting the results you want? You know, I hate to say it’s this cold, but is your investment paying off because make no mistake, this is an investment, these things are expensive. So you know, top to bottom, you know, right medication, right person takes a really good prescriber, we use World World Class prescribers, who who’ve been doing this for decades. Number two, you’ve got to have a great payroll program. So we do so we’ve always done, you know, we understand behavior, then number three, because we were born in the employer space, we’ve always done this, you got to track and report, you know, transparency is the key to all this.
Nick van Terheyden
So I’m going to essentially, you know, agree with you 100%. On this behavioral health, I think it has to be contributory. I’m going to push back a little on the employer thing, but it’s only again, it’s my I’ll represent my bias. I think employers shouldn’t be involved in the healthcare business at all. Frankly, they should just be out of it and you know, worried about their employees health but not in the way that they are, which is all about cost and you know, those elements, but what strikes me about this is given the essential I mean, almost everything in all of those points you cited was all about mental health or brain health, right? And if I was to talk about any of the other episodes, all I ever hear is, we don’t have those that you said we don’t have the obesity physicians, we sure as hell don’t have the behavioral health. How do we address that is the technologies.
Tim Church
That’s what we do our core weight loss program, you know, our core, our wonder weight loss program, I jokingly say it’s a mental health program that masquerades as a weight loss program. Yeah, we have to take advantage of technology take advantage of offerings like we have, where where you can, you can help hundreds of 1000s people at a time. And you know, what we’ll do is you could say, for some people, this need to be aware of this stuff and be given some strategies for other they need to be like, You know what, it’s time for you to get a referral and go see a true professional. So it’s kind of like, let’s throw this net wide net help as many people as we can. And let’s refer the people who need the specialty care. Now, it’s a challenge you hit, you hit the nail on the head. So
Nick van Terheyden
assuming that we can start to change the way of thinking and you know, it’s really striking the way you highlight that my life’s going to change, obviously, well, not obviously, but not something that ever occurred to me. You know, shocking that that’s even a thing, but clearly is because there’s an expectation, there’s huge change. We’ve got this inflection point, we’ve got these drugs. Do you see light at the end of this tunnel? Are we are we getting the training? Are we getting the research? What are we getting the data, tell us if you can, where we’re going,
Tim Church
I’m very hopeful for the first time of my career. I mean, very helpful, I think we’ve got the right tools in the toolbox to help people with their behavioral programs with his medications. I think we’re currently training enough people to help other people, we’re creating awareness, and you got solutions like ours, that can help hundreds of 1000s of people at a time, as opposed to say, a local doc who can help a couple people at a time. So I’m actually optimistic we’re a little bit not us, the world, we’re in this teenager stage, you know, we’re figuring it all out. But we’re gonna get through the teenager stage. And I’m actually very, very hopeful about this space. And I can’t emphasize this enough, there are so many frauds in this space right now. There are so many frauds, it drives me nuts. So go with reputable people go with board certified people go with proven experience and go with transparency. And you know, of course, it’s obviously what we do, I wouldn’t be saying those things. But but you know, one bad thing that came out of the pandemic is everybody and their brother created an app, and they’re trying to sell it to you. So that’s my one word of caution. While I’m very hopeful about what’s going on, there’s also a lot of this noise going on. So I think you
Nick van Terheyden
hit one of the major areas of concern is sort of teasing out the fluff from the reality, you know, from an individual, and obviously, there’s, you know, employer based, as, you know, large groups, but as an individual thinking about this, do you have any closing thoughts on how to sort of focus this, I mean, you highlighted a couple of things, and I’m just going to re emphasize that 3% At forgiving yourself.
Tim Church
approach this, yeah, at an individual level. Again, first and foremost, give yourself a break. Second of all, don’t take anything off Instagram or Facebook. Just don’t miss this. I read this stuff every night to see what’s out there. And it’s scares me. And then try to attach yourself to the best you can to trained professionals that do this, like us. Who can who can who can show you the past so you can walk down
Nick van Terheyden
and fantastic. Well, unfortunately, as we do each and every week, we’ve run out of time. I think fascinating conversation, very timely, very grateful for your insights, obviously, the long history and indeed, the important guidance and sort of rethinking about this in a way that most people might not. Tim, thanks for joining me today.
Tim Church
And it’s been an absolute pleasure and I don’t want to be too forward but I hope we can do it again.
