Random Thoughts: Health Insurance vs. Nutrition Advice

This is going to be a bit of a ramble, today, sorry: since I broke another personal weight marker last week (in the right direction, of course), it got me musing on healthcare in general and health insurance in particular.[1] I.e. very personal PoV, today.

Despite huge gains in life expectancy and reduced mortality due to infectious diseases – i.e. the things where medicine can find relatively “easy” solutions – the not-so-easy causes of mortality such as cancer, heart disease, Type 2 Diabetes (T2D), Alzheimers and many others, often called the “diseases of civilization” are steadily increasing. All these diseases are likely linked through an underlying condition, Metabolic Syndrome or Syndrome X, of which obesity is also a symptom. [3] Obesity is the outward sign of all these diseases, so let’s have a look at that. Here’s the chart for the U.S.[4]:

See that sharp break between 1974 and 1980? That’s when the first official Dietary Goals report was published, demonizing fat (especially saturated) and red meat and advising a high-carb diet for all ages. It worked: consumption of satuated fat and red meat has dropped, and we are eating more fruits and vegetables, and carbs than ever. As a reward, we are also fatter than ever…

But that’s because we are also eating more and are lazier, right? Well, no. It is becoming increasingly likely that the Calories-In-Calories-Out theory of weight is wrong. While it is certainly true that you can only lose weight if your body uses more energy than it stores and vice versa, this is not something you can control by willpower, at least not over the long term. You can’t outrun a bad diet.

The original dietary guidelines were never based on science, and most authorities are quietly dropping the recommendations one by one, e.g. the ban on fat or dietary cholesterol. Which brings me to the point of my post: I can understand why many stakeholders in the healthcare game are not willing to change their stance, ranging from caution to cynicism. But health insurers are in a special position. When people get healthier, it’s a real win-win – insurers spend less money and their customers/members, well, live longer and better. So why promote failed treatments like “exercise more” instead of those that work such as “eat real food”?

An example: T2D is a disease of insulin resistance, i.e. the body has enough insulin, but it cannot go anywhere. The obvious treatment would be to try to improve sensitivity to insulin through diet change (low carb and/or fasting), and that treatment actually works to reverse T2D. Yet instead the treatment that isn’t working – lowering insulin levels per drugs – is the one most prescribe.[5] What if insurers started saying “sorry, doctors, please start following what actually works (and the science)” and payed only for that?

Ok, this was longer than I thought and wanted – there are good books on this topic, minus the health insurance angle, though, which was why I was wondering. My musings from earlier this year still stands: there is a lot insurers could do per wearables etc to support their customers in getting healthier. Using (or even promoting) the best available science´would be even better. How about funding a high quality study, e.g. via NUSI.org?

Btw., I am now at 60 (US) pounds weight loss, and somewhere around 12-13% body fat…

[1] Total tangent: did you know that in German, it is called “illness insurance” (Krankenversicherung), not health insurance? Actually makes more sense, since illness is your insured event. [2]

[2] I know, life insurance is that way around, too. AFAIR, that’s because death insurance sounded too macabre. And maybe in the context of what this post is about, health insurance is the better choice, too.

[3] It’s a lot more complicated, and much is not understood yet; if you are interested, just search for Metabolic Syndrome

[4] Source: http://www.niddk.nih.gov/health-information/health-statistics/Pages/overweight-obesity-statistics.aspx

[5] https://intensivedietarymanagement.com/inflammation-and-t2d-t2d-part-1/