Obesity and Ozempic

My wife and I, both retired Navy medical officers, have lived in Southern California since 2016. With the lockdown necessitated by COVID-19, we have spent time educating our community (including our local League of Women Voters – Pasadena Area) about this pandemic. The stay-at-home orders leads one to find ways in retirement to feel productive. This was one of the first articles posted for our local LWV.  

Life in the Time of Coronavirus

Brought to you by Dr. TZ

Healthy Living During COVID-19 Lockdown

Anthony Fauci had a great saying about why we are practicing physical distancing during the COVID-19 pandemic: “The enemy of R naught is physical distancing.” Our job now in fighting this disease is largely to stop infections from occurring in the first place. This means we are primarily at home, avoiding contact with others. The stress of this isolation can lead to or worsen bad habits; we become even more sedentary in our ways and are tempted to eat and drink to help assuage the anxiety and fear we all have. Our metabolism and its many effects on our health should not be neglected during this time.

Margan and I made a New Year’s Resolution to try a variant of intermittent fasting (IF) during 2020. What is intermittent fasting? While some believe IF is just a fad, there is real science behind the effects it has on our metabolism and health. Monique Tello, MD, MPH from Harvard writes in the Harvard Health Blog about how this may be done and the various benefits it has on health, including decreased insulin levels, lowered blood pressure, and weight loss. While I hate anecdotes, I note that my weight on a time-restricted eating regimen (described here) has come down 9 pounds. A recent paper in the New England Journal of Medicine further described the multiple beneficial effects in both animal and human studies. Currently we eat between noon and 6 P.M. but one can begin with a wider time frame and shorten the “window” of eating over 4 to 6 weeks. As the articles in the links point out, it is important to eat during daylight hours; this allows the body to flip from metabolizing sugars to metabolizing fat. IF takes us back to our evolutionary roots; humans evolved to eat this way. One caveat: if you have a serious metabolic condition such as diabetes, check with your physician before embarking on time-restricted eating. Fortunately for those of us who enjoy coffee and tea, black coffee or plain tea (no sugar or milk) is ok when you get up in the morning. Yet another side benefit: two meals per day rather than three. Remember that three meals a day is a cultural habit. Go light on alcohol as well. It is caloric and harms the liver.

It is too easy to be sedentary at home. While it is an exaggeration to suggest that sitting is the new smoking, there are multiple studies that show improvements in metabolism when comparing people who sit for prolonged periods with people who sit less and move more. When I worked at Emmes in Rockville, Maryland, I began wearing a pedometer to help me quantitate how many steps I took per day. For two years I entered the data into a spreadsheet. After a baseline period, I began adding to the time I walked. It adds up surprisingly fast. I parked my car at the far end of the parking garage; I took “garage walks” for 15-20 minutes before starting work; then, when we moved to Bethesda, my daily steps increased going to and from the Metro. On average back then, I was taking 12000 steps daily.

What to do at home? First, even a modest increase in daily steps has a real impact on health. As an example, in older women, even 4400 steps daily diminished the risk of death. Additionally, newer research shows that the step intensity (running vs. walking vs pacing) was perhaps less important than the total number of steps daily. What to do? Pacing about the apartment will add steps to the daily count. If you use a pedometer or Fitbit, you can quantitate that or use time -- 30 minutes of pacing (broken up into 5- or 10-minute segments) -- as a useful metric. While pacing, I have found that listening to TED talks on my smartphone helps immensely -- and I learn at the same time! Music is also a great balm for the spirit. Whatever floats your boat. The message to take to heart is, watch how you eat and keep moving as much as you can. This necessary craziness of physical distancing will come to an end. Each of us is the enemy of COVID-19’s R naught.

Dr. Thad Zajdowicz is the Co-Chair of the League of Women Voters-Pasadena Area Healthcare Committee and a retired infectious diseases physician who spent many years in clinical practice, emergency preparedness, and pandemic planning for the US Navy. He holds a Doctor of Medicine degree from the Temple University School of Medicine and a Master of Public Health degree from Old Dominion University/Eastern Virginia School of Medicine.