It’s rare that an article title alone makes me want to stop what I’m doing and read it, but that’s what happened when I saw the title of Jess Craig’s recent article, “Why More Doctors are Billing Their Patients Like it’s the 1920’s.”

In this article, and subsequently, our conversation here on the podcast, Jess explains what she means, citing the growing number of physician practices organized around the concept of direct pay. That is, the practice or physician determines a set cash price for their services and the patient pays that price out of pocket. This model may seem like we’re going backwards, to a time when health insurance didn’t exist, but in fact, it’s starting to be seen as one of the most progressive ways of managing rapidly inflating costs and concern about quality. While there are still questions around accessibility, as Jess points out, it may be one of the first advances we’ve seen in over a decade that could actually move the needle.

Jess Craig is a health reporter for Straight Arrow News (SAN). Prior to joining SAN, Jess worked as an infectious disease epidemiologist and health security technical advisor for international research institutes and US government agencies, including the CDC, USDA, and USAID. Jess worked as a freelance journalist for eight years, covering science, health, and world news for various outlets. She also served as a reporting fellow for NPR in 2020 and for Vox in 2024.

With the recent explosion of GLP-1 drugs, the war on obesity seems to have taken a new and potent turn, but many are concerned about the recidivism, the side effects, and our reenergized obsession with being thin.

Our guest today, Dr. Laure DeMattia, is a board certified family medicine physician and obesity specialist. For her, obesity is personal, as she has struggled her entire life with this chronic condition. In this episode, Dr. DeMattia breaks down for us how GLP-1 drugs work to hyperdrive weight loss, why that loss is rarely sustainable without long term use of the drugs, and her own philosophy outside of medication that helps her patients feel seen, heard, and safe. It’s both an educational conversation and a behind-the-curtains look at the obesity epidemic from someone on the front lines.

Dr. Laure DeMattia helps women stop blaming themselves for their physiology and find lasting health for over 20 years. Her dual perspective as both a doctor and a patient makes her uniquely compassionate, challenging the myth that willpower is the solution. Author of the book, The 4 Food Cues, Dr. DeMattia hosts her own YouTube channel, Navigating Obesity with Dr. D, where she offers a compassionate, realistic viewpoint about weight and weight loss.

“It doesn’t matter what is going on in your life, nutrition is relevant.” And, at least for most Americans, getting help with their nutrition is covered by their insurance. So, why isn’t working with a dietician a normal part of every American’s care plan?

Our guest today is trying to address that question. Noah Kotlove, the CEO and Co-Founder of Berry Street, went through his own nutrition journey after spending his first thirty years clinically obese. He tried every fad diet imaginable, with great success, but like many, gained all of the weight back because of the unsustainability of so much restriction. He finally found lasting change when he met with a dietician, a step recommended by his primary care provider, and, surprisingly to him, totally covered by his insurance plan.

That personal experience led Noah to create Berry Street, an online, DTC nutrition therapy platform that helps clients access registered dieticians while taking the guesswork out of the payment part. In this episode, Noah shares how Berry Street works, why the relationship between dietician and client is such a critical part of success, and how they leverage information, expertise, and technology to improve the customer experience and increase the likelihood of sustainable outcomes.

Noah founded Berry Street after losing 60 pounds through nutrition therapy, aiming to scale insurance-covered care through technology and change the way Americans eat. A serial entrepreneur, Noah is also the Founder of Sobrietysoft, an addiction recovery app with over 6 million users. He sees technology as a tool that allows us to get creative about outcomes over products.