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It’s A Lifestyle: Adopting Behavioral Approach To Health Care Is Urgent

Discussion in 'Hospital' started by The Good Doctor, Nov 21, 2021.

  1. The Good Doctor

    The Good Doctor Golden Member

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    If you are a frequent flyer in an airlines program, this is often a benefit. If you are a “frequent flyer” in a health care setting, this is not. It means you may have a chronic illness and are often seen in a health care setting, treated, sent home, and quickly return because the care approach was not to prevent recurrence by implementing lifestyle changes.

    This is why lifestyle medicine is an urgent priority.

    Four case studies were shown to reverse disease and reduce health care costs through an intensive, therapeutic lifestyle intervention change. A recent study acknowledges the limitation of using case studies that contained self-reported data and expressed the need for lifestyle medicine economic research related to effects of ITLC interventions, cost savings compared to current disease-related costs, and lifestyle medicine outcomes impact on various payment models.

    This is good news for millions of Americans.

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    Six of every 10 Americans have a chronic disease, and four in 10 have two or more chronic diseases. These include but are not limited to diabetes, heart disease, cancer, stroke, chronic kidney disease, and Alzheimer’s. Chronic diseases are the number one cause of death and disability in America and account for the majority of the nation’s $3.8 trillion in annual health care costs, according to the Centers for Disease Control.

    Chronic disease remains a constant even during a pandemic. In fact, their presence can increase the severity of COVID-19 infection. While the U.S. is experiencing a decline in cases and deaths in some areas of COVID-19, more than 47 million Americans have contracted the virus, with 762,000 deaths so far.

    Chronic diseases such as diabetes, heart disease, nonalcoholic fatty liver disease, obstructive sleep apnea, and obesity are complex conditions that need specialized attention to lifestyle. Prevention and treatment for these conditions are not easy. It is not at all sufficient to tell someone to eat less, exercise more, and prescribe them medication.

    In 11 years as a nurse and a nurse practitioner, I built my career trajectory on the basis of keeping people healthy and out of the hospital. Lifestyle Medicine is about implementing evidenced-based therapeutic lifestyle interventions such as: eating a predominately whole-food plant-based diet; achieving at least 150 minutes per week of moderate physical activity with two days per week of strength training exercises; and stress management techniques like meditation. The goal as a health coach is to prevent, treat, and even reverse chronic disease, partnering with patients to adopt lifestyle modifications to improve their health.

    Since its founding in 2017, the American College of Lifestyle Medicine has assured 1,586 physicians and 585 other health professionals in the U.S. have become board certified in lifestyle medicine. According to the college, “Lifestyle Medicine is the use of evidence-based lifestyle therapeutic intervention—including a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection—as a primary modality, delivered by clinicians trained and certified in this specialty, to prevent, treat and often reverse chronic disease.”

    Lifestyle changes are difficult to sustain. Frequent follow-up visits to coach and motivate people through their successes and barriers are effective.

    For example, the CDC’s Diabetes Prevention Program (DPP) focused on many of these concepts and was proven to reduce progression to diabetes by 58 percent.


    Approaching modifiable risk factors is not an all-or-nothing endeavor. Improving health behaviors in diet, physical activity, smoking and/or alcohol can reduce the risk for mortality. A 2010 study in the United Kingdom found that people with poor health habits in four areas had a similar all-cause mortality risk as someone 12 years older. The study shows mortality risk progressively improved as patients removed the number of risk factors.

    Years ago as a new nurse on a medical-surgical unit, I found it physically and mentally draining as a caregiver putting the proverbial band-aid on the chronic illnesses and sending patients home, knowing they would be back. I wanted instead to help prevent these chronic illnesses and their exacerbations.

    Then as a performance improvement nurse, I was part of the health care transition to value-based care, accountable care organizations, and population health; this was why I became a nurse.

    It was too late to help one patient to avoid debilitating chronic disease. Struggling with depression and anxiety most of her adult life, this patient reported she turned to alcohol as a coping mechanism. She was a single mother, working full-time and raising her two children.

    She saw her primary care provider annually, and beyond being on an anti-depressant and thyroid medication, she was relatively healthy. When her children went to college, she reported that the transition to being an “empty nester” may have contributed to her alcohol use and the subsequent worsening of her mental health status.

    Who I saw as a once independent, social, successful woman was now withdrawn and isolated. Despite having insurance, the health care system failed her. She was willing to go to rehab, but insurance would not cover inpatient treatment.

    Her family reportedly paid $10,000 out of pocket for a treatment program, but her disease was too advanced. In 2019, she was hospitalized for deconditioning, dehydration, and mental confusion. She was diagnosed with alcohol-related dementia.

    Perhaps this outcome could have been prevented if our country had a systematic, non-stigmatizing approach to health and wellness. This person’s alcohol-related dementia is not one of the most common chronic illness faced today, but some of her lifestyle choices are not uncommon.

    There are complex interactions between all aspects of lifestyle–diet, physical activity, sleep, stress, mood, substance use, and relationships– that either increase or decrease the risk of developing chronic illness. Non-modifiable risk factors such as age, gender, race, ethnicity, socioeconomic, and family history also contribute.

    Modifiable risk factors account for 80 percent of heart disease, stroke, and type 2 diabetes. In addition, over 40 percent of cancers could be prevented, according to the World Health Organization.

    This accounts for four of the ten leading causes of death in the United States, the Centers for Disease Control reports in 2021.

    As this month millions of Americans opt into their health care insurance programs, and many switch from fee for service to value-based care and accountable care organizations, health care practitioners need to bolster the power of lifestyle medicine and team-based care.

    It is no longer sufficient to only offer reactive disease treatment in a modern health care system.

    Lifestyle Medicine’s foundational pillars include a specialized look into diet, physical activity, sleep, stress, mood, substance use, and relationships. Creating a patient-centered plan of care based on these areas are proven successful in preventing, treating, and reversing chronic diseases.

    Some may say that health care providers do not have time to focus on intensive lifestyle modification in their visits with patients. This is true in the current fee-for-service, physician-dominated care delivery model.

    But to be successful in obtaining shared-cost savings in the value-based care and as accountable care organizations, it is urgent to shift to utilizing more nurse practitioners, dietitians, nurses, social workers, and health coaches in chronic disease treatment and prevention.

    This makes it possible to reduce the social and economic impact that many chronic illnesses place on individuals, the health care system, and society.

    There is indeed a better way to better health for all Americans.

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