Lifestyle changes do make a difference

We've heard a lot of talk this year about needing change in our political system. It's also time to change the model of our health care system—from a disease model to a wellness model. By many estimates, close to our entire population will be overweight by 2040 if we don't take steps now to reverse the trend. 

My Smart Living Healthy Lifestyle Clinic is a comprehensive program that focuses on teaching self-management skills. Our program includes counseling on nutrition, exercise, stress and all other aspects of healthy living. We advocate a low glycemic load/Mediterranean-style eating plan, gentle exercise, and stress reduction. We offer hands-on learning, including classes in healthy cooking and individually designed exercise programs. Lifestyle educators are utilized and work alongside me in implementing this program. 

Patients are seen for 7 to 8 office visits over the course of 3 months. Initially, we do a complete medical history, goal setting, body composition testing, and meal planning. These visits are billed to patients' insurance under their comorbid health problems. The other parts of the program—fitness assessments, cooking classes, nutritional supplements, and emotional eating workshops—are offered at an extra cost and are optional.

How did I get started with the lifestyle clinic? I had been a family practice PA since 1991. My patient population was becoming larger and increasingly unhealthy. I felt I needed to do more than devote a few minutes to counseling each patient about making lifestyle changes. I moved my practice from a large clinic to a small office, which consisted of my supervising physician and me. I worked out a symbiotic relationship with him. I would be his employee in family practice for 2 days a week, and I would also run my own business out of his clinic 2 days a week. I would funnel my family practice patients into Smart Living if they were interested in making lifestyle changes. I also get referrals from other primary care providers and from specialists in the area. 

In the clinic, we see health problems that include metabolic syndrome, diabetes, cardiovascular disease, hyperlipidemia, fatigue, joint pain, fibromyalgia, depression, sleep apnea, mobility limitation, and other conditions associated with poor lifestyle habits. When they start the program, most patients have a poor quality of life. After just a week or two of being on the program, their food cravings are gone and they have more energy. In the past 31/2 years, I have run more than 600 patients through the program. 

Ms. W. is a 42-year-old woman with a stressful job. She had GERD, hypertension, hyperlipidemia, and arthralgias. Her LDL cholesterol level was 192 mg/dL, and I advised her to begin statin therapy as well as to make lifestyle changes. She resisted going on medication, and so we agreed to give Smart Living a trial for 3 months. Her goals included eating better, getting regular exercise, and reducing stress. 

At the start, Ms. W.'s statistics were as follows: weight, 199 lb; body mass index, 32.1 kg/m2; BP, 140/90 mm Hg; waist circumference, 42 inches; hip circumference, 46 inches; waist-to-hip ratio, .91; fat-free mass, 63.3% (nl 77%); fat mass: 36.7% (nl 23%); total cholesterol, 255 mg/dL; LDL cholesterol, 192 mg/dL; HDL cholesterol, 44 mg/dL; triglycerides, 83 mg/dL. Her score on our lifestyle questionnaire was 49. The higher the score, the more complaints the patient has.

Ms. W. started a low glycemic load eating plan, which consisted of 3 small meals and 2 to 3 snacks a day. She used a soy-based medical food with plant sterols and started a daily walking program. She kept food journals, and we reviewed them. She had lessons on food label reading, monitoring sodium intake, restaurant eating, stress, exercise, and other topics related to healthy living. She weighed in on a weekly basis.

Three and a half months after starting the program, Ms. W.'s statistics were as follows: weight, 168 lb; BMI, 27.2 kg/m2; BP, 128/88 mm Hg; waist circumference, 34.5 inches; hip circumference, 43.2 inches; waist-to-hip ratio, .79; fat mass, 33.4%; lean body mass, 67%; total cholesterol, 220 mg/dL; LDL cholesterol, 141 mg/dL; HDL cholesterol, 44 mg/dL; triglycerides, 155 mg/dL; lifestyle score, 1. We have deferred giving her statins. Her GERD symptoms are gone, and she has no more joint pain.

The lifestyle clinic has proved to be a great way to make a difference in my community. My job satisfaction, sense of autonomy, and financial situation have drastically improved. It was also rewarding to make such a difference in Ms. W.'s life. I have enjoyed watching many patients from our program achieve similar results; many have also decreased or stopped medications such as proton pump inhibitors, antihypertensive agents, and diabetes and pain medications. We all know that therapeutic lifestyle changes are the first line of treatment in dealing with weight-related health problems, but we don't have the time to fully address these issues during our busy days. The Smart Living Healthy Lifestyle Clinic helps to demonstrate the difference that such an approach can make. JAAPA