1. Welcome to Lifestyle Intervention Program
Kay Theyerl, MD, MS, FACP, ABIHM

2. Tonight Overview of Lifestyle Medicine
Lifestyle Intervention Program – from a medical perspective
Group visit to review labs/biometrics
Questions

3. Crisis of Chronic Diseases
80% of chronic diseases are caused by:
tobacco and alcohol use
unhealthy dietary choices
inadequate physical activity
poor management of chronic psychological stress
Up to 80% of chronic diseases can be prevented by lifestyle modifications
L 180 was started due to the crisis
Partnership to Fight Chronic Disease: “The Growing Crisis of Chronic Disease in the United States”, 2009
Willett WC: Science 296: , 2002; Ford ES et al: Arch Intern Med, 169: , 2009

4. Disease management continuum
Low Risk for Disease
At goal
Healthy Lifestyle
Increased Risk for Disease
BMI
Cholesterol BP
Blood Sugar
Tobacco Use
Emerging Disease
Cardio metabolic syndrome
Disease State
Confirmed diabetes and/or CAD
End Stage Disease
With Complications
CHF
Renal failure

5. Disease can be reversed with lifestyle intervention
Low Risk for Disease
At goal
Healthy Lifestyle
Increased Risk for Disease
BMI
Cholesterol BP
Blood Sugar
Tobacco Use
Emerging Disease
Cardio metabolic syndrome
Disease State
Confirmed diabetes and/or CAD
End Stage Disease
With Complications
CHF
Renal failure

6. Lifestyle Lifestyle is more important than:
Genetics
Age
Gender
Percentage of common diseases that are likely preventable
Colon cancer 71%
Stroke 70%
Heart Disease 82%
Diabetes 91%

8. Pt will say – I will never give up meat/cheese – then you can never give up cancer/heart disease

9. Origins of Lifestyle Medicine
Health/Healing = Whole
Healthy diet
“Let Food be thy Medicine”
Physical activity
Healthy emotions
response to stressors
Dr Dysinger so elegantly presented the crisis of chronic disease – morbidity/cost/drain on the healthcare system. He and Dr Kelly have offered insights into the effects of lifestyle on our health and have provided the evidence supporting lifestyle medicine
Does anyone feel a Paradigm shift?
Sternberg EM: The Balance Within, 2000

10. What Can We Do?
Eat Healthy Foods
Move!
Manage Stress
These are simple concepts and take work, planning, commitment, and practice

11. It’s Simple -- Eat Foods As Grown
Foods that provide optimal health are eaten as close to their original form as possible: fruits, vegetables, whole grains, and beans

12. Physical Activity is needed for Good Health
Helps to prevent and treat:
cancers, heart disease,
high blood pressure,
diabetes, depression,
fractures, stroke,
obesity, pain…
If you don’t move – move! IF you do move, move more

13. Timeless Knowledge A merry heart does good medicine make
Proverbs 17;22

14. Can I just take a Pill?
Medicine may help and may be necessary in some patients
But – we can “overeat” our medicines
Medicines have side effects
Medicine can be expensive
With proper lifestyle, most patients can decrease or eliminate the need for many medicines
…And reduce their overall health risks
85% of people who currently take medicines for high cholesterol and Type II Diabetes could gain control with lifestyle alone!

15. Results Weight loss Medication decreased and/or discontinued
Cholesterol decreased
BP decreased
Off CPAP
Blood sugar normalized
Prediabetes to normal
Decreased inflammation

16. Knowing is not enough; we must apply.
Willing is not enough; we must do.
Johann Wolfgang von Goethe 
Knowledge/guidance and coaching/motivation/accountability
Thedacare’s mission is to improve the health of the communities. By teaching, facilitating, and supporting our employees , they reach their goals

17. ThedaCare Lifestyle Programs
Lifestyle (Pilot)
1-year program/ 24 sessions
Over 250 participants
Thedacare employees and spouses/domestic partners (NC)
Employers
Community members
How did these folks achieve these amazing results?
Through TC lifestyle medicine Programs

18. Lifestyle Intervention Program
Enables participants to reverse their chronic disease states through a structured approach to:
Nutrition
Cooking
Physical activity
Stress management
Yoga
in a way that is attainable, practical, and engaging

19. Lifestyle…IS the Most Powerful Medicine
For general good health
To prevent and treat chronic diseases including:
Diabetes, heart disease, hypertension, obesity, cancer, inflammatory diseases
ThedaCare Lifestyle Intervention Program - designed to help you gain and sustain good health
L 180 is one effective way to:
Help us to turn things around and reclaim our health
We feel so fortunate to be a part of the Lifestyle 180 team and we look forward to working with you as you take advantage of this lifechanging opportunity that Thedacare is making available to you

20. Visionary
The doctor of the future will give no medicine, but instead will interest his patients in the care of the human frame, in diet, and in the cause and prevention of disease.
Thomas Edison

21. Lifestyle Team Congratulations!!! Fortunate to be part of the team
Leading this transformation at ThedaCare and at other employers in the Valley – Appvion/Galloway
Look forward to walking with you as you take your first steps in this life-changing journey

22. Lifestyle Intervention Program
Group Visit # 1

23. Group Visit: Biometrics and Labs
Teammates Concept We are all on this journey together!

24. Biometrics and Labs HAT Lifestyle Tool
Group Visit to review results (tonight)
Medical Director
Group data
Individual data
May request to opt out of group visit
Communication with PCP
Participant and Medical Director
Labs/biometrics
Medical Director will not treat, change medication, or recommend individual treatment

25. Biometrics and Labs Timing Baseline 6 weeks 6 months 1 year 18 months
2 years

26. Labs Lipid panel Glucose Liver panel Hgb A1c TSH level (thyroid)
The baseline labs :
Lipid panel
Glucose
Liver panel
Hgb A1c
TSH level (thyroid)
Vitamin D
High sensitivity C-reactive Protein (hs-CRP)
Insulin Assay . 

27. Group Visit Personal Health Assessment (PHA) Tool! Lifestyle Habits
Biometrics
Biometric (HAT) score
Measurements
Height (baseline only)
Weight
Waist BP
Lab Results

28. Reminders Communicate with your PCP Your PCP will:
Manage your chronic diseases
Work with you to manage your medications
Give specific recommendations
Lifestyle Medical Director will:
Make general recommendations
Communicate with your PCP if needed

29. Biometrics and Labs Definitions – what does it measure?
Implications – what does it mean?
Expectations – how will the Lifestyle Intervention Program affect it?

30. Personal Health Assessment (PHA) Tool
Summary
Lifestyle Habits
Biometrics
Measurements
Lab Results

31. Results At-A-Glance (page 3)
Lifestyle Habits
Nutrition
Physical Activity
Stress and Depression
Alcohol Consumption
Need to Work On
Keep Up the Good Work

32. Results At-A-Glance
Biometrics for HAT
Labs
BMI
Tobacco

33. Health Trends – HAT (page 4)
Measurements
Weight
BMI
Lifestyle: waist measurement BP
Labs (usual HAT labs)
Lifestyle
Biometrics (HAT) Score
Lifestyle 180 labs at the end of the hat

34. Lifestyle Lab Trends - page 22
Lifestyle Labs for comparison

35. HAT (Pages 5-9) Nutrition Physical Activity Stress and Depression
Alcohol Consumption
Tobacco Use
informational

36. Weight Management (page 10)
Height (health trends – page 4)
Weight (health trends – page 4)
BMI
High Risk: increases risk for
High Blood Pressure
Heart Disease
Diabetes
Cancer
Decreasing body weight by 5% can reduce risk – visceral fat (dangerous fat) is the first to go!

37. Weight Goals/expectations Body composition
Decrease in fat
Increase in muscle
How will program affect weight and BMI?
Healthy weight loss?

38. Blood Pressure High Blood Pressure increases your risk of:
Heart Disease
Stroke
Ideal: <120/80
PreHypertension: /80-89
Hypertension - 1: /90-99
Hypertension - 2: over 160/100
Stay in touch with your PCP. Might see a drop quickly. Black licorice, cold meds ect.

39. “What do I need to do to be able to change my medications?”
Blood Pressure
How does the program affect BP?
Goals/expectations
What if I am taking medication for Blood Pressure?
How will I know if my medications need to be adjusted?
What do I tell my PCP?
“What do I need to do to be able to change my medications?”

40. Hypotension (low blood pressure )
Symptoms:
May occur upon change of position or after standing
Dizziness/lightheaded feeling
Blurry vision
Confusion
Weakness
Sleepiness
Nausea

41. Hypotension What to do:
Immediately sit or lie down until symptoms resolve
Change positions slowly
Drink plenty of water especially as we embark on an exercise program
Contact PCP with report of symptoms and blood pressure readings
Call 911 to go to Emergency Department if
Skin is cold/clammy or turns pale or blue
Pulse is weak and rapid
Breathing is rapid/labored

42. Blood Tests (page 12 - 14) LDL HDL Total Cholesterol/HDL Ratio
Triglycerides
Total Cholesterol
Glucose

43. Lipids Total Cholesterol <200 mg/dl LDL <100 mg/dl
“Bad” cholesterol
Increases risk of cardiovascular diseases
Animal products/saturated fat
HDL >39 mg/dl
“Good” Cholesterol
Protective
Exercise
Triglycerides <150 mg/dl
Fat
Sugar
Alcohol
Lack of exercise

44. “What do I need to do to be able to change my medications?”
Lipids
How does the program affect lipids?
Goals/expectations
What if I am taking medications for lipids?
How will I know if my medications could be adjusted?
What do I tell my PCP?
“What do I need to do to be able to change my medications?”

45. Glucose ( mg/dL) Low Risk: less than 100
Increased Risk: 100 – 125 (Prediabetes)
High Risk: 126 and greater* (Diabetes)
*diagnosis requires 2 readings >125

46. Diabetes and Pre-Diabetes
How will the program affect these?
Goals/expectations
What is I am taking medication for diabetes?
How will I know if my medications may need to be changed?

47. Prediabetes (Groups 1-9)
83 participants had Prediabetes
41 (>49%) became normal by all criteria!!!
9 at 6 weeks
15 more at 6 months
17 more at 1 year

48. Diabetes – groups 1-7 32 participants with Diabetes At 6 months:
A1C dropped by an average of .85
85% were at goal (A1C<7)
At 1 year:
A1C dropped by an average of 1.56

49. Hypoglycemia (low blood sugar)
Symptoms:
Shaking
Blurry vision
Confusion
Rapid heartbeat
Weakness
Anxiety
Dizziness
Hunger
Headache
Pale skin
Sweating
irritability

50. Hypoglycemia What to do? Check your blood sugar or notify staff
Eat if past mealtime and if BG is less than 80
Fruit juice/glucose tabs
Rest/Repeat/Recheck glucose
Eat light snack
Contact your PCP and report symptoms and readings
Call 911 to go to Emergency Department for:
Seizures/loss of consciousness/extreme weakness

51. Metabolic Syndrome (page 15)
Metabolic Syndrome is a name for a group of risk factors that occur together and increase the risk for coronary artery disease, stroke, and type II diabetes.
According to the American Heart Association and the National Heart, Lung, and Blood Institute, metabolic syndrome is present if you have three or more of the following signs:
Blood pressure ≥ 130/85 mmHg
Fasting blood sugar (glucose) ≥100 mg/dL
Large waist circumference
Men - 40 inches or more
Women - 35 inches or more
Low HDL cholesterol:
Men - under 40 mg/dL
Women - under 50 mg/dL
Triglycerides ≥ 150 mg/dL

52. Hemoglobin A1C (HgBA1C) High Risk (Diabetes) >6.5
This is a blood test used to look at your average blood sugar control over the past 3 months. When the blood sugar is high, the sugar attaches to the hemoglobin protein in red blood cells, forming hemoglobin A1C.
 High Risk (Diabetes) >6.5
If your HgBA1C score is in the High Risk level, this confirms you have diabetes. You should consult your healthcare provider.
Increased Risk (Prediabetes)
If your HgBA1C score is in the Increased Risk level, this confirms you are prediabetic. You should consult your healthcare provider.
Low Risk <5.7

53. Thyroid Stimulating Hormone (TSH) (page 17)
This is a blood test that measures how well your thyroid gland is working. The TSH test is one of several thyroid tests used to check for thyroid disease. The thyroid gland makes hormones that control your metabolism (the process of turning the food you eat into energy). The thyroid gland is critical for maintaining body temperature and controlling heart rate, appetite, and digestive tract function.
If your TSH test is Abnormal, you should consult your healthcare provider.
If TSH is elevated, it may mean that thyroid function is reduced
Normal Range uIU/mL

54. Vitamin D (25-Hydroxyvitamin D2 & D3)
Tests the level of Vitamin D in your system. For reasons yet unclear, Vitamin D is associated with insulin resistance and low levels may increase your risk of developing metabolic syndrome. If you have metabolic syndrome, you're at increased risk for diabetes, hypertension, heart disease, and stroke. Visceral fat affects metabolism of Vit D.
Low Risk ng/mL
Increased Risk ng/mL
High Risk <10 ng/mL
If your Vitamin D (25-Hydroxyvitamin D2/D3) test is Abnormal, you should consult your healthcare provider. If Vit D3 < 25 – consider treating. Ideal Goal: 50 – 80 ng/mL

55. High Sensitivity C-Reactive Protein (HSCRP)
This test is used to check the level of a substance called C-reactive protein, or HSCRP. The level of HSCRP in your blood goes up when there is inflammation in the body, specifically in the circulatory system (blood vessels). Increased HSCRP is a risk factor for coronary artery (heart) disease. An anti-inflammatory, plant-based diet reduces inflammation as well as blood glucose, blood cholesterol, and blood pressure, and helps control body weight.
Normal Range
Low Risk <1.0 mg/L
Your HSCRP score is in the Low Risk level, which decreases your relative risk for developing heart disease.
Increased Risk mg/L
High Risk >3.0 mg/L
Your HSCRP score is in the Increased/High Risk level, which increases your relative risk for developing heart disease. You should consult your healthcare provider.

56. Inflammation = Illness Broad Perspective
Acute Inflammation/Acute Disease
Injury
Trauma
Infection
Toxins
Immune reaction/allergies
Treatment
Modern Model of Medicine
Very effective

57. Chronic Diseases Atherosclerosis Cancer Diabetes Hypertension Obesity
Coronary heart disease
Stroke
Peripheral artery disease
Cancer
Diabetes
Hypertension
Obesity
Asthma
Chronic Pain
Rheumatoid Arthritis
Autoimmune Disease
Alzheimer’s Disease
Acne
Systemic Lupus Erythematosus (SLE) MS
IBD
But what about chronic disease? And the list goes on

58. Treatment Current model
Just give a pill, perform a procedure, right?
If we do not address underlying cause it = bandaid
Expensive
Ineffective in the long run

59. Inflammation Chronic Disease Gone awry
If we can find a common thread and address that – we could effectively prevent/treat

60. Inflammation: Underlying Factor in Chronic Disease
Increase Inflammation
Processed foods
Sugar/High Fructose Corn Syrup
Saturated Fats
Animal Products
Toxins
Smoking
Alcohol
Salt
Fried Foods
Sedentary Lifestyle
Stress
Decrease Inflammation
Fruits
Vegetables
Whole Grains
Leafy Greens
Legumes
Sleep
Water
Curcumin/Turmeric
Vitamin D/Antioxidants
Moderate Exercise
Meditation/Yoga
Ideas re what might cause/increase inflammation
How do we treat it? A pill/procedure?

61. Insulin
This test measures the amount of insulin in the blood after a fasting period of at least eight hours. High levels are seen in people with metabolic syndrome (insulin resistance), which increases the risk of developing type II diabetes.
If your Insulin Assay Blood test is Abnormal; you should consult your healthcare provider.
Normal Range
mcIU/mL
> 25 mcIU/mL = PREDIABETES

62. Group 11 Data - 30 Vitamin D deficiency <25: 15 (5 on low end)
Contact PCP to discuss plan
Prediabetes : 11
hs-CRP: Only 4 were in low risk category
High lipids: 23
Per each group facts

63. I Have Control?

64. Questions