Presentation on theme: "Welcome to Lifestyle Intervention Program"— Presentation transcript:
1 Welcome to Lifestyle Intervention Program Kay Theyerl, MD, MS, FACP, ABIHM
2 Tonight Overview of Lifestyle Medicine Lifestyle Intervention Program – from a medical perspectiveGroup visit to review labs/biometricsQuestions
3 Crisis of Chronic Diseases 80% of chronic diseases are caused by:tobacco and alcohol useunhealthy dietary choicesinadequate physical activitypoor management of chronic psychological stressUp to 80% of chronic diseases can be prevented by lifestyle modificationsL 180 was started due to the crisisPartnership to Fight Chronic Disease: “The Growing Crisis of Chronic Disease in the United States”, 2009Willett WC: Science 296: , 2002; Ford ES et al: Arch Intern Med, 169: , 2009
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 = WholeHealthy diet“Let Food be thy Medicine”Physical activityHealthy emotionsresponse to stressorsDr 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 medicineDoes anyone feel a Paradigm shift?Sternberg EM: The Balance Within, 2000
10 What Can We Do?Eat Healthy FoodsMove!Manage StressThese 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 patientsBut – we can “overeat” our medicinesMedicines have side effectsMedicine can be expensiveWith proper lifestyle, most patients can decrease or eliminate the need for many medicines…And reduce their overall health risks85% 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 decreasedBP decreasedOff CPAPBlood sugar normalizedPrediabetes to normalDecreased 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/accountabilityThedacare’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 sessionsOver 250 participantsThedacare employees and spouses/domestic partners (NC)EmployersCommunity membersHow 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:NutritionCookingPhysical activityStress managementYogain a way that is attainable, practical, and engaging
19 Lifestyle…IS the Most Powerful Medicine For general good healthTo prevent and treat chronic diseases including:Diabetes, heart disease, hypertension, obesity, cancer, inflammatory diseasesThedaCare Lifestyle Intervention Program - designed to help you gain and sustain good healthL 180 is one effective way to:Help us to turn things around and reclaim our healthWe 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 VisionaryThe 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/GallowayLook forward to walking with you as you take your first steps in this life-changing journey
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 DirectorGroup dataIndividual dataMay request to opt out of group visitCommunication with PCPParticipant and Medical DirectorLabs/biometricsMedical 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
27 Group Visit Personal Health Assessment (PHA) Tool! Lifestyle Habits BiometricsBiometric (HAT) scoreMeasurementsHeight (baseline only)WeightWaistBPLab Results
28 Reminders Communicate with your PCP Your PCP will: Manage your chronic diseasesWork with you to manage your medicationsGive specific recommendationsLifestyle Medical Director will:Make general recommendationsCommunicate 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 SummaryLifestyle HabitsBiometricsMeasurementsLab Results
31 Results At-A-Glance (page 3) Lifestyle HabitsNutritionPhysical ActivityStress and DepressionAlcohol ConsumptionNeed to Work OnKeep Up the Good Work
32 Results At-A-GlanceBiometrics for HATLabsBMITobacco
33 Health Trends – HAT (page 4) MeasurementsWeightBMILifestyle: waist measurementBPLabs (usual HAT labs)LifestyleBiometrics (HAT) ScoreLifestyle 180 labs at the end of the hat
35 HAT (Pages 5-9) Nutrition Physical Activity Stress and Depression Alcohol ConsumptionTobacco Useinformational
36 Weight Management (page 10) Height (health trends – page 4)Weight (health trends – page 4)BMIHigh Risk: increases risk forHigh Blood PressureHeart DiseaseDiabetesCancerDecreasing body weight by 5% can reduce risk – visceral fat (dangerous fat) is the first to go!
37 Weight Goals/expectations Body composition Decrease in fatIncrease in muscleHow will program affect weight and BMI?Healthy weight loss?
38 Blood Pressure High Blood Pressure increases your risk of: Heart DiseaseStrokeIdeal: <120/80PreHypertension: /80-89Hypertension - 1: /90-99Hypertension - 2: over 160/100Stay 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 PressureHow does the program affect BP?Goals/expectationsWhat 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 standingDizziness/lightheaded feelingBlurry visionConfusionWeaknessSleepinessNausea
41 Hypotension What to do: Immediately sit or lie down until symptoms resolveChange positions slowlyDrink plenty of water especially as we embark on an exercise programContact PCP with report of symptoms and blood pressure readingsCall 911 to go to Emergency Department ifSkin is cold/clammy or turns pale or bluePulse is weak and rapidBreathing is rapid/labored
42 Blood Tests (page 12 - 14) LDL HDL Total Cholesterol/HDL Ratio TriglyceridesTotal CholesterolGlucose
43 Lipids Total Cholesterol <200 mg/dl LDL <100 mg/dl “Bad” cholesterolIncreases risk of cardiovascular diseasesAnimal products/saturated fatHDL >39 mg/dl“Good” CholesterolProtectiveExerciseTriglycerides <150 mg/dlFatSugarAlcoholLack of exercise
44 “What do I need to do to be able to change my medications?” LipidsHow does the program affect lipids?Goals/expectationsWhat 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/expectationsWhat 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 Prediabetes41 (>49%) became normal by all criteria!!!9 at 6 weeks15 more at 6 months17 more at 1 year
48 Diabetes – groups 1-7 32 participants with Diabetes At 6 months: A1C dropped by an average of .8585% were at goal (A1C<7)At 1 year:A1C dropped by an average of 1.56
50 Hypoglycemia What to do? Check your blood sugar or notify staff Eat if past mealtime and if BG is less than 80Fruit juice/glucose tabsRest/Repeat/Recheck glucoseEat light snackContact your PCP and report symptoms and readingsCall 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 mmHgFasting blood sugar (glucose) ≥100 mg/dLLarge waist circumferenceMen - 40 inches or moreWomen - 35 inches or moreLow HDL cholesterol:Men - under 40 mg/dLWomen - under 50 mg/dLTriglycerides ≥ 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) >6.5If 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 reducedNormal 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/mLIncreased Risk ng/mLHigh Risk <10 ng/mLIf 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 RangeLow Risk <1.0 mg/LYour HSCRP score is in the Low Risk level, which decreases your relative risk for developing heart disease.Increased Risk mg/LHigh Risk >3.0 mg/LYour 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 DiseaseInjuryTraumaInfectionToxinsImmune reaction/allergiesTreatmentModern Model of MedicineVery effective
57 Chronic Diseases Atherosclerosis Cancer Diabetes Hypertension Obesity Coronary heart diseaseStrokePeripheral artery diseaseCancerDiabetesHypertensionObesityAsthmaChronic PainRheumatoid ArthritisAutoimmune DiseaseAlzheimer’s DiseaseAcneSystemic Lupus Erythematosus (SLE)MSIBDBut 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 = bandaidExpensiveIneffective 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 InflammationProcessed foodsSugar/High Fructose Corn SyrupSaturated FatsAnimal ProductsToxinsSmokingAlcoholSaltFried FoodsSedentary LifestyleStressDecrease InflammationFruitsVegetablesWhole GrainsLeafy GreensLegumesSleepWaterCurcumin/TurmericVitamin D/AntioxidantsModerate ExerciseMeditation/YogaIdeas re what might cause/increase inflammationHow do we treat it? A pill/procedure?
61 InsulinThis 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 RangemcIU/mL> 25 mcIU/mL = PREDIABETES
62 Group 11 Data - 30 Vitamin D deficiency <25: 15 (5 on low end) Contact PCP to discuss planPrediabetes : 11hs-CRP: Only 4 were in low risk categoryHigh lipids: 23Per each group facts