Medically Based Programs Effectively Prevent or Reverse Disease
“Therapeutic lifestyle change” is the new $10 term that describes medically based, structured, supportive programs to help people change lifestyle habits to lower their risk of life-threatening conditions such as diabetes, hypertension, heart disease and stroke… whether it be improving their diet, exercising, losing excess weight, managing stress or quitting smoking. I’m glad to hear this concept is gaining traction in the healthcare community — TLC programs aim to prevent or reverse disease and disease-related complications. It’s the same sermon we’ve long preached here at Daily Health News, but one that has been largely ignored by mainstream medicine, where it’s arguably easier to get an insurer to pay for bypass surgery than, say, nutritional counseling that might prevent heart disease from developing.
Though we talk constantly about the rapidly escalating health care costs, in this country less than 3% of our total annual health care expenditures is directed at preventing the chronic diseases that account for most of the spending, pointed out Neil Gordon, MD, PhD, chief medical and science officer for Nationwide Better Health, a health and productivity management company. “It’s unfortunate that we pay to treat a condition once it has developed, but not for TLC programs, which could prevent them,” he said.
A LITTLE TLC CAN GO A LONG WAY
Dr. Gordon, a board-certified preventive cardiologist, knows firsthand that this approach can really work. He was lead author of a 2004 study, published in the American Journal of Cardiology, reporting the effectiveness of 12 weeks of participation in a community-based lifestyle management program in helping patients who had hypertension (high blood pressure), abnormal cholesterol, or pre-diabetes or diabetes, to bring down their risk without the use of medications. Dr. Gordon and his team found that after completing the program, many patients achieved their goal. Specifically…
- 67% of participants with an elevated baseline diastolic blood pressure achieved their goal level value.
- 64% of participants with elevated systolic blood pressure achieved their goal.
- 39% of participants with an elevated fasting glucose level achieved their goal level value.
- 21% of patients with elevated LDL cholesterol level achieved their goal level value.
- Of those with baseline fasting glucose levels compatible with a diagnosis of diabetes, 37% normalized their blood glucose level values.
WHAT TLC PROGRAMS DO
The programs that tend to be more effective are comprehensive, flexible and personalized, I was told by David A. Alter, MD, PhD, a cardiologist at St. Michael’s Hospital, senior scientist at the Institute for Clinical Evaluative Sciences (ICES) and associate professor in the department of medicine at the University of Toronto. Dr. Alter wrote a research commentary on the subject, published last year in the Canadian Medical Association Journal.
A good TLC program begins with an assessment of the patient’s health status and his/her risk for disease (such as heart disease or diabetes) … the establishment of realistic behavior modification goals (such as losing weight, exercising or quitting smoking) … followed by an action plan (such as adopting a low-calorie diet or an exercise schedule) … and providing the patient with supportive tools to help achieve these goals (such as educational materials and counseling). “The programs should be personalized and tailored according to the patient’s own biology and behavior, since we are all dealing with a unique combination of environmental factors and genetic traits,” said Dr. Alter. Ultimately though, what all TLC programs must rely on is the patient’s willingness to change behavior — and therein lies the challenge.
BARRIERS TO SUCCESS
It seems obvious that working to improve health rather than just to manage symptoms would be better all around, but a major barrier is over-scheduled physicians. Managed care is largely responsible for this problem — doctors now must see larger numbers of patients in order to meet their costs, let alone make money — and like it or not, medicine is a business. As a physician, Dr. Gordon acknowledges that “it’s a whole lot easier to write a prescription than it is to counsel the patient about the importance of therapeutic lifestyle changes… then again, if more people practiced therapeutic lifestyle changes, it’s likely that fewer people would need doctors’ services each day.” Increasingly hospitals and large corporate employers are establishing TLC programs in collaboration with physicians to provide the structure for patients to get healthier. “The good news is, doctors are beginning to refer patients to these programs,” says Dr. Gordon.
Still many TLC programs are not covered by insurance — though that, too, may be changing, says Dr. Gordon. He said that employers are beginning to focus on the benefits of disease prevention. “They realize that prevention is a key to reducing unnecessary medical expenditures,” he said. Dr. Alter noted 54% of US corporations currently offer TLC programs.
IS IT A GOOD PROGRAM?
If you’re considering a TLC program for yourself or a loved one, evaluate it by asking the right questions…
- How credible is the sponsoring company or medical center providing the service?
- Does the staff working directly with patients have appropriate qualifications?
- Are they certified or trained in the appropriate modalities? For instance, nurses and dietitians should be certified health care professionals.
- What mechanisms are in place for communicating with the primary care provider? There should be a formalized system to allow your health care providers to be kept aware, involved and updated on your progress.
- What is the goal? Some programs are focused on a specific goal — such as lowering blood pressure — while others are more encompassing, for instance, preventing or reversing heart disease. Be wary of programs that boast about results but have never been subject to a formal evaluation.
YOU CAN DO IT YOURSELF TOO
TLC programs are a means to an end — the result of a successful program is that you’ve learned how to take charge of your own health. Some people benefit from the accountability and structure of such programs, but others can succeed with a do-it-yourself approach, using educational tools, health risk assessments and health coaching on many US government or other health organizations’ Web sites including Medline Plus (www.nlm.nih.gov/medlineplus/healthyliving.html), the American Heart Association (www.americanheart.org), the American Diabetes Association (www.diabetes.org) and the American Cancer Society (www.cancer.org).
“TLC programs are really vehicles to empower patients to take better care of themselves,” said Dr. Alter. “It’s putting the responsibility to take charge of your health back on your shoulders — which is where it belongs.”
