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Welcome to. Lifestyle Intervention Program. Kay Theyerl , MD, MS, FACP, ABIHM. Tonight. Overview of Lifestyle Medicine Lifestyle Intervention Program – from a medical perspective Group visit to review labs/biometrics Questions. Crisis of Chronic Diseases.

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  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 Partnership to Fight Chronic Disease: “The Growing Crisis of Chronic Disease in the United States”, 2009 Willett WC: Science 296: 695-698, 2002; Ford ES et al: Arch Intern Med, 169:1355-1362, 2009

  4. Disease management continuum

  5. Disease can be reversed with lifestyle intervention

  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%

  7. Origins of Lifestyle Medicine • Health/Healing = Whole • Healthy diet • “Let Food be thy Medicine” • Physical activity • Healthy emotions • response to stressors http://classics.mit.edu/Browse/browse-Hippocrates.html Sternberg EM: The Balance Within, 2000

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

  9. 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

  10. Physical Activity is needed for Good Health Helps to prevent and treat: cancers, heart disease, high blood pressure, diabetes, depression, fractures, stroke, obesity, pain…

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

  12. 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!

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

  14. Knowing is not enough; we must apply. Willing is not enough; we must do. Johann Wolfgang von Goethe

  15. ThedaCare Lifestyle Programs • Lifestyle (Pilot) • 1-year program/ 24 sessions • Over 250participants • Thedacare employees and spouses/domestic partners (NC) • Employers • Community members

  16. 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

  17. 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

  18. 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

  19. 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

  20. Lifestyle Intervention Program Group Visit # 1

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

  22. 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

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

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

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

  26. 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

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

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

  29. 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

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

  31. Health Trends – HAT (page 4) • Measurements • Weight • BMI • Lifestyle: waist measurement • BP • Labs (usual HAT labs) • Lifestyle • Biometrics (HAT) Score

  32. Lifestyle Lab Trends - page 22 • Lifestyle Labs for comparison

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

  34. 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!

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

  36. Blood Pressure • High Blood Pressure increases your risk of: • Heart Disease • Stroke • Ideal: <120/80 • PreHypertension: 120-139/80-89 • Hypertension - 1: 140-159/90-99 • Hypertension - 2: over 160/100

  37. 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?”

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

  39. 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

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

  41. 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

  42. 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?”

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

  44. 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?

  45. 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

  46. 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 • 85% were at goal (A1C<7)

  47. Hypoglycemia (low blood sugar) • Symptoms:

  48. 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

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