As insurers focus on lifestyle, doctors are scrambling to become better nutrition and exercise coaches
BY FRANCINE RUSSO, Time magazine January 10, 2011
YOUR DOCTOR EVER GIVEN YOU AN
Rx for exercise? June
Chapman got one last summer, a first for the
87-year-old retiree in
San Marcos, Calif. "You sit on a chair, arms at your
she says of the exercise
her internist prescribed,
up and sit back down
on it. Every day. Repeat as often as you can."
Chapman's doctor was a
little ahead of the curve
in recommending this
kind of chairobic
a doctor is mainly
problems - and may
only a minute or two scolding
right or exercising
more - a wellness
is designed to promote health and include
lessons in how to make
choices so you can avoid
or reduce the effects
of conditions like
and heart disease. Medicare recipients
will be able to get
this kind of coaching
free once a year. And if the health
care reform law kicks
in as scheduled, many
private health plans will be required - or, in some cases,
given incentives - to offer expanded wellness benefits by 2014.
"For the first time, doctors will be reimbursed
by Medicare for talking to patients on an ongoing basis about healthy behaviors,"
Edward Phillips, director of the Institute of Lifestyle
Medicine (ILM), an education and advocacy group co-founded in 2007 by Harvard
Medical School and Boston's Spaulding Rehabilitation Hospital.
The only downside: the current crop of physicians isn't
nearly as good at
routines as it is at treating sickness. "The
average doctor is hamstrung by
lack of time, training and interest," says Dr. Alex
director of primary care at the University of Chicago. "How many sit down with
patients and talk about the barriers to losing weight?
are riot there [yet)."
The new wellness
benefit tasks doctors with creating "personalized
prevention plans," which
ideally will be
tailored to each patient's
daily routine, psyche
and family life. And if that sounds more like a nanny-state mandate than
medicine, consider that some 75% of the $2.47 trillion in annual U.S.
health care costs stems from chronic diseases,
many of which can be prevented
or delayed by lifestyle choices.
no question Americans need to stop smoking, eat less junk food and get more
exercise. But can physicians - many of whom have little training in
nutrition or exercise coaching - succeed in altering behaviors? "We are working
our buns off trying to get these people to change their lifestyle,"
a family physician in a Minneapolis suburb.
"But the public hasn't bought
into it yet."
insurers and corporate wellness initiatives have even resorted, with limited
success, to offering cash, gifts and reductions in insurance premiums in an
effort to motivate people to change their ways.
in trying to bring down health care costs, have hired
health coaches to reach out to the sedentary or overweight to get them moving
more. Others use interactive voice-response systems to keep tabs on
participants' progress. In a study, Aetna set out to see whether it could reduce
hypertension - and the attendant risks of stroke,
heart attack and kidney failure - among
its Medicare Advantage members.
Some 75% of U.S. health care costs stems from chronic diseases, many of which
can be prevented by lifestyle choices
More than 1,100 participants were given automated
blood-pressure cuffs and told to call in with readings at least monthly. They also
got quarterly reminders to dial
in. When they
did so, an automated
system run by
provided immediate feedback, explaining what the readings meant and where to
call for further advice. Alerts were also sent to nurse managers when readings
were dangerously high. The result:
of the 217 people who started out with uncontrolled
hypertension and stuck
with the program for a year
or so, nearly 57% got
their blood pressure under control.
This kind of prodding is too labor intensive for
physicians to take on alone. And if they're going to lead a team of dietitians,
exercise physiotherapists and other health professionals,
need more training. That's
where the nascent field of lifestyle medicine comes in. For example, in
2009, Chapman's internist,
Dr. Brian Meyerhoff, took an ILM course called Active Doctors, Active Patients:
the Science and Experience of Exercise,
which not only teaches physicians to be better role
models by increasing their own fitness level but also helps them prescribe
exercise regimens tailored to a patient's age and health. Nutrition is on the
medical menu too: Harvard's upcoming continuing education course Healthy
Kitchens, Healthy Lives: Caring for Our Patients and Ourselves sold out five
months in advance.
The key to getting doctors to bone up on these
kinds of topics is reimbursement, says Dr.
the California based physician who has spent three decades
showing how altering patients'
habits can reverse heart disease. "Doctors don't
learn this in medical school because they're
not paid for it,"
But that is beginning to
change. In August,
Medicare doubled coverage of Ornish's
programs, to 72 one-hour
sessions with a hospital-based team whose specialties include exercise, yoga and
psychology. The catch is that all the sessions have to be completed within 18
interventions are not easy, but they can have big payoffs. In 1985,
when San Francisco restaurateur Mel Lefer had a
massive heart attack
at age 53, he could barely walk a block and was not expected to live out the
year. After enrolling in one of Ornish's team-based programs,
he started doing yoga and eating a low-fat,
He lost weight and strengthened his heart along the
way. Now 78, Lefer says,
"I can toss my
grandchildren in the air. I have a wonderful life." But it
took a lot of
coaching - and lifestyle changes - to get him there.
This is a tremendously positive trend that we enthusiastically endorse. But if
you aren't yet old enough (for Medicare), and/or your doctor isn't able to give
you good lifestyle and diet advice, then you are still on your own. Our advice
to everyone is to 'take charge' of your own health, and - as the cornerstone of
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