Intensive Lifestyle Intervention
The US Preventive Task Force (USPTF), The American Heart Association, The American College of Cardiologists, The Center for Disease Control (CDC), The American Diabetes Association, and The American College of Endocrinologists have all published position recommendations on or around 2014, indicating that Intensive Lifestyle Intervention is the New Standard of Care for the treatment of coronary heart disease, hypertension, prediabetes, diabetes and Alzheimer’s disease.
We are unique in this community because of our approach and the number of tools we have at our disposal for assisting patients with meaningful lifestyle changes. As noted above, our program starts with a review of specialized and advanced metabolic labs along with a complete nutritional workup in most patients. This review is performed by my specially trained Nurse Practitioners (Sapphira Clark and Sophie Hill). In theory, this review is intended to point out specific risks of interest and potential roadblocks to making progress with weight loss, and to provide you with strategies to work around those roadblocks.
Based on the results of these tests, the patients are placed in a personalized program for lifestyle and preventive management. Depending on the readiness for change and the number and magnitude of health problems, there are 3 levels of “Intensive Lifestyle Intervention” that we refer to as the Lifestyle Program. To qualify as “Intense Lifestyle Intervention” program, the guidelines provided by the US Prevention Task Force (USPTF) and the ADA recommend a minimum of 16 sessions over a 6-month period lasting 30-60 minutes each.
The program director is Tracy Evans who is certified as a Lifestyle Educator from the American Academy of Lifestyle Medicine, as well as other certifications in Metabolic Physiology. She has also lost 80 pounds and has been able to keep it off for over a decade. Our other Lifestyle Educators are Katie Collins who is also a registered dietitian, and Brittany Hall who is also a certified personal trainer and health coach through the American College of Exercise (ACE). Their job is to keep you motivated and accountable to the program, guiding you in your weekly visits through the pillars of Lifestyle medicine. There are 6 pillars to Lifestyle Medicine; Stress resilience, adequate sleep quantity and quality, exercise, diet, nicotine and alcohol addictions. The later 2 are dealt with by qualified medical providers, while the former four pillars are addressed by the Lifestyle Educators on each of your visits.
Our Wellness Program is an extension of the Lifestyle Program and is designed for those wanting to make gradual changes or with numerous barriers to change. The outline is similar, but the promoted changes are less intensive than for the Lifestyle Program. Progress is evaluated monthly.
Changing your Lifestyle can be a tall order for anyone. That is why we offer a personalized physician-led Healthy Living Program. We recommend this program be a 2-year journey learning new health habits during which you are seeing educators frequently in the beginning but gradually weaning to maintenance visits towards the end.
For Lifestyle Program participants: on each visit after you weigh-in on our body composition scale and you receive your vitamin shots, you will consult with one of our Lifestyle Educators weekly until you feel comfortable with the program (usually after 6 months or so), after which you may wish to come in bi-weekly or even monthly for sessions. During these sessions, your individual goals will be discussed based on the practitioner’s advice, which is based on your labs and health conditions. We provide exercise assessments and training by our Health Coach and Personal Trainer, Brittany Hall. We offer Group Education classes on prevention and reversal of chronic diseases held by Dr. Evans, and the Certified Lifestyle Educators.
Community support is provided by our closed Lifestyle Facebook Group, and we recommend continued 3-month lab reviews with one of our practitioners to see how you are progressing and to provide ongoing support. Once you have graduated from the lifestyle program, these labs will reinforce that you have maintained your health, including your weight.
In each session the educators review your stress and help with techniques to improve resilience. Recent studies have shown. for example, that people that are stressed have a change in taste sensation (more bitter and less sweet) which leaves them dissatisfied and wanting more food (emotional eating). Stress also depletes our energy, distracts us from creativity and leads to poor coping skills which can set you up for bad lifestyle choices. Stress also compromises our immune system and sets us up for gastro-intestinal problems.
Sleep duration and quality (including compliance with CPAP if sleep apnea is being treated) will be assessed with each visit because people sleeping less than 6 hours a night over a lifetime can shave a decade off their life.
Exercise starts with basic movement for some and more advanced for others. Eventually, all patients are advised that optimum health is associated with moderate physical activity amounting to 150 minutes a week. When appropriate, patients may be referred to our ACE certified personal trainer.
Discussions regarding your personal Diet Plan will depend on your goals, and your health. Some are calorie restricted, while others are not, but all patients will start a journey towards a healthier diet, which includes whole foods and mostly plants. There are some conditions where we HIGHLY recommend a complete plant-based diet (APOE-4 genetic defect, Type 2 Diabetes with reversal intentions, known cardiovascular disease with reversal intentions, or anyone with a family history for Alzheimer’s disease). Some patients join the Lifestyle Program for weight reduction, and these individuals may be calorie and oil restricted (if not pure plant- based). There is no need to count calories in most people who adopt a whole-foods plant-based way of eating who wish to lose weight.
Our focus is to repair the underlying physiological problems using evidence-based principles, which incorporate lifestyle changes to obtain benefits for your health and quality of life. It takes time to change lifestyle habits, and the hardest work in is the first 3-6 months. Should you decide to join the program, you will have taken the first step in taking control of your own destiny, and it is our job while you are here to facilitate “your journey.”
The essential goal of this program is to remove what is causing damage and allow the body to heal. To make it truly workable though, it is not just a matter of convincing the patient, but also the patients’ community. Food is how we connect with people and telling people not to eat unhealthy foods puts them on the defensive, not only because of the changes that are suggested to make, but because we have all been eating unhealthy most of our lives. It can also be difficult when a patient is eating healthy around family and friends that are eating unhealthily and giving signals that the Lifestyle patient should eat the same way they are eating. Once the patient has made it past this defensive posturing and has made the decision to stay on track, then they are faced with a new way to enjoy the life they have and maybe get to see the benefits of the changes they have asked their friends and family to make.
Intrinsically, people do not like to make changes, and too much change too soon sends them back to old habits. For this reason, we refer to this as “your journey,” and like all journeys, there will be obstacles, and switchbacks, and even restarts, and we embrace all of these without judgement.
Our analysis of our results for the 2017-2018 year showed that in people highly motivated with diabetes, an average 3-month weight loss of 14.5 pounds and improvement in insulin resistance (sugars) and cholesterol. At 6 months 69% of these patients had reversed their prediabetes and 50% had normalized their cholesterol.