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Becker’s Healthcare Podcast
Advancing Lifestyle Medicine to Prevent and Reverse Chronic Disease with Dr. Michelle McMacken
00:18:24
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- [00:00]
A
Welcome to the Beckers Healthcare Podcast. My name is Paige Twenter and I'm with the Beckers editorial team. I'm joined today by Dr. Michelle McMaken, the Executive Director of Nutrition and Lifestyle Medicine at NYC Health and Hospitals. Dr. McMaken, I am just so excited to talk with you today. For today's audience, can you briefly introduce yourself and your organization?
- [00:23]
B
Thank you so much for having me on the show. It's great to. It's great to be back. So I am a primary care physician. I've been working as a primary care physician for more than 20 years, trained in internal medicine. And along the way, I got very excited about the concept of lifestyle medicine, which is something that I now am also board certified in. In addition to internal medicine and my entire career past, my training has been at New York City Health and Hospitals. That's where I've done all of my clinical work. I'm very passionate about working in our health care system. So New York City Health and Hospitals is, as many of your listeners may know, the largest municipal health care system in the United States. We serve more than a million New Yorkers, and part of the mission is to serve individuals regardless of ability to pay, which something I'm very aligned with. We have a very diverse patient population, both culturally, racially, ethnically, linguistically. It's a very, very exciting place to work and a lot of folks who, you know, you know, who choose to work at New York City Health and hospitals, you know, we're just all very aligned with this mission. So it's a. It's a wonderful place to be.
- [01:41]
A
Can you kind of take us through the lifelong lifestyle medicine program? You told Beckers earlier that it's focused on patients with chronic illnesses, right?
- [01:54]
B
Yeah. So I would love to take you back to the beginning, if that's okay. We actually had the opportunity to start a pilot lifestyle medicine program at one of our acute care facilities within our healthcare system. That facility is Bellevue hospital. Back in 2019, we started a very small pilot with several physicians with a registered dietitian and a certified health coach. We worked with patients who were at who are already living with cardiometabolic disease, whether that was Pre diabetes, type 2 diabetes, high blood pressure, existing coronary artery disease, or other atherosclerotic disease or health concerns related to excess weight. So living with obesity and other concerns related to excess weight. And really our goal was to leverage what we call sort of the pillars of lifestyle change, most of which are very common sense. Right. Most people think about diet and exercise and those are very important pillars of lifestyle change. What a lot of us forget about is sleep health, for example. That's something that we focus, you know, we, we've learned over the years the importance of focusing on sleep health. I can, you know, share a little bit more about that. We also focus on managing stress. You know, my personal favorite, we're all, we all experience stress and how we, how we cultivate resilience and how we respond to it is really key for, you know, for really staying healthy. We focus on avoiding substance use, so avoiding tobacco use, avoiding excess alcohol, avoiding other substance use. And I think the pillar that many people forget about completely is the pillar of connectedness, which sounds a little touchy feely, but it's really, you know, we know loneliness is a huge risk factor for mortality, right? That, that came out with our, you know, previous Surgeon General had a focus on that. And I think a lot of people heard about that. So being connected, whether you're extrovert or an introvert, you still need to have connections, right? You need to be connected to other people or, you know, your pets, nature. There's a lot of different ways to be connected and find meaning. So those are really the pillars of lifestyle. And putting that all together, the evidence is very, very powerful that we cannot just help prevent all of these common chronic conditions, but we can actually significantly improve them. And that's our passion and that's our mission in the pilot program. In our pilot program, we found that we had really high demand for services in that program. There was a lot of people wanting to join the program, more than 850 people on a waiting list at one point. So we knew we were onto something, but, and then we also had really good signal for positive clinical outcomes and behavior changes. Our external evaluation. So Fast forward to 2022 and we were actually able to expand that program to seven total sites across New York City health and hospitals spanning all five boroughs of New York. And that's where we are now.
- [05:04]
A
I, I remember you told Becker's few years ago that patients were like knocking down doors to join the program. So is it still kind of rolled out in like a, you know, one on one visits, enroll in fitness and group classes, receive like lifelong programs, or has it, has it changed a bit since then?
- [05:30]
B
Yeah, so basically we know it. So we know that if you're going to help individuals change their lifestyle, it does have, you have to do it in a way that actually is sustainable for them. It's, you know, it's great to change your lifestyle for Two months. But it's obviously way better to maintain those changes. So what we've built is a program structure that really sets people up for success and then we have touch points indefinitely. So our program structure basically includes, you know, we have an interdisciplinary team. So we work with physicians, nurse practitioners, registered dietitians, certified health coaches. We now also have psychologists at four of our sites. We have community health workers, which are individuals who really have brought so much value to our patients in our program because they can help address our patients social needs and their barriers to making lifestyle changes, like if they're experiencing food insecurity or transportation needs or so forth. We also have a fitness instructor in our program, so we really have this great team. Patients come in, they have one on one visits with the medical providers, the dietitian and the health coach as a standard for everybody. And then they also participate in our group visits, which are really the core and the heart and soul of our program. So our group visits I can talk about in a few more minutes. The design is as a shared medical appointment, but essentially individuals are getting the opportunity to learn about these pillars of lifestyle that I talked about before, while also getting to interact with other peers. So we're kind of touching on that connectedness pillar. And then they have a breakout with our nurse practitioner for a few minutes every single week in the group to check in. How are your goals going, what are you working on? And throughout all of these individual visits, whether it's that visit within the group or the traditional individual visit, everybody has a chance to have our guidance tailored to their life. So we never, as a, as a team, we never, you know, tell people what to do because we have learned that that does not really work. You have to understand what is the person's goal, what's their situation, whether it's their, you know, their budget, their family, their cooking skills, their culinary traditions, the foods that they like and don't like, and really let them think about what they want to change and then help guide them to, you know, a next step that's really practical and realistic for them and really tailor it to whatever their situation is. So that's how we work with people. And that's honestly the best way to make it sustainable. You tie it to something that the person really cares about, what is their overall goal and tailor it in a way that really works for them and their family.
- [08:14]
A
And how is that personalization tailored in the group design?
- [08:18]
B
So there's a couple of ways. The first is that the actual structured curriculum that we offer has been Adapted across the, across different cultural traditions. It's, you know, it's very, you know, it's very based on promoting foods and eating patterns and lifestyle changes that are affordable, you know, and accessible to the majority of people. So that's one. But more importantly, again, when patients meet with the nurse practitioner within that group session, they're doing it privately in a one on one session. So that's the opportunity to really provide the tailored counseling and discuss. You know, last week we talked about that you were going to try, you know, a bowl of old fashioned oatmeal with banana and some peanuts. How did that work out for you? Any problems with that? And really talk through one on one how that worked and then maybe set some new plans and new steps for the next week.
- [09:15]
A
I, I love that example because it's not just like here are the food groups or like here's, you know, kind of the main goal. It's like specific, like we talked about this specific meal. Like, you know, is that in your daily habit? Like, is it affordable? You know, is it doable with your time schedule, with your work schedule? Yeah, I just, I love that example.
- [09:38]
B
Exactly. I mean we, you know, again, we work with patients from very, very different, you know, cultural background. So I really will never say to a patient, I incur. I would like to ask you to start eating oatmeal every. And if they've never heard of oatmeal, it's like it's not going to make sense. So we really start, we know, we know broadly what are the, you know, the different, the eating pattern that tends to, you know, improve chronic disease and lower the risk of complications. So within that, you know, within the category of fruits, vegetables, skewing towards more whole grains, different, you know, healthy protein sources. I like to ask patients, what do you like within this category? What did you grow up eating? What do you know how to prepare on your own or someone in your family who does the cooking knows how to prepare so we can really make it realistic for them.
- [10:25]
A
I want to raise a little bit to the, for lack of a better cliche like 30,000 foot view of program. I'm just curious, what outcome or clinical result are you most proud of seeing after, you know, years of running this program?
- [10:43]
B
You know, I honestly, there are. So we've seen patients who have, for example, dramatically improved their hemoglobin A1C, you know, as, you know, a marker of blood sugar control in people with diabetes. We've seen people who've experienced weight loss. We've seen people who've improved their, you know, cholesterol, their blood pressure. But to me, the thing that's the most rewarding is actually when a patient sits in front of me and tells me I feel so much better. Like, I feel like I have a new understanding of like, you know, how I want to live my life in a way that will support me now and in the future. And then when I have patients who a lot of times they're part of their motivation is they want to be healthy for their kids, you know, to be there and be sort of a model or an inspiration for their kids. And then they tell me that their kids are also on board and starting to, you know, eat more fruits and veggies because they're seeing their parent do it. It's just, it's honestly the best feeling and knowing that people just are feeling better, they have more energy and feel motivated to continue this lifestyle. And you know, that they are, you know, they're really, really supporting not just people's cardiometabolic health, but their overall well being in their life.
- [12:03]
A
Yeah. One thing I'm wondering, just because the program is tailored for patients with chronic illnesses, I'm wondering if NYC Health and Hospitals tracks admissions or changes in admissions. Just because I remember reading a statistic recently, I believe it was From Vizient that 11% of the population has multiple chronic conditions or illnesses.
- [12:26]
B
But.
- [12:27]
A
And that 11% makes up for 52% of hospital admissions. So I'm just wondering if you're currently tracking admissions in that program.
- [12:39]
B
We definitely have the ability to track it. And I, and I think, you know, you're absolutely right that when we look just again, that bird's eye view of what we're talking about from the perspective from the vantage point of healthcare service delivery and the cost of healthcare, it really makes a lot of sense to focus on, you know, lifestyle change. Not to say that, you know, medications don't have a very, you know, can have a very powerful role as well and procedures when needed. But to put all of that on a foundation of lifestyle change for everyone to the extent that they can and really support people in doing that. Because we know that our most common chronic conditions that account for the most healthcare spending are rooted in lifestyle change in addition to other factors. You know, we know that social determinants play a huge role as well. But, and it's important to address those too, you know, at the individual and policy level. But with lifestyle change and helping people, regardless of their situation, in doing what they can to, to access healthier food and add More healthy food to their plate and move their bodies a little bit more and help them manage stress can go a really long way. It's, it's first line in all of our, you know, the guidelines of our major medical societies, lifestyle is there. So I do think there's a case for, we can't really afford not to focus on this. You know, what for what is the cost of inaction in terms of the risk of chronic disease and complications, particularly, which are extremely costly. If you have a patient with type 2 diabetes and just as soon as they're diagnosed, you start talking to them about lifestyle change. They are, you know, the science is very clear that that's someone who has, you know, a potential to put their diabetes in remission. Imagine the difference between putting your diabetes in remission and keeping it there versus progressing with type 2 diabetes and having complications in the future and chronic kidney disease and dialysis and so forth. I mean, imagine the costs that could be saved. So long winded. Long winded answer to your question, but I couldn't agree more.
- [14:49]
A
Yeah, not, not long winded at all. Totally good. I do have one more question. Just because we're nearing the end of our time here. I'm trying to encapsulate everything. So I'd love to hear one suggested first step for other healthcare leaders who are listening, who are interested in launching something similar. You mentioned great results of, you know, lowered hemoglobin, A1, CS, weight loss, blood pressure reductions, just lifestyle changes, not only within that patient, but in their home, you know, with their kids. And of course, just that sound or just hearing, you know, I feel so much better. So I, I can imagine a lot of other people would love to, you know, launch something similar at their own systems. In my long winding question in response, where do you start?
- [15:46]
B
So if I could share from the vantage point of a physician or other medical provider and the vantage point of a health care leader or executive, I think from the standpoint of a healthcare provider, physician, nurse practitioner, so forth, I think, you know, there are, there are, there's a recent study showing that healthcare providers that adopt lifestyle medicine in their practice actually have documented lower rate of burnout. And it makes sense to me because for many years I did not, I didn't really even know what lifestyle medicine was. And I could see a huge difference when I started practicing lifestyle medicine within my primary care practice, even though I didn't have a whole team yet at that point. You know, first of all, you see your patients actually getting healthier. You know, you feel like you're helping empower them. You're working in a true partnership with them to get healthier. Again, not that medications don't help people get healthier, but it's. We're looking at the whole person here. And then also you connect with people in a way that you don't necessarily connect if you're not asking those questions about how do you manage stress and so forth. Now it's great to do it with a team because we don't, a lot of us don't have a lot of time to spend in our short visits. So it's great to have a whole team and I'm very fortunate to be in that position. So if you're a healthcare provider that's interested in learning more, I would definitely recommend going to the American College of Lifestyle Medicine website and thinking about attending their conference. They have an annual conference you can attend in person or virtually and just kind of seeing what is this all about and getting, you know, just learning more. And then if you're interested, you can get board certified like I did and start incorporating in your practice. For healthcare leaders, I would actually offer the same advice because the American College of Lifestyle Medicine has what's called a health systems Council. I think they have Some, something like 120 health systems across the United States now who are part of that council and sharing best practices in adopting lifestyle medicine and integrating it into the healthcare services of systems. So there's lots of different models out there. You don't have to start with the level of program that we have at New York City Health and Hospitals, which is among the biggest in the country at this point. You can start small and that's completely appropriate, you know, the way we did as a pilot and just great to hear what other places are doing and what's worked and what hasn't worked.
- [18:10]
A
Well, thank you so much for joining us today. I just really enjoyed hearing about this program and listening to you passionately talk about it. So I really appreciate it.
- [18:20]
B
My pleasure. Thank you so much for having me.