Welcome to the Becker's Healthcare Podcast.
My name is Paige Twenter, and I'm with
the Becker's editorial team.
I'm joined today by doctor Michelle McMacken,
the executive director of nutrition and lifestyle medicine
at NYC Health and Hospitals.
Doctor McMacken, I am just so excited to
talk with you today.
For today's audience, can you briefly introduce yourself
and your organization?
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 twenty 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 born 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.
So we serve more than a million New
Yorkers, and part of the mission is to
serve individuals regardless of ability to pay,
which, you know, I'm something I'm very aligned
with.
And,
you know, 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.
Can you kinda take us through
the lifelong
lifestyle medicine
program?
You told, Bikers earlier that it's,
focused on patients with chronic illnesses. Right?
Yeah. So,
I I would love to take you back
to the beginning if that's okay. So we,
we actually had the opportunity to start a
pilot lifestyle medicine program
at one of our, acute care facilities within
our health care system.
That facility is, Bellevue Hospital.
So back in 2019, we started a very
small pilot with several physicians,
with a registered dietitian
and a certified health coach.
And we worked with patients who were at
who are already living with cardiometabolic
disease,
whether that was prediabetes,
type two 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've
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.
Right? 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, how to 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 you know, your pet's 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 that's our passion and that's our mission,
in in the pilot program.
So,
in our pilot program, we found that we
had really we had really high demand for
services in that program. There was a 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.
And,
and then we also had, you know, really
good signal for positive clinical outcomes, and behavior
changes in our in about, you know, 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.
I I remember you, told Becker's,
a few years ago that patients were, like,
knocking down
doors to join the
program.
So is it still,
kind of rolled out in, like,
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?
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 kinda 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 wanna 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.
And how is that personalization
tailored in the group design?
So there's a couple of ways. The first
is that the actual,
structured curriculum that we offer has been adapted
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.
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 goals. 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. Exactly.
I mean, we you know, again, we work
with patients,
from very, very different, you know, cultural
backgrounds. So,
I really will never say to a patient,
I incur I would like to ask you
to start eating oatmeal every morning. And if
they've never heard of oatmeal, it's like it's
not gonna 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 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.
I wanna 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?
You know, I honestly,
there are so so we've seen patients who
have, for example,
dramatically improved their hemoglobin a one c, 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 wanna be healthy
for their kids,
you know, to be there and 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 it's honestly the best feeling,
and 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 we're really, really supporting not
just people's cardiometabolic health, but their overall well-being,
in their life.
Yeah. One thing I'm wondering just because the
program is, tailored for patients with chronic illnesses,
I I'm wondering if NYC,
health and hospitals
tracks
admissions or changes in admissions just because I
I remember reading a statistic recently. I believe
it was from Visiant that
eleven percent of the population has multiple chronic
conditions or illnesses,
but and that eleven percent makes up for
fifty two percent
of hospital admissions.
So I'm just wondering if,
you know, you're currently tracking
admissions in that program.
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 from the vantage point of health
care service delivery and the cost of health
care, 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 health
care 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 what is the cost of
inaction
and in terms of the risk of chronic
disease and complications,
particularly, which are extremely costly?
If you have a patient with type two
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 two diabetes
and, you know, having complications in the future,
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'm I I couldn't agree more.
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,
actually great results of, you know, lowered hemoglobin
A1Cs,
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 winded question in response,
where do you start?
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 health care provider, physician, nurse practitioner, so
forth,
I think, you know, there are there are
there's a recent study showing that
health care 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 you 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 we're 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, you know, 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 health care 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 it
you know, just learning more.
And then if you're interested, you can get
board certified like I did and and start
incorporating your practice.
For health care 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 somewhat something like a 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 health care services of 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.
Well, thank you so much for joining us
today. I I just really enjoyed hearing about
this program and, you know, listening to you
passionately talk about it. So I really appreciate
it. My pleasure. Thank you so much for
having me.