1 00:00:00,080 --> 00:00:02,179 Welcome to the Becker's Healthcare Podcast. 2 00:00:02,639 --> 00:00:04,559 My name is Paige Twenter, and I'm with 3 00:00:04,559 --> 00:00:06,179 the Becker's editorial team. 4 00:00:06,480 --> 00:00:08,660 I'm joined today by doctor Michelle McMacken, 5 00:00:08,960 --> 00:00:11,939 the executive director of nutrition and lifestyle medicine 6 00:00:12,080 --> 00:00:13,779 at NYC Health and Hospitals. 7 00:00:14,425 --> 00:00:16,585 Doctor McMacken, I am just so excited to 8 00:00:16,585 --> 00:00:17,644 talk with you today. 9 00:00:18,105 --> 00:00:20,824 For today's audience, can you briefly introduce yourself 10 00:00:20,824 --> 00:00:21,644 and your organization? 11 00:00:22,585 --> 00:00:24,025 Thank you so much for having me on 12 00:00:24,025 --> 00:00:25,945 the show. It's great to it's great to 13 00:00:25,945 --> 00:00:26,309 be back. 14 00:00:27,349 --> 00:00:30,550 So I am a, primary care physician. I've 15 00:00:30,550 --> 00:00:32,710 been working as a primary care physician for 16 00:00:32,710 --> 00:00:35,210 more than twenty years, trained in internal medicine. 17 00:00:35,590 --> 00:00:36,809 And along the way, 18 00:00:37,189 --> 00:00:39,884 I got very excited about the concept of 19 00:00:39,884 --> 00:00:42,045 lifestyle medicine, which is something that I now 20 00:00:42,045 --> 00:00:44,445 am also born certified in in addition to 21 00:00:44,445 --> 00:00:45,344 internal medicine. 22 00:00:45,965 --> 00:00:46,465 And 23 00:00:46,924 --> 00:00:47,664 my entire 24 00:00:48,045 --> 00:00:50,924 career past my training has been at New 25 00:00:50,924 --> 00:00:52,384 York City Health and Hospitals. 26 00:00:52,920 --> 00:00:54,520 That's where I've done all of my clinical 27 00:00:54,520 --> 00:00:56,840 work. I'm very passionate about working in our 28 00:00:56,840 --> 00:00:57,899 health care system. 29 00:00:58,679 --> 00:00:59,179 So 30 00:00:59,799 --> 00:01:01,960 New York City Health and Hospitals is, as 31 00:01:01,960 --> 00:01:03,719 many of your listeners may know, 32 00:01:04,439 --> 00:01:05,099 the largest 33 00:01:05,560 --> 00:01:06,060 municipal 34 00:01:06,734 --> 00:01:08,674 health care system in The United States. 35 00:01:09,375 --> 00:01:11,215 So we serve more than a million New 36 00:01:11,215 --> 00:01:13,135 Yorkers, and part of the mission is to 37 00:01:13,135 --> 00:01:15,715 serve individuals regardless of ability to pay, 38 00:01:16,255 --> 00:01:18,255 which, you know, I'm something I'm very aligned 39 00:01:18,255 --> 00:01:18,734 with. 40 00:01:19,295 --> 00:01:19,795 And, 41 00:01:20,105 --> 00:01:22,140 you know, we have a very diverse patient 42 00:01:22,140 --> 00:01:23,200 population both 43 00:01:23,739 --> 00:01:24,239 culturally, 44 00:01:24,939 --> 00:01:28,540 racially, ethnically, linguistically. It's a very, very exciting 45 00:01:28,540 --> 00:01:31,019 place to work, and a lot of folks 46 00:01:31,019 --> 00:01:33,564 who, you know you know, who choose to 47 00:01:33,564 --> 00:01:35,245 work at New York City Health and Hospitals, 48 00:01:35,245 --> 00:01:36,924 you know, we're just all very aligned with 49 00:01:36,924 --> 00:01:38,765 this mission. So it's a it's a wonderful 50 00:01:38,765 --> 00:01:39,665 place to be. 51 00:01:40,685 --> 00:01:42,465 Can you kinda take us through 52 00:01:43,005 --> 00:01:43,984 the lifelong 53 00:01:44,605 --> 00:01:45,825 lifestyle medicine 54 00:01:46,379 --> 00:01:46,879 program? 55 00:01:47,340 --> 00:01:50,299 You told, Bikers earlier that it's, 56 00:01:50,620 --> 00:01:53,599 focused on patients with chronic illnesses. Right? 57 00:01:54,379 --> 00:01:54,939 Yeah. So, 58 00:01:56,459 --> 00:01:58,424 I I would love to take you back 59 00:01:58,424 --> 00:02:00,665 to the beginning if that's okay. So we, 60 00:02:00,905 --> 00:02:03,064 we actually had the opportunity to start a 61 00:02:03,064 --> 00:02:04,844 pilot lifestyle medicine program 62 00:02:05,305 --> 00:02:07,944 at one of our, acute care facilities within 63 00:02:07,944 --> 00:02:09,085 our health care system. 64 00:02:09,385 --> 00:02:11,485 That facility is, Bellevue Hospital. 65 00:02:12,209 --> 00:02:14,289 So back in 2019, we started a very 66 00:02:14,289 --> 00:02:16,310 small pilot with several physicians, 67 00:02:17,569 --> 00:02:19,189 with a registered dietitian 68 00:02:19,729 --> 00:02:21,430 and a certified health coach. 69 00:02:21,969 --> 00:02:25,009 And we worked with patients who were at 70 00:02:25,245 --> 00:02:26,944 who are already living with cardiometabolic 71 00:02:27,245 --> 00:02:27,745 disease, 72 00:02:28,205 --> 00:02:29,824 whether that was prediabetes, 73 00:02:30,764 --> 00:02:32,944 type two diabetes, high blood pressure, 74 00:02:33,485 --> 00:02:33,985 existing 75 00:02:34,764 --> 00:02:36,864 coronary artery disease or other atherosclerotic 76 00:02:37,245 --> 00:02:39,770 disease, or health concerns related to, 77 00:02:40,250 --> 00:02:42,490 excess weight. So living with obesity and other, 78 00:02:43,050 --> 00:02:45,849 concerns related to excess weight. And, really, our 79 00:02:45,849 --> 00:02:47,469 goal was to leverage, 80 00:02:48,169 --> 00:02:50,009 what we call sort of the pillars of 81 00:02:50,009 --> 00:02:52,985 lifestyle change. Most of which are very common 82 00:02:52,985 --> 00:02:55,145 sense. Right? Most people think about diet and 83 00:02:55,145 --> 00:02:57,625 exercise, and those are very important pillars of 84 00:02:57,625 --> 00:02:58,525 lifestyle change. 85 00:02:58,985 --> 00:03:00,844 What a lot of us forget about, 86 00:03:01,625 --> 00:03:03,004 is sleep health, 87 00:03:03,580 --> 00:03:04,319 for example. 88 00:03:04,620 --> 00:03:06,459 That's something that we focus you know, we've 89 00:03:06,459 --> 00:03:08,300 we've learned over the years the importance of 90 00:03:08,300 --> 00:03:09,680 focusing on sleep health. 91 00:03:09,979 --> 00:03:11,580 I can, you know, share a little bit 92 00:03:11,580 --> 00:03:14,459 more about that. We also focus on managing 93 00:03:14,459 --> 00:03:14,959 stress, 94 00:03:15,259 --> 00:03:16,719 you know, my personal favorite. 95 00:03:17,254 --> 00:03:19,974 Right? We're all we all experience stress, and 96 00:03:19,974 --> 00:03:22,375 how we how we cultivate resilience and how 97 00:03:22,375 --> 00:03:24,375 we respond to it is really key for, 98 00:03:25,014 --> 00:03:26,634 you know, for really staying healthy. 99 00:03:27,574 --> 00:03:30,534 We focus on avoiding substance use, so avoiding 100 00:03:30,534 --> 00:03:31,514 tobacco use, 101 00:03:31,860 --> 00:03:35,299 avoiding excess alcohol, avoiding other substance use. And 102 00:03:35,299 --> 00:03:37,299 I think the pillar that many people forget 103 00:03:37,299 --> 00:03:39,799 about completely is the pillar of connectedness, 104 00:03:40,659 --> 00:03:42,659 which sounds a little touchy feely, but it's 105 00:03:42,659 --> 00:03:44,500 really you know, we know loneliness is a 106 00:03:44,500 --> 00:03:46,805 huge risk factor for mortality. Right? That that 107 00:03:46,805 --> 00:03:48,965 came out with our, you know, previous surgeon 108 00:03:48,965 --> 00:03:50,245 general, how to focus on that, and I 109 00:03:50,245 --> 00:03:51,944 think a lot of people heard about that. 110 00:03:52,324 --> 00:03:55,284 So being connected, whether you're extrovert or an 111 00:03:55,284 --> 00:03:57,525 introvert, you still need to have connections. Right? 112 00:03:57,525 --> 00:03:59,384 You need to be connected to other people, 113 00:04:00,164 --> 00:04:02,379 or, you you know, your pet's nature. There's 114 00:04:02,379 --> 00:04:03,979 a lot of different ways to be connected 115 00:04:03,979 --> 00:04:05,259 and find meaning. So, 116 00:04:05,580 --> 00:04:07,419 those are really the pillars of lifestyle. And 117 00:04:07,419 --> 00:04:08,560 putting that all together, 118 00:04:09,099 --> 00:04:11,259 the evidence is very, very powerful that we 119 00:04:11,259 --> 00:04:12,319 cannot just 120 00:04:13,099 --> 00:04:13,840 help prevent 121 00:04:14,335 --> 00:04:16,435 all of these common chronic conditions, 122 00:04:17,134 --> 00:04:19,694 but we can actually significantly improve them. And 123 00:04:19,694 --> 00:04:21,855 that's that's our passion and that's our mission, 124 00:04:22,095 --> 00:04:23,634 in in the pilot program. 125 00:04:24,095 --> 00:04:24,595 So, 126 00:04:25,214 --> 00:04:26,975 in our pilot program, we found that we 127 00:04:26,975 --> 00:04:28,814 had really we had really high demand for 128 00:04:28,814 --> 00:04:30,949 services in that program. There was a a 129 00:04:30,949 --> 00:04:32,970 lot of people wanting to join the program, 130 00:04:33,509 --> 00:04:34,709 more than 850 131 00:04:34,709 --> 00:04:36,649 people on a waiting list at one point. 132 00:04:37,029 --> 00:04:38,569 So we knew we were onto something. 133 00:04:39,509 --> 00:04:40,009 And, 134 00:04:40,550 --> 00:04:42,470 and then we also had, you know, really 135 00:04:42,470 --> 00:04:45,985 good signal for positive clinical outcomes, and behavior 136 00:04:45,985 --> 00:04:47,904 changes in our in about, you know, our 137 00:04:47,904 --> 00:04:49,524 external evaluation. So, 138 00:04:50,305 --> 00:04:52,865 fast forward to 2022, and we were actually 139 00:04:52,865 --> 00:04:54,884 able to expand that program 140 00:04:55,345 --> 00:04:56,805 to seven total sites 141 00:04:57,389 --> 00:04:59,089 across New York City health and hospitals 142 00:04:59,470 --> 00:05:02,029 spanning all five boroughs of New York, and 143 00:05:02,029 --> 00:05:03,329 that's where we are now. 144 00:05:04,350 --> 00:05:06,850 I I remember you, told Becker's, 145 00:05:07,709 --> 00:05:09,550 a few years ago that patients were, like, 146 00:05:09,550 --> 00:05:10,370 knocking down 147 00:05:10,750 --> 00:05:12,850 doors to join the 148 00:05:13,185 --> 00:05:13,685 program. 149 00:05:14,944 --> 00:05:16,165 So is it still, 150 00:05:16,785 --> 00:05:18,324 kind of rolled out in, like, 151 00:05:19,185 --> 00:05:21,504 you know, one on one visits, enroll in 152 00:05:21,504 --> 00:05:22,564 fitness and group 153 00:05:23,185 --> 00:05:23,685 classes, 154 00:05:24,625 --> 00:05:26,165 receive, like, lifelong 155 00:05:26,819 --> 00:05:28,579 programs, or has it has it changed a 156 00:05:28,579 --> 00:05:29,560 bit since then? 157 00:05:30,259 --> 00:05:32,500 Yeah. So, basically, we know it so, 158 00:05:32,899 --> 00:05:35,060 we know that if you're going to help 159 00:05:35,060 --> 00:05:37,300 individuals change their lifestyle, it does have you 160 00:05:37,300 --> 00:05:38,579 have to do it in a way that 161 00:05:38,579 --> 00:05:40,439 actually is sustainable for them. 162 00:05:40,865 --> 00:05:42,465 It's, you know, it's great to change your 163 00:05:42,465 --> 00:05:44,805 lifestyle for two months, but it's obviously 164 00:05:45,185 --> 00:05:47,045 way better to maintain those changes. 165 00:05:47,745 --> 00:05:49,585 So what we've built is a program structure 166 00:05:49,585 --> 00:05:51,824 that really sets people up for success, and 167 00:05:51,824 --> 00:05:53,845 then we have touch points indefinitely. 168 00:05:54,479 --> 00:05:57,439 So our program structure basically includes, you know, 169 00:05:57,439 --> 00:05:59,519 we have an interdisciplinary team. So we work 170 00:05:59,519 --> 00:06:01,379 with physicians, nurse practitioners, 171 00:06:02,000 --> 00:06:02,979 registered dietitians, 172 00:06:03,680 --> 00:06:06,899 certified health coaches. We now also have psychologists 173 00:06:07,199 --> 00:06:08,339 at four of our sites. 174 00:06:08,785 --> 00:06:10,564 We have community health workers, 175 00:06:11,824 --> 00:06:13,985 which are individuals who, 176 00:06:14,305 --> 00:06:17,105 really have brought so much value to our 177 00:06:17,105 --> 00:06:19,205 patients in our program because they can help 178 00:06:19,425 --> 00:06:22,399 address our patients' social needs and their barriers 179 00:06:22,399 --> 00:06:24,800 to making lifestyle changes, like if they're experiencing 180 00:06:24,800 --> 00:06:27,860 food insecurity or transportation needs or so forth. 181 00:06:28,639 --> 00:06:29,680 We also have, 182 00:06:30,000 --> 00:06:31,139 a fitness instructor, 183 00:06:31,759 --> 00:06:33,599 in our program. So we really have this 184 00:06:33,599 --> 00:06:35,599 great team. Patients come in. They have one 185 00:06:35,599 --> 00:06:38,355 on one visits with the medical providers, the 186 00:06:38,355 --> 00:06:40,995 dietitian, and the health coach as a standard 187 00:06:40,995 --> 00:06:41,735 for everybody. 188 00:06:42,595 --> 00:06:43,335 And then 189 00:06:43,795 --> 00:06:46,754 they also participate in our group visits, which 190 00:06:46,754 --> 00:06:47,254 are 191 00:06:47,634 --> 00:06:49,395 really the core and the heart and soul 192 00:06:49,395 --> 00:06:51,560 of our program. So our group visits, 193 00:06:52,019 --> 00:06:53,300 I can talk about in a few more 194 00:06:53,300 --> 00:06:55,459 minutes. The design is as a shared medical 195 00:06:55,459 --> 00:06:55,959 appointment, 196 00:06:56,579 --> 00:06:59,639 but essentially, individuals are getting the opportunity 197 00:07:00,019 --> 00:07:00,519 to 198 00:07:00,979 --> 00:07:03,300 learn about these pillars of lifestyle that I 199 00:07:03,300 --> 00:07:04,279 talked about before 200 00:07:04,664 --> 00:07:06,664 while also getting to interact with other peers. 201 00:07:06,664 --> 00:07:08,444 So we're kinda touching on that connectedness, 202 00:07:09,305 --> 00:07:09,805 pillar. 203 00:07:10,745 --> 00:07:12,044 And then they have a breakout 204 00:07:12,425 --> 00:07:14,584 with our nurse practitioner for a few minutes 205 00:07:14,584 --> 00:07:16,925 every single week in the group to check-in. 206 00:07:17,360 --> 00:07:18,959 How are your goals going? What are you 207 00:07:18,959 --> 00:07:19,699 working on? 208 00:07:20,079 --> 00:07:22,720 And throughout all of these individual visits, whether 209 00:07:22,720 --> 00:07:25,279 it's that visit within the group or the 210 00:07:25,279 --> 00:07:25,779 traditional 211 00:07:26,319 --> 00:07:27,300 individual visit, 212 00:07:27,759 --> 00:07:30,740 everybody has a chance to have our guidance 213 00:07:30,879 --> 00:07:33,675 tailored to their life. So we never, as 214 00:07:33,675 --> 00:07:35,294 a as a team, we never, 215 00:07:35,914 --> 00:07:38,314 you know, tell people what to do because 216 00:07:38,314 --> 00:07:39,914 we have learned that that does not really 217 00:07:39,914 --> 00:07:40,414 work. 218 00:07:40,714 --> 00:07:42,634 You have to understand what is the person's 219 00:07:42,634 --> 00:07:45,115 goal, what's their situation, whether it's their, you 220 00:07:45,115 --> 00:07:47,615 know, their budget, their family, their cooking skills, 221 00:07:48,230 --> 00:07:50,470 their culinary traditions, the foods that they like 222 00:07:50,470 --> 00:07:52,410 and don't like, and really let them 223 00:07:52,870 --> 00:07:54,710 think about what they wanna change and then 224 00:07:54,710 --> 00:07:55,930 help guide them to, 225 00:07:56,310 --> 00:07:58,150 you know, a next step that's really practical 226 00:07:58,150 --> 00:08:00,150 and realistic for them and really tailor it 227 00:08:00,150 --> 00:08:02,625 to whatever their situation is. So, that's how 228 00:08:02,625 --> 00:08:04,225 we work with people, and that's honestly the 229 00:08:04,225 --> 00:08:06,144 best way to make it sustainable. You tie 230 00:08:06,144 --> 00:08:07,824 it to something that the person really cares 231 00:08:07,824 --> 00:08:10,305 about, what is their overall goal, and tailor 232 00:08:10,305 --> 00:08:11,824 it in a way that really works for 233 00:08:11,824 --> 00:08:12,805 them and their family. 234 00:08:13,824 --> 00:08:15,204 And how is that personalization 235 00:08:15,745 --> 00:08:17,285 tailored in the group design? 236 00:08:17,779 --> 00:08:19,459 So there's a couple of ways. The first 237 00:08:19,459 --> 00:08:20,600 is that the actual, 238 00:08:21,459 --> 00:08:24,180 structured curriculum that we offer has been adapted 239 00:08:24,180 --> 00:08:25,879 across different cultural traditions. 240 00:08:26,660 --> 00:08:29,060 It's, you know, it's very, you know, it's 241 00:08:29,060 --> 00:08:30,279 very based on 242 00:08:30,794 --> 00:08:33,835 promoting foods and eating patterns and lifestyle changes 243 00:08:33,835 --> 00:08:36,095 that are affordable, you know, and accessible 244 00:08:36,394 --> 00:08:37,774 to the majority of people. 245 00:08:38,955 --> 00:08:41,995 So that's one. But more importantly, again, when 246 00:08:41,995 --> 00:08:44,799 patients meet with the nurse practitioner within that 247 00:08:44,799 --> 00:08:46,899 group session, they're doing it privately 248 00:08:47,279 --> 00:08:49,039 in a one on one session. So that's 249 00:08:49,039 --> 00:08:52,500 the opportunity to really provide the tailored counseling 250 00:08:52,639 --> 00:08:54,639 and discuss, you know last week, we talked 251 00:08:54,639 --> 00:08:56,259 about that you were going to 252 00:08:56,625 --> 00:08:58,705 try, you know, a bowl of old fashioned 253 00:08:58,705 --> 00:08:59,205 oatmeal, 254 00:08:59,825 --> 00:09:00,644 with banana, 255 00:09:01,424 --> 00:09:02,804 and some peanuts. 256 00:09:03,345 --> 00:09:05,044 How did that work out for you? 257 00:09:05,424 --> 00:09:08,144 Any problems with that? And really talk through 258 00:09:08,144 --> 00:09:09,985 one on one how that worked and then 259 00:09:09,985 --> 00:09:12,759 maybe set some new, plans and new steps 260 00:09:12,759 --> 00:09:13,659 for the next week. 261 00:09:14,759 --> 00:09:16,919 I I love that example because it's not 262 00:09:16,919 --> 00:09:18,919 just like, here are the food groups or, 263 00:09:18,919 --> 00:09:19,740 like, here's, 264 00:09:20,200 --> 00:09:22,759 you know, kind of the main goals. Like, 265 00:09:22,759 --> 00:09:24,779 specific like, we talked about this specific 266 00:09:25,334 --> 00:09:26,074 meal. Like, 267 00:09:26,454 --> 00:09:28,554 you know, is that in your daily habit? 268 00:09:28,694 --> 00:09:30,235 Like, is it affordable? 269 00:09:31,014 --> 00:09:33,414 You know, is it doable with your time 270 00:09:33,414 --> 00:09:34,875 schedule, with your work schedule? 271 00:09:35,814 --> 00:09:38,054 Yeah. I just I love that example. Exactly. 272 00:09:38,054 --> 00:09:39,735 I mean, we you know, again, we work 273 00:09:39,735 --> 00:09:40,475 with patients, 274 00:09:41,580 --> 00:09:44,720 from very, very different, you know, cultural 275 00:09:45,019 --> 00:09:46,080 backgrounds. So, 276 00:09:46,620 --> 00:09:48,399 I really will never say to a patient, 277 00:09:48,620 --> 00:09:50,299 I incur I would like to ask you 278 00:09:50,299 --> 00:09:52,059 to start eating oatmeal every morning. And if 279 00:09:52,059 --> 00:09:53,659 they've never heard of oatmeal, it's like it's 280 00:09:53,659 --> 00:09:55,534 not gonna make sense. So we really start 281 00:09:55,695 --> 00:09:58,254 we know we know broadly what are the, 282 00:09:58,254 --> 00:10:00,254 you know, the different the eating pattern that 283 00:10:00,254 --> 00:10:03,214 tends to, you know, improve chronic disease and 284 00:10:03,214 --> 00:10:04,595 lower the risk of complications. 285 00:10:04,975 --> 00:10:07,054 So within that, you know, within the category 286 00:10:07,054 --> 00:10:08,115 of fruits, vegetables, 287 00:10:08,909 --> 00:10:11,549 skewing towards more whole grains, different, you know, 288 00:10:11,549 --> 00:10:12,850 healthy protein sources, 289 00:10:13,230 --> 00:10:14,909 I I like to ask patients, what do 290 00:10:14,909 --> 00:10:16,669 you like within this category? What did you 291 00:10:16,669 --> 00:10:18,589 grow up eating? What do you know how 292 00:10:18,589 --> 00:10:20,190 to prepare on your own or someone in 293 00:10:20,190 --> 00:10:21,710 your family who does the cooking knows how 294 00:10:21,710 --> 00:10:23,389 to prepare? So we can really make it 295 00:10:23,389 --> 00:10:24,404 realistic for them. 296 00:10:25,365 --> 00:10:27,384 I wanna raise a little bit to the, 297 00:10:27,764 --> 00:10:30,185 for lack of a better cliche, like, 30,000 298 00:10:30,485 --> 00:10:32,585 foot view of program. 299 00:10:33,205 --> 00:10:34,665 I'm just curious. What 300 00:10:35,125 --> 00:10:37,865 outcome or clinical result are you most 301 00:10:38,500 --> 00:10:40,040 proud of seeing after, 302 00:10:40,420 --> 00:10:42,279 you know, years of running this program? 303 00:10:43,220 --> 00:10:44,519 You know, I honestly, 304 00:10:46,019 --> 00:10:48,500 there are so so we've seen patients who 305 00:10:48,500 --> 00:10:49,559 have, for example, 306 00:10:49,940 --> 00:10:52,820 dramatically improved their hemoglobin a one c, you 307 00:10:52,820 --> 00:10:54,315 know, as you know, a marker of blood 308 00:10:54,475 --> 00:10:56,495 sugar control in people with diabetes. 309 00:10:56,955 --> 00:10:58,174 We've seen people who've, 310 00:10:58,955 --> 00:11:01,595 experienced weight loss. We've seen people who've improved 311 00:11:01,595 --> 00:11:02,975 their, you know, cholesterol, 312 00:11:03,914 --> 00:11:04,894 their blood pressure. 313 00:11:05,434 --> 00:11:05,934 But 314 00:11:06,315 --> 00:11:09,000 to me, the thing that's the most rewarding 315 00:11:09,059 --> 00:11:11,139 is actually when a patient sits in front 316 00:11:11,139 --> 00:11:12,820 of me and tells me I feel so 317 00:11:12,820 --> 00:11:13,480 much better. 318 00:11:13,940 --> 00:11:15,940 Like, I feel like I have a new 319 00:11:15,940 --> 00:11:16,440 understanding 320 00:11:17,059 --> 00:11:17,559 of, 321 00:11:17,940 --> 00:11:19,000 like, you know, 322 00:11:19,715 --> 00:11:21,875 how I want to live my life in 323 00:11:21,875 --> 00:11:24,514 a way that will support me now and 324 00:11:24,514 --> 00:11:26,754 in the future. And then when I have 325 00:11:26,754 --> 00:11:29,075 patients who a lot of times, they're part 326 00:11:29,075 --> 00:11:30,835 of their motivation is they wanna be healthy 327 00:11:30,835 --> 00:11:31,654 for their kids, 328 00:11:31,970 --> 00:11:33,490 you know, to be there and and be 329 00:11:33,490 --> 00:11:35,009 sort of a model or an inspiration for 330 00:11:35,009 --> 00:11:36,529 their kids. And then they tell me that 331 00:11:36,529 --> 00:11:38,690 their kids are also on board and starting 332 00:11:38,690 --> 00:11:40,370 to, you know, eat more fruits and veggies 333 00:11:40,370 --> 00:11:42,309 because they're seeing their parent do it. 334 00:11:42,929 --> 00:11:46,205 It's just it's it's honestly the best feeling, 335 00:11:46,985 --> 00:11:49,465 and and knowing that people just are feeling 336 00:11:49,465 --> 00:11:51,865 better, they have more energy and feel motivated 337 00:11:51,865 --> 00:11:53,945 to continue this lifestyle, and you know that 338 00:11:53,945 --> 00:11:54,764 they are, 339 00:11:56,024 --> 00:11:58,264 you know, they're we're really, really supporting not 340 00:11:58,264 --> 00:12:01,245 just people's cardiometabolic health, but their overall well-being, 341 00:12:01,679 --> 00:12:02,419 in their life. 342 00:12:03,120 --> 00:12:05,759 Yeah. One thing I'm wondering just because the 343 00:12:05,759 --> 00:12:08,740 program is, tailored for patients with chronic illnesses, 344 00:12:08,799 --> 00:12:10,500 I I'm wondering if NYC, 345 00:12:11,440 --> 00:12:12,259 health and hospitals 346 00:12:13,120 --> 00:12:13,620 tracks 347 00:12:14,725 --> 00:12:17,605 admissions or changes in admissions just because I 348 00:12:17,605 --> 00:12:19,524 I remember reading a statistic recently. I believe 349 00:12:19,524 --> 00:12:20,904 it was from Visiant that 350 00:12:21,285 --> 00:12:24,264 eleven percent of the population has multiple chronic 351 00:12:24,565 --> 00:12:25,785 conditions or illnesses, 352 00:12:26,404 --> 00:12:28,404 but and that eleven percent makes up for 353 00:12:28,404 --> 00:12:29,465 fifty two percent 354 00:12:29,940 --> 00:12:31,559 of hospital admissions. 355 00:12:31,940 --> 00:12:33,399 So I'm just wondering if, 356 00:12:34,019 --> 00:12:35,480 you know, you're currently tracking 357 00:12:36,419 --> 00:12:37,960 admissions in that program. 358 00:12:38,419 --> 00:12:40,820 We definitely have the ability to track it, 359 00:12:41,139 --> 00:12:42,660 and I and I think, you know, you're 360 00:12:42,660 --> 00:12:44,120 absolutely right that 361 00:12:44,495 --> 00:12:46,735 when we look just, again, that bird's eye 362 00:12:46,735 --> 00:12:48,174 view of what we're talking about, 363 00:12:48,735 --> 00:12:51,534 from the from the vantage point of health 364 00:12:51,534 --> 00:12:53,375 care service delivery and the cost of health 365 00:12:53,375 --> 00:12:55,375 care, it really makes a lot of sense 366 00:12:55,375 --> 00:12:56,514 to focus on, 367 00:12:56,919 --> 00:12:58,460 you know, lifestyle change. 368 00:12:58,840 --> 00:13:01,000 Not to say that, you know, medications don't 369 00:13:01,000 --> 00:13:02,200 have a very you know, can have a 370 00:13:02,200 --> 00:13:04,519 very powerful role as well and procedures when 371 00:13:04,519 --> 00:13:07,320 needed, but to put all of that on 372 00:13:07,320 --> 00:13:09,500 a foundation of lifestyle change for everyone, 373 00:13:10,045 --> 00:13:11,425 to the extent that they can, 374 00:13:11,804 --> 00:13:13,985 and really support people in doing that because, 375 00:13:14,524 --> 00:13:15,745 we know that 376 00:13:16,125 --> 00:13:17,264 our most common 377 00:13:17,804 --> 00:13:19,884 chronic conditions that account for the most health 378 00:13:19,884 --> 00:13:20,625 care spending 379 00:13:21,085 --> 00:13:22,304 are rooted in 380 00:13:22,740 --> 00:13:25,379 lifestyle change in addition to other factors. You 381 00:13:25,379 --> 00:13:27,220 know, we know that social determinants play a 382 00:13:27,220 --> 00:13:29,940 huge role as well, but and it's important 383 00:13:29,940 --> 00:13:31,620 to address those too, you know, at the 384 00:13:31,620 --> 00:13:33,480 individual and policy level. But, 385 00:13:33,860 --> 00:13:35,879 with lifestyle change and helping people 386 00:13:36,259 --> 00:13:37,639 regardless of their situation 387 00:13:38,634 --> 00:13:40,334 in doing what they can to, 388 00:13:40,954 --> 00:13:43,355 to access healthier food and add more healthy 389 00:13:43,355 --> 00:13:45,115 food to their plate and move their bodies 390 00:13:45,115 --> 00:13:46,634 a little bit more and help them manage 391 00:13:46,634 --> 00:13:48,654 stress can go a really long way. 392 00:13:49,595 --> 00:13:52,170 It's it's first line in all of our, 393 00:13:52,170 --> 00:13:54,410 you know, the guidelines of our major medical 394 00:13:54,410 --> 00:13:56,250 societies. Lifestyle is there. So, 395 00:13:56,809 --> 00:13:58,889 I do think there's a case for we 396 00:13:58,889 --> 00:14:01,290 can't really afford not to focus on this. 397 00:14:01,290 --> 00:14:03,389 You know, what what is the cost of 398 00:14:03,794 --> 00:14:04,294 inaction 399 00:14:04,754 --> 00:14:06,914 and in terms of the risk of chronic 400 00:14:06,914 --> 00:14:08,054 disease and complications, 401 00:14:08,674 --> 00:14:10,855 particularly, which are extremely costly? 402 00:14:11,235 --> 00:14:13,394 If you have a patient with type two 403 00:14:13,394 --> 00:14:13,894 diabetes 404 00:14:14,434 --> 00:14:14,934 and 405 00:14:15,649 --> 00:14:17,410 just as soon as they're diagnosed, you start 406 00:14:17,410 --> 00:14:19,110 talking to them about lifestyle change. 407 00:14:19,410 --> 00:14:21,730 They are you know, the science is very 408 00:14:21,730 --> 00:14:24,370 clear that that's someone who has, you know, 409 00:14:24,370 --> 00:14:26,629 a potential to put their diabetes in remission. 410 00:14:27,250 --> 00:14:29,570 Imagine the difference between putting your diabetes in 411 00:14:29,570 --> 00:14:31,904 remission and keeping it there versus 412 00:14:32,684 --> 00:14:34,384 progressing with type two diabetes 413 00:14:35,004 --> 00:14:37,565 and, you know, having complications in the future, 414 00:14:37,565 --> 00:14:39,804 chronic kidney disease and dialysis and so forth. 415 00:14:39,804 --> 00:14:41,725 I mean, imagine the costs that could be 416 00:14:41,725 --> 00:14:42,225 saved. 417 00:14:43,639 --> 00:14:46,519 So long winded long winded, answer to your 418 00:14:46,519 --> 00:14:49,179 question, but I'm I I couldn't agree more. 419 00:14:49,399 --> 00:14:52,059 Yeah. Not not long winded at all. 420 00:14:52,600 --> 00:14:55,899 Totally good. I do have, one more question 421 00:14:55,960 --> 00:14:58,139 just because we're nearing the end of our 422 00:14:58,279 --> 00:14:59,100 time here. 423 00:15:00,134 --> 00:15:01,754 I'm trying to encapsulate everything. 424 00:15:02,375 --> 00:15:04,235 So I'd love to hear 425 00:15:04,695 --> 00:15:08,054 one suggested first step for other healthcare leaders 426 00:15:08,054 --> 00:15:09,274 who are listening, who 427 00:15:09,575 --> 00:15:12,475 are interested in launching something similar. You mentioned, 428 00:15:12,934 --> 00:15:15,740 actually great results of, you know, lowered hemoglobin 429 00:15:15,879 --> 00:15:16,379 A1Cs, 430 00:15:17,160 --> 00:15:17,899 weight loss, 431 00:15:18,600 --> 00:15:20,299 blood, pressure reductions, 432 00:15:21,559 --> 00:15:24,679 just lifestyle changes not only within that patient 433 00:15:24,679 --> 00:15:26,840 but in their home, you know, with their 434 00:15:26,840 --> 00:15:27,340 kids. 435 00:15:28,040 --> 00:15:31,075 And, of course, just that sound or just 436 00:15:31,075 --> 00:15:33,414 hearing, you know, I feel so much better. 437 00:15:33,794 --> 00:15:35,475 So I I can imagine a lot of 438 00:15:35,475 --> 00:15:37,394 other people would love to, you know, launch 439 00:15:37,394 --> 00:15:39,254 something similar at their own systems. 440 00:15:40,115 --> 00:15:42,534 In my long winded question in response, 441 00:15:43,875 --> 00:15:44,934 where do you start? 442 00:15:45,929 --> 00:15:46,429 So 443 00:15:47,129 --> 00:15:48,970 if I could share from the vantage point 444 00:15:48,970 --> 00:15:49,470 of 445 00:15:50,009 --> 00:15:52,889 a physician or other medical provider and the 446 00:15:52,889 --> 00:15:55,449 vantage point of a health care leader or 447 00:15:55,449 --> 00:15:55,949 executive, 448 00:15:57,355 --> 00:15:59,375 I think from the standpoint of 449 00:15:59,754 --> 00:16:02,634 a health care provider, physician, nurse practitioner, so 450 00:16:02,634 --> 00:16:03,134 forth, 451 00:16:03,754 --> 00:16:05,914 I think, you know, there are there are 452 00:16:05,995 --> 00:16:07,855 there's a recent study showing that 453 00:16:08,235 --> 00:16:11,274 health care providers that adopt lifestyle medicine in 454 00:16:11,274 --> 00:16:12,894 their practice actually have 455 00:16:13,639 --> 00:16:15,500 documented lower rate of burnout. 456 00:16:16,440 --> 00:16:18,700 And it makes sense to me because 457 00:16:19,879 --> 00:16:21,559 for many years, I did not I didn't 458 00:16:21,559 --> 00:16:23,559 really even know what lifestyle medicine was, and 459 00:16:23,559 --> 00:16:25,000 I could see a huge difference when I 460 00:16:25,000 --> 00:16:27,559 started practicing lifestyle medicine within my primary care 461 00:16:27,559 --> 00:16:28,975 practice even though I didn't have a whole 462 00:16:28,975 --> 00:16:30,694 team yet at that point. You know, first 463 00:16:30,694 --> 00:16:32,595 of all, you you you see your patients 464 00:16:32,815 --> 00:16:33,954 actually getting healthier. 465 00:16:34,414 --> 00:16:36,654 You know, you feel like you're helping empower 466 00:16:36,654 --> 00:16:38,414 them. You're working in a true partnership with 467 00:16:38,414 --> 00:16:39,394 them to get healthier. 468 00:16:39,855 --> 00:16:42,254 Again, not that medications don't help people get 469 00:16:42,254 --> 00:16:44,379 healthier, but it's we're we're we're looking at 470 00:16:44,379 --> 00:16:45,600 the whole person here. 471 00:16:45,980 --> 00:16:48,220 And then also you connect with people in 472 00:16:48,220 --> 00:16:50,940 a way that you don't necessarily connect if 473 00:16:50,940 --> 00:16:52,860 you're not asking those questions about how do 474 00:16:52,860 --> 00:16:54,779 you manage stress and so forth. Now it's 475 00:16:54,779 --> 00:16:56,220 great to do it with a team because 476 00:16:56,220 --> 00:16:57,500 we don't a lot of us don't have 477 00:16:57,500 --> 00:16:59,134 a lot of time, you know, to spend 478 00:16:59,274 --> 00:17:00,795 in our short visits. So it's great to 479 00:17:00,795 --> 00:17:02,555 have a whole team, and I'm very fortunate 480 00:17:02,555 --> 00:17:03,535 to be in that position. 481 00:17:04,075 --> 00:17:05,674 So if you're a health care provider that's 482 00:17:05,674 --> 00:17:08,015 interested in learning more, I would definitely recommend 483 00:17:08,555 --> 00:17:11,695 going to, the American College of Lifestyle Medicine, 484 00:17:12,509 --> 00:17:15,549 website and thinking about attending their conference. They 485 00:17:15,549 --> 00:17:17,230 have an annual conference you can attend in 486 00:17:17,230 --> 00:17:19,070 person or virtually and just kind of seeing 487 00:17:19,070 --> 00:17:20,430 what is this all about and getting it 488 00:17:20,509 --> 00:17:21,970 you know, just learning more. 489 00:17:22,509 --> 00:17:24,109 And then if you're interested, you can get 490 00:17:24,109 --> 00:17:26,109 board certified like I did and and start 491 00:17:26,109 --> 00:17:27,490 incorporating your practice. 492 00:17:28,805 --> 00:17:29,944 For health care leaders, 493 00:17:30,325 --> 00:17:32,805 I would actually offer the same advice because 494 00:17:32,805 --> 00:17:35,144 the American College of Lifestyle Medicine has, 495 00:17:35,525 --> 00:17:37,444 what's called a health systems council. I think 496 00:17:37,444 --> 00:17:39,765 they have somewhat something like a 120 497 00:17:39,765 --> 00:17:42,109 health systems across The United States now who 498 00:17:42,109 --> 00:17:44,130 are part of that council and sharing 499 00:17:44,430 --> 00:17:47,730 best practices in adopting lifestyle medicine and integrating 500 00:17:47,789 --> 00:17:50,109 it into the health care services of of 501 00:17:50,109 --> 00:17:52,350 systems. So there's lots of different models out 502 00:17:52,350 --> 00:17:55,095 there. You don't have to start with the 503 00:17:55,095 --> 00:17:56,615 level of program that we have at New 504 00:17:56,615 --> 00:17:58,294 York City Health and Hospitals, which is among 505 00:17:58,294 --> 00:18:00,454 the biggest in the country at this point. 506 00:18:00,454 --> 00:18:02,775 You can start small, and that's completely appropriate, 507 00:18:02,775 --> 00:18:03,974 you know, the way we did as a 508 00:18:03,974 --> 00:18:06,375 pilot. And just great to hear what other 509 00:18:06,375 --> 00:18:08,694 places are doing and what's worked and what 510 00:18:08,694 --> 00:18:09,515 hasn't worked. 511 00:18:09,970 --> 00:18:11,970 Well, thank you so much for joining us 512 00:18:11,970 --> 00:18:14,870 today. I I just really enjoyed hearing about 513 00:18:15,009 --> 00:18:17,190 this program and, you know, listening to you 514 00:18:17,250 --> 00:18:19,410 passionately talk about it. So I really appreciate 515 00:18:19,410 --> 00:18:21,730 it. My pleasure. Thank you so much for 516 00:18:21,730 --> 00:18:22,470 having me.