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MedCity Influencers, Consumer
By Tiffany Avery 
The U.S. healthcare system is designed to take care of people when they get sick. According to the CDC, chronic diseases such as heart disease, cancer, diabetes, and stroke are the leading causes of death and disability in the U.S. They are also the top drivers of the nation’s $3.8 trillion annual health care costs, with 90% of these costs attributed to the treatment of chronic conditions and mental health.
Rates of cardiovascular disease, diabetes, and obesity are projected to increase over the next ten years, increasing related healthcare spending. About 60% of U.S. adults have one chronic disease, and 40% have two or more chronic conditions. As a result, healthcare professionals recognize the need to prevent disease and implement strategies to manage chronic conditions. Wellness and lifestyle change are proven to address disease prevention and condition management cost-effectively. Additionally, lifestyle change empowers patients in their health outcomes, affecting physical and mental health. The challenge is supporting and guiding lifestyle change and wellness within the current healthcare system.
Wellness in the healthcare system
The impact of lifestyle habits in preventing and managing chronic diseases is well documented. Citing guidelines regarding diet, exercise, smoking avoidance, and alcohol intake, the American College of Cardiology, American Heart Association, American Cancer Society, American Diabetes Association, and others recognize that lifestyle factors contribute to wellness.
The Diabetes Prevention Program is a powerful example of how lifestyle intervention can aid in preventing diabetes. Subjects who participated in an intensive lifestyle program compared to those with no lifestyle changes saw a 58% reduction in the risk of developing diabetes. A study follow-up showed that the benefits of the Diabetes Prevention Program persist over two decades later. Diabetes is one the most expensive chronic disease in the U.S., with a cost of $327 billion each year between direct medical costs and reduced productivity. Given the economic impact of diabetic care, economic analyses have found that lifestyle intervention for diabetes is either cost-saving or highly cost-effective.
Although we know the benefits of a lifestyle that includes a healthy diet, physical activity, and avoiding smoking, one study published in the Mayo Clinic Proceedings found that less than 3% of the over 4,000 participants lived a healthy lifestyle defined by those factors. More than 80% of participants did not get at least five servings of fruits and vegetables a day. A study of the state of U.S. health from 1990-2010 identified diet as the most critical risk factor for chronic diseases, associated with 26% of deaths and 14% of disability-associated life-years. Diets low in fruits, nuts, seeds, and vegetables and high in sodium, processed meats, and trans fats presented the most significant risks.
Research has proven the value of medical team guidance in effecting lifestyle change in patients. Counseling concerning lifestyle habits helps patients make changes, increases patient satisfaction, and strengthens the patient-doctor relationship. Another benefit of lifestyle counseling is patient empowerment. Now more than ever, with unprecedented access to healthcare research and information, patients are more informed and want to be involved in their healthcare decisions and options. Lifestyle change firmly puts the patient in the driver’s seat regarding their health outcomes.
With the known benefits of lifestyle change, not enough progress has been made to increase lifestyle counseling in medical practice. According to a recent study, the average primary care visit lasts 18 minutes. Doctors need to address chronic issues and make preventative recommendations, such as age-appropriate cancer screenings in that short amount of time. There is little to no time left to counsel and support lifestyle changes. For patients to make and sustain significant lifestyle changes, they need education and support, which is time-intensive. Another significant obstacle to implementing this type of care is reimbursement. A study of primary care practices applying lifestyle counseling found that over half were not reimbursed for this service, citing understanding of frequently changing rules related to CPT codes as one barrier. Indeed, the most successful practices were those in which patients self-pay for the services.
Another barrier to implementing lifestyle change is patient readiness. Techniques for counseling and supporting patients through lifestyle changes are rooted in the transtheoretical model, recognizing that people can be in different stages of behavior change. Successful counseling is predicated on starting with patients in stages that signal readiness to change.
Lastly, recognizing social determinants of health (SDOH) is critical in managing patients in making lifestyle changes. Social determinants of health are those factors outside of the medical complex that impact health – access to healthy food, safe places for exercise, socioeconomic status, access to quality education, and healthcare services. These factors determine up to 50% of an individual’s health. Recognizing the importance of SDOH and strategies to provide support when needed is essential to the success of a lifestyle medicine program.
Changes must be made in how we address healthcare to protect the healthcare system’s solvency and provide the maximum benefit to patients. In addition to economic benefits, incorporating wellness and supporting healthy lifestyle change in healthcare is a powerful way to empower patients on their healthcare journey. Prevention and management of chronic diseases is a significant benefit. Still, habits such as regular exercise, a healthy diet, and adequate sleep make a difference in overall well-being, energy levels, healthy aging, and mental health.
There are two caveats to avoid in the discussion of wellness in healthcare. One is the idea that all changes must happen at once. Successful changes are most often made when patients start small and identify specific interest areas as a starting point. Secondly, it is vital to avoid blaming people then they have a chronic disease. While we have robust data to support prevention, we know that people can do all the right things and still develop diseases. Incorporating wellness habits benefits the quality of life in addition to prevention and disease control – and that alone is reason enough to undertake these changes. When we look at wellness from a holistic view and identify goals to achieve and sustain a healthy lifestyle, individuals and their communities will reap the benefits. This, in turn, will positively impact the healthcare system by reducing costs and promoting wellness in society.
Photo: fcafotodigital, Getty Images
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Dr. Tiffany Avery is NantHealth’s Chief Medical Officer, responsible for providing clinical strategic direction. Dr. Avery joined NantHealth in 2019 as the Medical Director of Oncology and is board-certified in Medical Oncology with a special interest in breast cancer and differences in cancer survival. Prior to her role at NantHealth, she served as an Assistant Professor of Oncology at Thomas Jefferson University and Wake Forest Baptist Health. After completing fellowship training at MD Anderson Cancer Center in Houston, Texas, Dr. Avery focused and lectured on clinical research and the care of breast cancer patients. Dr. Avery earned her B.S. and MPH in Epidemiology from Tulane University and M.D. from LSU Health Sciences Center New Orleans, Louisiana. She is also certified in Lifestyle Medicine and co-host of 3 Black Docs, a podcast aimed at addressing health and cancer disparities.
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