Behavior Change and Lifestyle: The Hot New Drug (Brown, 1/15/2020)

Thank you to Dr. Ben Brown for a motivational Grand Rounds this week on behavior change and lifestyle as “the hot new drug”. 

We are 16 days into the month, and I am still on track with my New Year’s resolution to exercise more. How’s your lifestyle goal going? Read on if you need a little motivation.

Dr. Brown’s pearls:

Lifestyle changes lead to measureable improvement and meaningful outcomes. For real.

• Weight loss, cholesterol-lowering, blood pressure, HbA1C, depression scores
• Lifestyle change prevents, stabilizes and even reverses heart disease
• Lifestyle changes lead to downregulation of cancer oncogenes (yup!)

Medicine operates under the assumption that “Taking a pill is easy, lifestyle change is hard.

• That isn’t exactly true. Unfortunately, studies show that less than 1/3 of patients after an acute event are taking their statin at 6 months
• BUT in supportive lifestyle change programs, adherence is as high 87% at one year (it actually feels good)

Which “lifestyle changes” is Dr. Brown talking about? Four pillars:

o   Exercising (at least 150 minutes/week)

o   Not smoking

o   Eating a healthy diet

o   Keeping a healthy weight (normal BMI)

It’s not rocket science, people, BUT that doesn’t mean it’s easy. A large Mayo Clinic population study found :

o    11.1% of participants met NONE of the above criteria,

o   33.5% had one

o   36.8% had two

o    16% had three

o   ONLY 2.7% of adults met all FOUR healthy lifestyle criteria

If you or a patient is interested, intensive lifestyle management is actually a covered benefit under Medicare (specific dx include ACS, CAD s/p CABG or PCI, CHF, valvular abnormalities);

• Dean Ornish program in Marin: 415-927-6172 (Max Drake, program director), closest to Santa Rosa

Hey Doctors, it’s time to WALK THE WALK!

·         Physicians who perform aerobic exercise regularly are MORE likely to counsel patients about aerobic exercise (Clin J Sport Med, 2000)

·         Physicians who eat healthy are more likely to ask about dietary practice, advise about dietary practices, an ASSIST PATIENTS in making changes (Preventive Med 2002)

Ben’s advice: keep it simple

1) Pick a single action (e.g. exercising regularly)

2) Establish a (reasonable) floor and a (ideal) ceiling (e.g. 15 minutes a day is my floor, 1 hour a day is my ceiling)

3) Set a Time and place (e.g. starting tonight 9pm, after I put my kids in bed, living room. Anyone want to join?)