Latest / Becker’s Healthcare - Clinical Leadership Podcast / Advancing Lifestyle Medicine to Address Chronic Disease with Dr. Michelle McMacken

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Advancing Lifestyle Medicine to Address Chronic Disease with Dr. Michelle McMacken · Becker’s Healthcare - Clinical Leadership Podcast

• 0:00
  Welcome to the Becker's Healthcare Podcast.
• 0:02
  My name is Paige Twenter, and I'm with
• 0:04
  the Becker's editorial team.
• 0:06
  I'm joined today by doctor Michelle McMacken,
• 0:08
  the executive director of nutrition and lifestyle medicine
• 0:12
  at NYC Health and Hospitals.
• 0:14
  Doctor McMacken, I am just so excited to
• 0:16
  talk with you today.
• 0:18
  For today's audience, can you briefly introduce yourself
• 0:20
  and your organization?
• 0:22
  Thank you so much for having me on
• 0:24
  the show. It's great to it's great to
• 0:25
  be back.
• 0:27
  So I am a, primary care physician. I've
• 0:30
  been working as a primary care physician for
• 0:32
  more than twenty years, trained in internal medicine.
• 0:35
  And along the way,
• 0:37
  I got very excited about the concept of
• 0:39
  lifestyle medicine, which is something that I now
• 0:42
  am also born certified in in addition to
• 0:44
  internal medicine.
• 0:45
  And
• 0:46
  my entire
• 0:48
  career past my training has been at New
• 0:50
  York City Health and Hospitals.
• 0:52
  That's where I've done all of my clinical
• 0:54
  work. I'm very passionate about working in our
• 0:56
  health care system.
• 0:58
  So
• 0:59
  New York City Health and Hospitals is, as
• 1:01
  many of your listeners may know,
• 1:04
  the largest
• 1:05
  municipal
• 1:06
  health care system in The United States.
• 1:09
  So we serve more than a million New
• 1:11
  Yorkers, and part of the mission is to
• 1:13
  serve individuals regardless of ability to pay,
• 1:16
  which, you know, I'm something I'm very aligned
• 1:18
  with.
• 1:19
  And,
• 1:20
  you know, we have a very diverse patient
• 1:22
  population both
• 1:23
  culturally,
• 1:24
  racially, ethnically, linguistically. It's a very, very exciting
• 1:28
  place to work, and a lot of folks
• 1:31
  who, you know you know, who choose to
• 1:33
  work at New York City Health and Hospitals,
• 1:35
  you know, we're just all very aligned with
• 1:36
  this mission. So it's a it's a wonderful
• 1:38
  place to be.
• 1:40
  Can you kinda take us through
• 1:43
  the lifelong
• 1:44
  lifestyle medicine
• 1:46
  program?
• 1:47
  You told, Bikers earlier that it's,
• 1:50
  focused on patients with chronic illnesses. Right?
• 1:54
  Yeah. So,
• 1:56
  I I would love to take you back
• 1:58
  to the beginning if that's okay. So we,
• 2:00
  we actually had the opportunity to start a
• 2:03
  pilot lifestyle medicine program
• 2:05
  at one of our, acute care facilities within
• 2:07
  our health care system.
• 2:09
  That facility is, Bellevue Hospital.
• 2:12
  So back in 2019, we started a very
• 2:14
  small pilot with several physicians,
• 2:17
  with a registered dietitian
• 2:19
  and a certified health coach.
• 2:21
  And we worked with patients who were at
• 2:25
  who are already living with cardiometabolic
• 2:27
  disease,
• 2:28
  whether that was prediabetes,
• 2:30
  type two diabetes, high blood pressure,
• 2:33
  existing
• 2:34
  coronary artery disease or other atherosclerotic
• 2:37
  disease, or health concerns related to,
• 2:40
  excess weight. So living with obesity and other,
• 2:43
  concerns related to excess weight. And, really, our
• 2:45
  goal was to leverage,
• 2:48
  what we call sort of the pillars of
• 2:50
  lifestyle change. Most of which are very common
• 2:52
  sense. Right? Most people think about diet and
• 2:55
  exercise, and those are very important pillars of
• 2:57
  lifestyle change.
• 2:58
  What a lot of us forget about,
• 3:01
  is sleep health,
• 3:03
  for example.
• 3:04
  That's something that we focus you know, we've
• 3:06
  we've learned over the years the importance of
• 3:08
  focusing on sleep health.
• 3:09
  I can, you know, share a little bit
• 3:11
  more about that. We also focus on managing
• 3:14
  stress,
• 3:15
  you know, my personal favorite.
• 3:17
  Right? We're all we all experience stress, and
• 3:19
  how we how we cultivate resilience and how
• 3:22
  we respond to it is really key for,
• 3:25
  you know, for really staying healthy.
• 3:27
  We focus on avoiding substance use, so avoiding
• 3:30
  tobacco use,
• 3:31
  avoiding excess alcohol, avoiding other substance use. And
• 3:35
  I think the pillar that many people forget
• 3:37
  about completely is the pillar of connectedness,
• 3:40
  which sounds a little touchy feely, but it's
• 3:42
  really you know, we know loneliness is a
• 3:44
  huge risk factor for mortality. Right? That that
• 3:46
  came out with our, you know, previous surgeon
• 3:48
  general, how to focus on that, and I
• 3:50
  think a lot of people heard about that.
• 3:52
  So being connected, whether you're extrovert or an
• 3:55
  introvert, you still need to have connections. Right?
• 3:57
  You need to be connected to other people,
• 4:00
  or, you you know, your pet's nature. There's
• 4:02
  a lot of different ways to be connected
• 4:03
  and find meaning. So,
• 4:05
  those are really the pillars of lifestyle. And
• 4:07
  putting that all together,
• 4:09
  the evidence is very, very powerful that we
• 4:11
  cannot just
• 4:13
  help prevent
• 4:14
  all of these common chronic conditions,
• 4:17
  but we can actually significantly improve them. And
• 4:19
  that's that's our passion and that's our mission,
• 4:22
  in in the pilot program.
• 4:24
  So,
• 4:25
  in our pilot program, we found that we
• 4:26
  had really we had really high demand for
• 4:28
  services in that program. There was a a
• 4:30
  lot of people wanting to join the program,
• 4:33
  more than 850
• 4:34
  people on a waiting list at one point.
• 4:37
  So we knew we were onto something.
• 4:39
  And,
• 4:40
  and then we also had, you know, really
• 4:42
  good signal for positive clinical outcomes, and behavior
• 4:45
  changes in our in about, you know, our
• 4:47
  external evaluation. So,
• 4:50
  fast forward to 2022, and we were actually
• 4:52
  able to expand that program
• 4:55
  to seven total sites
• 4:57
  across New York City health and hospitals
• 4:59
  spanning all five boroughs of New York, and
• 5:02
  that's where we are now.
• 5:04
  I I remember you, told Becker's,
• 5:07
  a few years ago that patients were, like,
• 5:09
  knocking down
• 5:10
  doors to join the
• 5:13
  program.
• 5:14
  So is it still,
• 5:16
  kind of rolled out in, like,
• 5:19
  you know, one on one visits, enroll in
• 5:21
  fitness and group
• 5:23
  classes,
• 5:24
  receive, like, lifelong
• 5:26
  programs, or has it has it changed a
• 5:28
  bit since then?
• 5:30
  Yeah. So, basically, we know it so,
• 5:32
  we know that if you're going to help
• 5:35
  individuals change their lifestyle, it does have you
• 5:37
  have to do it in a way that
• 5:38
  actually is sustainable for them.
• 5:40
  It's, you know, it's great to change your
• 5:42
  lifestyle for two months, but it's obviously
• 5:45
  way better to maintain those changes.
• 5:47
  So what we've built is a program structure
• 5:49
  that really sets people up for success, and
• 5:51
  then we have touch points indefinitely.
• 5:54
  So our program structure basically includes, you know,
• 5:57
  we have an interdisciplinary team. So we work
• 5:59
  with physicians, nurse practitioners,
• 6:02
  registered dietitians,
• 6:03
  certified health coaches. We now also have psychologists
• 6:07
  at four of our sites.
• 6:08
  We have community health workers,
• 6:11
  which are individuals who,
• 6:14
  really have brought so much value to our
• 6:17
  patients in our program because they can help
• 6:19
  address our patients' social needs and their barriers
• 6:22
  to making lifestyle changes, like if they're experiencing
• 6:24
  food insecurity or transportation needs or so forth.
• 6:28
  We also have,
• 6:30
  a fitness instructor,
• 6:31
  in our program. So we really have this
• 6:33
  great team. Patients come in. They have one
• 6:35
  on one visits with the medical providers, the
• 6:38
  dietitian, and the health coach as a standard
• 6:40
  for everybody.
• 6:42
  And then
• 6:43
  they also participate in our group visits, which
• 6:46
  are
• 6:47
  really the core and the heart and soul
• 6:49
  of our program. So our group visits,
• 6:52
  I can talk about in a few more
• 6:53
  minutes. The design is as a shared medical
• 6:55
  appointment,
• 6:56
  but essentially, individuals are getting the opportunity
• 7:00
  to
• 7:00
  learn about these pillars of lifestyle that I
• 7:03
  talked about before
• 7:04
  while also getting to interact with other peers.
• 7:06
  So we're kinda touching on that connectedness,
• 7:09
  pillar.
• 7:10
  And then they have a breakout
• 7:12
  with our nurse practitioner for a few minutes
• 7:14
  every single week in the group to check-in.
• 7:17
  How are your goals going? What are you
• 7:18
  working on?
• 7:20
  And throughout all of these individual visits, whether
• 7:22
  it's that visit within the group or the
• 7:25
  traditional
• 7:26
  individual visit,
• 7:27
  everybody has a chance to have our guidance
• 7:30
  tailored to their life. So we never, as
• 7:33
  a as a team, we never,
• 7:35
  you know, tell people what to do because
• 7:38
  we have learned that that does not really
• 7:39
  work.
• 7:40
  You have to understand what is the person's
• 7:42
  goal, what's their situation, whether it's their, you
• 7:45
  know, their budget, their family, their cooking skills,
• 7:48
  their culinary traditions, the foods that they like
• 7:50
  and don't like, and really let them
• 7:52
  think about what they wanna change and then
• 7:54
  help guide them to,
• 7:56
  you know, a next step that's really practical
• 7:58
  and realistic for them and really tailor it
• 8:00
  to whatever their situation is. So, that's how
• 8:02
  we work with people, and that's honestly the
• 8:04
  best way to make it sustainable. You tie
• 8:06
  it to something that the person really cares
• 8:07
  about, what is their overall goal, and tailor
• 8:10
  it in a way that really works for
• 8:11
  them and their family.
• 8:13
  And how is that personalization
• 8:15
  tailored in the group design?
• 8:17
  So there's a couple of ways. The first
• 8:19
  is that the actual,
• 8:21
  structured curriculum that we offer has been adapted
• 8:24
  across different cultural traditions.
• 8:26
  It's, you know, it's very, you know, it's
• 8:29
  very based on
• 8:30
  promoting foods and eating patterns and lifestyle changes
• 8:33
  that are affordable, you know, and accessible
• 8:36
  to the majority of people.
• 8:38
  So that's one. But more importantly, again, when
• 8:41
  patients meet with the nurse practitioner within that
• 8:44
  group session, they're doing it privately
• 8:47
  in a one on one session. So that's
• 8:49
  the opportunity to really provide the tailored counseling
• 8:52
  and discuss, you know last week, we talked
• 8:54
  about that you were going to
• 8:56
  try, you know, a bowl of old fashioned
• 8:58
  oatmeal,
• 8:59
  with banana,
• 9:01
  and some peanuts.
• 9:03
  How did that work out for you?
• 9:05
  Any problems with that? And really talk through
• 9:08
  one on one how that worked and then
• 9:09
  maybe set some new, plans and new steps
• 9:12
  for the next week.
• 9:14
  I I love that example because it's not
• 9:16
  just like, here are the food groups or,
• 9:18
  like, here's,
• 9:20
  you know, kind of the main goals. Like,
• 9:22
  specific like, we talked about this specific
• 9:25
  meal. Like,
• 9:26
  you know, is that in your daily habit?
• 9:28
  Like, is it affordable?
• 9:31
  You know, is it doable with your time
• 9:33
  schedule, with your work schedule?
• 9:35
  Yeah. I just I love that example. Exactly.
• 9:38
  I mean, we you know, again, we work
• 9:39
  with patients,
• 9:41
  from very, very different, you know, cultural
• 9:45
  backgrounds. So,
• 9:46
  I really will never say to a patient,
• 9:48
  I incur I would like to ask you
• 9:50
  to start eating oatmeal every morning. And if
• 9:52
  they've never heard of oatmeal, it's like it's
• 9:53
  not gonna make sense. So we really start
• 9:55
  we know we know broadly what are the,
• 9:58
  you know, the different the eating pattern that
• 10:00
  tends to, you know, improve chronic disease and
• 10:03
  lower the risk of complications.
• 10:04
  So within that, you know, within the category
• 10:07
  of fruits, vegetables,
• 10:08
  skewing towards more whole grains, different, you know,
• 10:11
  healthy protein sources,
• 10:13
  I I like to ask patients, what do
• 10:14
  you like within this category? What did you
• 10:16
  grow up eating? What do you know how
• 10:18
  to prepare on your own or someone in
• 10:20
  your family who does the cooking knows how
• 10:21
  to prepare? So we can really make it
• 10:23
  realistic for them.
• 10:25
  I wanna raise a little bit to the,
• 10:27
  for lack of a better cliche, like, 30,000
• 10:30
  foot view of program.
• 10:33
  I'm just curious. What
• 10:35
  outcome or clinical result are you most
• 10:38
  proud of seeing after,
• 10:40
  you know, years of running this program?
• 10:43
  You know, I honestly,
• 10:46
  there are so so we've seen patients who
• 10:48
  have, for example,
• 10:49
  dramatically improved their hemoglobin a one c, you
• 10:52
  know, as you know, a marker of blood
• 10:54
  sugar control in people with diabetes.
• 10:56
  We've seen people who've,
• 10:58
  experienced weight loss. We've seen people who've improved
• 11:01
  their, you know, cholesterol,
• 11:03
  their blood pressure.
• 11:05
  But
• 11:06
  to me, the thing that's the most rewarding
• 11:09
  is actually when a patient sits in front
• 11:11
  of me and tells me I feel so
• 11:12
  much better.
• 11:13
  Like, I feel like I have a new
• 11:15
  understanding
• 11:17
  of,
• 11:17
  like, you know,
• 11:19
  how I want to live my life in
• 11:21
  a way that will support me now and
• 11:24
  in the future. And then when I have
• 11:26
  patients who a lot of times, they're part
• 11:29
  of their motivation is they wanna be healthy
• 11:30
  for their kids,
• 11:31
  you know, to be there and and be
• 11:33
  sort of a model or an inspiration for
• 11:35
  their kids. And then they tell me that
• 11:36
  their kids are also on board and starting
• 11:38
  to, you know, eat more fruits and veggies
• 11:40
  because they're seeing their parent do it.
• 11:42
  It's just it's it's honestly the best feeling,
• 11:46
  and and knowing that people just are feeling
• 11:49
  better, they have more energy and feel motivated
• 11:51
  to continue this lifestyle, and you know that
• 11:53
  they are,
• 11:56
  you know, they're we're really, really supporting not
• 11:58
  just people's cardiometabolic health, but their overall well-being,
• 12:01
  in their life.
• 12:03
  Yeah. One thing I'm wondering just because the
• 12:05
  program is, tailored for patients with chronic illnesses,
• 12:08
  I I'm wondering if NYC,
• 12:11
  health and hospitals
• 12:13
  tracks
• 12:14
  admissions or changes in admissions just because I
• 12:17
  I remember reading a statistic recently. I believe
• 12:19
  it was from Visiant that
• 12:21
  eleven percent of the population has multiple chronic
• 12:24
  conditions or illnesses,
• 12:26
  but and that eleven percent makes up for
• 12:28
  fifty two percent
• 12:29
  of hospital admissions.
• 12:31
  So I'm just wondering if,
• 12:34
  you know, you're currently tracking
• 12:36
  admissions in that program.
• 12:38
  We definitely have the ability to track it,
• 12:41
  and I and I think, you know, you're
• 12:42
  absolutely right that
• 12:44
  when we look just, again, that bird's eye
• 12:46
  view of what we're talking about,
• 12:48
  from the from the vantage point of health
• 12:51
  care service delivery and the cost of health
• 12:53
  care, it really makes a lot of sense
• 12:55
  to focus on,
• 12:56
  you know, lifestyle change.
• 12:58
  Not to say that, you know, medications don't
• 13:01
  have a very you know, can have a
• 13:02
  very powerful role as well and procedures when
• 13:04
  needed, but to put all of that on
• 13:07
  a foundation of lifestyle change for everyone,
• 13:10
  to the extent that they can,
• 13:11
  and really support people in doing that because,
• 13:14
  we know that
• 13:16
  our most common
• 13:17
  chronic conditions that account for the most health
• 13:19
  care spending
• 13:21
  are rooted in
• 13:22
  lifestyle change in addition to other factors. You
• 13:25
  know, we know that social determinants play a
• 13:27
  huge role as well, but and it's important
• 13:29
  to address those too, you know, at the
• 13:31
  individual and policy level. But,
• 13:33
  with lifestyle change and helping people
• 13:36
  regardless of their situation
• 13:38
  in doing what they can to,
• 13:40
  to access healthier food and add more healthy
• 13:43
  food to their plate and move their bodies
• 13:45
  a little bit more and help them manage
• 13:46
  stress can go a really long way.
• 13:49
  It's it's first line in all of our,
• 13:52
  you know, the guidelines of our major medical
• 13:54
  societies. Lifestyle is there. So,
• 13:56
  I do think there's a case for we
• 13:58
  can't really afford not to focus on this.
• 14:01
  You know, what what is the cost of
• 14:03
  inaction
• 14:04
  and in terms of the risk of chronic
• 14:06
  disease and complications,
• 14:08
  particularly, which are extremely costly?
• 14:11
  If you have a patient with type two
• 14:13
  diabetes
• 14:14
  and
• 14:15
  just as soon as they're diagnosed, you start
• 14:17
  talking to them about lifestyle change.
• 14:19
  They are you know, the science is very
• 14:21
  clear that that's someone who has, you know,
• 14:24
  a potential to put their diabetes in remission.
• 14:27
  Imagine the difference between putting your diabetes in
• 14:29
  remission and keeping it there versus
• 14:32
  progressing with type two diabetes
• 14:35
  and, you know, having complications in the future,
• 14:37
  chronic kidney disease and dialysis and so forth.
• 14:39
  I mean, imagine the costs that could be
• 14:41
  saved.
• 14:43
  So long winded long winded, answer to your
• 14:46
  question, but I'm I I couldn't agree more.
• 14:49
  Yeah. Not not long winded at all.
• 14:52
  Totally good. I do have, one more question
• 14:55
  just because we're nearing the end of our
• 14:58
  time here.
• 15:00
  I'm trying to encapsulate everything.
• 15:02
  So I'd love to hear
• 15:04
  one suggested first step for other healthcare leaders
• 15:08
  who are listening, who
• 15:09
  are interested in launching something similar. You mentioned,
• 15:12
  actually great results of, you know, lowered hemoglobin
• 15:15
  A1Cs,
• 15:17
  weight loss,
• 15:18
  blood, pressure reductions,
• 15:21
  just lifestyle changes not only within that patient
• 15:24
  but in their home, you know, with their
• 15:26
  kids.
• 15:28
  And, of course, just that sound or just
• 15:31
  hearing, you know, I feel so much better.
• 15:33
  So I I can imagine a lot of
• 15:35
  other people would love to, you know, launch
• 15:37
  something similar at their own systems.
• 15:40
  In my long winded question in response,
• 15:43
  where do you start?
• 15:45
  So
• 15:47
  if I could share from the vantage point
• 15:48
  of
• 15:50
  a physician or other medical provider and the
• 15:52
  vantage point of a health care leader or
• 15:55
  executive,
• 15:57
  I think from the standpoint of
• 15:59
  a health care provider, physician, nurse practitioner, so
• 16:02
  forth,
• 16:03
  I think, you know, there are there are
• 16:05
  there's a recent study showing that
• 16:08
  health care providers that adopt lifestyle medicine in
• 16:11
  their practice actually have
• 16:13
  documented lower rate of burnout.
• 16:16
  And it makes sense to me because
• 16:19
  for many years, I did not I didn't
• 16:21
  really even know what lifestyle medicine was, and
• 16:23
  I could see a huge difference when I
• 16:25
  started practicing lifestyle medicine within my primary care
• 16:27
  practice even though I didn't have a whole
• 16:28
  team yet at that point. You know, first
• 16:30
  of all, you you you see your patients
• 16:32
  actually getting healthier.
• 16:34
  You know, you feel like you're helping empower
• 16:36
  them. You're working in a true partnership with
• 16:38
  them to get healthier.
• 16:39
  Again, not that medications don't help people get
• 16:42
  healthier, but it's we're we're we're looking at
• 16:44
  the whole person here.
• 16:45
  And then also you connect with people in
• 16:48
  a way that you don't necessarily connect if
• 16:50
  you're not asking those questions about how do
• 16:52
  you manage stress and so forth. Now it's
• 16:54
  great to do it with a team because
• 16:56
  we don't a lot of us don't have
• 16:57
  a lot of time, you know, to spend
• 16:59
  in our short visits. So it's great to
• 17:00
  have a whole team, and I'm very fortunate
• 17:02
  to be in that position.
• 17:04
  So if you're a health care provider that's
• 17:05
  interested in learning more, I would definitely recommend
• 17:08
  going to, the American College of Lifestyle Medicine,
• 17:12
  website and thinking about attending their conference. They
• 17:15
  have an annual conference you can attend in
• 17:17
  person or virtually and just kind of seeing
• 17:19
  what is this all about and getting it
• 17:20
  you know, just learning more.
• 17:22
  And then if you're interested, you can get
• 17:24
  board certified like I did and and start
• 17:26
  incorporating your practice.
• 17:28
  For health care leaders,
• 17:30
  I would actually offer the same advice because
• 17:32
  the American College of Lifestyle Medicine has,
• 17:35
  what's called a health systems council. I think
• 17:37
  they have somewhat something like a 120
• 17:39
  health systems across The United States now who
• 17:42
  are part of that council and sharing
• 17:44
  best practices in adopting lifestyle medicine and integrating
• 17:47
  it into the health care services of of
• 17:50
  systems. So there's lots of different models out
• 17:52
  there. You don't have to start with the
• 17:55
  level of program that we have at New
• 17:56
  York City Health and Hospitals, which is among
• 17:58
  the biggest in the country at this point.
• 18:00
  You can start small, and that's completely appropriate,
• 18:02
  you know, the way we did as a
• 18:03
  pilot. And just great to hear what other
• 18:06
  places are doing and what's worked and what
• 18:08
  hasn't worked.
• 18:09
  Well, thank you so much for joining us
• 18:11
  today. I I just really enjoyed hearing about
• 18:15
  this program and, you know, listening to you
• 18:17
  passionately talk about it. So I really appreciate
• 18:19
  it. My pleasure. Thank you so much for
• 18:21
  having me.