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Dynamic Chiropractic June 3, 2008, Volume 26, Issue 12 |
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Therapeutic Lifestyle Change (TLC) ProgramsA New Opportunity for Health Care PractitionersBy Jeffrey S. Bland, PhD, FACN, CNS
You see them every day: patients with or at risk of developing, lifestyle-related chronic diseases. In the United States, type 2 diabetes, cardiovascular disease and other chronic conditions have reached epidemic proportions, affecting nearly half of the population and contributing to seven of every 10 deaths.1 Perhaps even more disturbing is that these numbers could be drastically reduced with widespread adoption of simple lifestyle changes, including healthier eating and moderate exercise. Yet despite overwhelming clinical and scientific evidence, most health care practitioners fail to counsel their patients on these important issues. A Global Epidemic In the U.S., one in three adults is obese. One in five children is overweight and likely to carry their health-related problems into adulthood.2 Twenty-one million people have diabetes, including 6 million who don’t know they have it. Another 54 million are insulin-resistant.3 One in five adults has doctor-diagnosed arthritis.4 Similar numbers have been reported from all seven continents. According to the World Health Organization, lifestyle-related chronic diseases contribute to 60 percent of all deaths and 80 percent of deaths in low- and middle-income countries.5 Why TLC Makes Economic Sense In the U.S., more than $1.5 trillion is spent annually on the diagnosis and treatment of chronic illnesses,1 including $60 billion for five of the top 10 classes of blockbuster drugs.6 How are we spending so much and getting so little in return? It’s worth noting that the American health-care delivery and financial-reimbursement systems traditionally have been structured on the use of high-cost diagnostics, procedures and pharmaceuticals developed to treat acute illness, while less emphasis has been placed on wellness and prevention. And ironically, despite its name, less than 3 percent of the Centers for Disease Control and Prevention’s 2008 budget is allocated toward chronic disease prevention,7 although its own Third Report of the National Cholesterol Education Program’s Adult Treatment Panel (ATP III) recommends the use of therapeutic lifestyle changes and medical nutrition therapy to reduce the risk for chronic heart disease. Fortunately, the balance has begun to shift. A recent MetLife survey found more than a quarter of all employers offer some type of wellness benefit.8 And Medicare beneficiaries are now entitled to a one-time physical examination, key screenings, and nutritional and smoking cessation counseling and other wellness benefits. However, these are very limited. For example, cardiovascular screening will be covered only once every five years. Nutritional counseling will be covered only for patients already diagnosed with type 2 diabetes or kidney disease, and is limited to just three hours the first year and just two hours in subsequent years.9 Notwithstanding, wide-scale savings (billions of dollars and, more importantly, hundreds of thousands of lives) derived from therapeutic lifestyle changes (TLC) have been amply demonstrated. For example:
Making a Difference, One Patient at a Time A recent American Heart Association (AHA) survey of cardiologists and primary care physicians revealed the following:13
In his 2005 presidential address to the AHA, endocrinologist and researcher Dr. Robert Eckel challenged his colleagues to change these attitudes, saying, “We have an unprecedented arsenal of weapons [to prevent cardiovascular disease], including many potent medications. However, this power is not enough and, in fact, in some cases, it has led us to ignore some very simple, effective and human measures.”14 At the very heart of these measures are TLC. Health care practitioners who appreciate the value of TLC and want to incorporate them into their practices must find ways to address the issues of communication, patient compliance, time management and financial reimbursement. These challenges could be overcome by taking several steps:
A scientific statement from the Collaborative Writing Committee comprised of the American Cancer Society, the American Diabetes Association, and the AHA concluded that TLC represents a “new opportunity” for clinicians to target important risk factors and effect positive outcomes in the prevention and management of leading chronic conditions.16 Those who successfully implement a TLC program that addresses the issues of communication, patient compliance, time management and financial reimbursement will be well-positioned to create sustainable new revenues while improving their patients’ health. References
Dr. Jeffrey S. Bland is a nutritional biochemist and author of several books on nutritional medicine. He is chief science officer for Metagenics, Inc., a manufacturer of science-based nutraceuticals and medical foods. He can be reached at jeffbland@metagenics.com.
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Dynamic Chiropractic June 3, 2008, Volume 26, Issue 12 |
Printer Friendly Version E-mail to a Friend |
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