10/13/2017. Being overweight is the #1 cause of preventable & chronic disease in America. Mark Nelson, MD, FACC, MPH

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1 Beyond Sickness: How to Create Health & Well-Being for Ourselves and Our Patients Mark Nelson, MD, FACC, MPH OPTAVIA Certified Coach Optimal Health Practitioner & Practice Wellness Consultant Cardiologist Lectures on Creating and & Empowering Health & Well-Being for Lifelong Transformation Being overweight is the #1 cause of preventable & chronic disease in America. 1

2 Prevalence of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2015 Prevalence estimates reflect BRFSS methodological changes started in These estimates should not be compared to prevalence estimates before % *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) 30%. Prevalence of Self-Reported Obesity Among Hispanic Adults, by State and Territory, BRFSS, % *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) 30%. Prevalence of Self-Reported Obesity Among Non- Hispanic Black Adults, by State and Territory, BRFSS, % *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) 30%. 2

3 85 Million 13 3

4 Health Affairs August % of GDP by 2025 Feb 14, 2017 AHA President Steven Houser Our new projections indicate cardiovascular disease is on a course that could bankrupt our nation s economy and health care system. 4

5 Surging rates of obesity and type 2 diabetes in younger adults are more impactful than we had anticipated Houser said. Health Risks of Childhood Obesity Type 2 Diabetes Asthma Obstructive Sleep Apnea Cardiovascular Disease Risk Factors CVD Mental Health Disorders Musculoskeletal problems Epilepsy Premature Death Black and Hispanic individuals have about a 50 percent chance of developing diabetes over the course of their lifetimes, and Americans overall have a 40 percent chance. The authors of the study, epidemiologists at the Centers for Disease Control and Prevention, used mortality data of nearly 600,000 Americans from 1985 to 2011 to determine the risk that Americans face of developing type 1 or type 2 diabetes, categorized by race. Medical Daily August 13, 2014 Lancet Diabetes & Endocrinology August 12,

6 DIABESITY Diabetes: 3 rd Leading Cause of Death (95% of Diabetes is Type 2) Marlene Busko January 31, 2017 A new study based on recent national surveys estimates that diabetes accounts for many more deaths in the U.S. than are being reported on death certificates-and that diabetes is actually the third leading cause of death. Diabetes: Leading cause of Blindness, Kidney Failure, Limb Amputation & a major contributor to CVD. CVD #1 6

7 One third of cancer deaths in women are now attributable to excess body weight. Obesity Increases the Risk of 19 Cancers Bladder cancer Brain cancer Breast cancer (postmenopausal) Cervical cancer Colon cancer Endometrial/uterine cancer Esophageal cancer Gallbladder cancer Head and neck cancer Kidney/renal cancer Leukemia Liver cancer Multiple myeloma Non-Hodgkin lymphoma Ovarian cancer Pancreatic cancer Prostate cancer (prognosis is worse, not necessarily increased risk) Stomach cancer Thyroid cancer 20 Obesity Algorithm Obesity Medicine Association. Reference/s: [41-45] Obesity, chronic pain & inflammation Pre Diabetes Type 2 Diabetes Heart Disease Stroke PCOS Gout Venous Stasis Disease Depression Cancer 7

8 Health Professionals: The top five causes of burnout: * Too many bureaucratic tasks * Spending too many hours at work * Increased computerization of practice * Income not high enough * Feeling like "just a cog in the wheel 8

9 It is time to change direction and change the structure of the medical system from a system that focuses on micromanaging physicians time and decisions to a system that focuses on long term health. Editorial: December 2015 Volume 90 Number 12 Does Managing Disease mean Healthier Patients? The 2 nd Era of Healthcare Treating & Managing Chronic Disease 9

10 The Challenge: To Move Beyond Sickness Creating Health & Well-Being Optimal Health NEW HEALTH PATH: The 3 rd Era Non-sick CURRENT HEALTH PATH FORECASTED HEALTH PATH Sick Birth 50 Years 100+ Years How do we Design our Lives & Practice to Create Health & Well-Being? 10

11 We are not what we know but what we are willing to learn Mary Catherine Bateson Disease Centric Problem Solving Reacting to Disease High Tech-Low Touch Health Centric Creating Health & Well-Being Low Tech-High Touch 11

12 The Enemy of Learning Psychosclerois: Hardening of the Psyche Change is the result of Daily Choices & Actions. ALL Transformation is Driven by Choices. 12

13 How do we Prioritize Our Choices? Well-Being Non-Sick Habits of Health + Optimal Health Unhealthy Sick Habits of Disease Disease Habits of Healthy Thinking & Living Healthy Weight Healthy Eating Healthy Motion Healthy Sleep Habits of Healthy Support Healthy Stress Reduction & Mindfulness Plant based nutrition 13

14 93% of Heart Attacks are Preventable The InterHeart Study Lancet 2004 Lifestyle: Not Smoking, Exercise, Healthy Diet, Healthy Weight The team at Harvard Medical School calculated that 20-40% of cancer cases, and half of cancer deaths, could be prevented if people quit smoking, avoided heavy drinking, kept a healthy weight, and got just a half hour a day of moderate exercise. JAMA Oncology May 19,

15 Type 2 Diabetes & Pre Diabetes 90% Preventable and 90% Reversible The Twin Cycle Hypothesis Healthy Weight Healthy Eating Healthy Motion Healthy Sleep How Powerful? Habits of Health Habits of Healthy Support Healthy Stress Reduction & Mindfulness 15

16 ALEXANDRIA, Va. A study of 992 patients with stage III colon cancer found that those who reported a healthy lifestyle during and following adjuvant (post-surgery) treatment had a 42% lower chance of death and a trend for lower chance of cancer recurrence than those who had less healthy lifestyles year follow-up. Specifically, researchers assessed individuals based on recommendations for: Maintaining a healthy body weight Engaging in regular physical activity Eating a diet rich in whole grains, vegetables, and fruits and low in red meat and processed meat When moderation in alcohol consumption was included, risk of death or cancer recurrence was 51% lower. May 17,2017 Method: 23,153 German participants aged 35 to 65 years from the European Prospective Investigation Into Cancer and Nutrition Potsdam study. Mean follow-up 7.8 years. Assessed for 4 Healthy Lifestyle factors: Never smoking, Having a body mass index lower than 30 Performing 3.5 h/week or more of physical activity Healthy dietary principles (high intake of fruits, vegetables, and wholegrain bread and low meat consumption). Results: Participants with all 4 factors at baseline had a 78% lower risk of developing a chronic disease: Diabetes, 93% Myocardial infarction, 81% Stroke, 50% Cancer, 36% Compared with those with none. 16

17 Genes are Destiny Lifestyle, Lifespan and Telomeres 17

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19 Favorable Lifestyle No current smoking No obesity Physical activity at least once a week Healthy diet: (Mediterranean) 19

20 1 in 3 adults don t get enough sleep A good night s sleep is critical for good health Sleeping less than seven hours per day is associated with an increased risk of developing chronic conditions such as obesity, diabetes, high blood pressure, heart disease, stroke, and frequent mental distress. CDC Feb After controlling for age, a family history of Alzheimer s, the ApoE gene that increases Alzheimer s risk and other factors, they found that poor sleep quality, sleep problems and daytime sleepiness were associated with increased spinal fluid indicators of Alzheimer s disease. New York Times 20

21 Healthy Sleep Habits Mindset: Sleep as Restorative Sleep Routine Limit Caffeine Relaxing Tea Sleep Mask, earplugs Condition Environment Guidance & Support Habits of Health Habits of Healthy Motion Mindset: Life in Motion Our Daily Activity Work and Play Add 30 Minutes a Day Home or Gym Guidance & Support Habits of Health 21

22 Healthy Weight Loss & Healthy Eating Habits Mindset: Food as fuel Portion Control 9 Plate Small, frequent, low glycemic meals Adequate hydration Guidance & Support Habits of Health Habits of a Healthy Mind Mindset: Move from Reacting to Responding Life Redesign Grow Yourself Personal Time Guides & Mentors Community & Family Time Fun & Unplugged Guidance & Support Healthy Mind 22

23 STRESS: React or Respond? If Something Upsets You: Stimulus Space Response Optimal Health is a journey taken one step, one habit, and one day at a time. 23

24 MACRA & MIPS: From Volume to Value Based Health Professional Reimbursement Fee for Service - on Life Support ( Volume based reimbursement) The Future - Value based reimbursement Value= Quality Cost WEIGHT LOSS & HEALING MET SYN 80% Resolved DM2 83% Resolved CVD 82% Risk Reduction Diabetes Resolved Resource Utilization $0 TOM: Age 72, Lost 64 lbs Type 2 DM Resolved HISTORY AFTER 4 MONTHS ON AFTER 18 MONTHS PROGRAM BMI 37 BMI AIC 6.8 AIC 5.6 AIC 5.4 FBG (Metformin 1,000 BID) (Met 250 BID D/C d) 108 (off all meds) LDL C (on Crestor 20) Triglycerides Blood Pressure 138/72 110/62 116/64 Average weight loss for Clients on the Optimal Weight 5&1 Plan with support is 20 pounds. 24

25 Dr. Bernstein New Choices Birth a New Future 25

26 Dr. Mark Nelson Nursewellbeing.com 26