Metabolic syndrome is an increasing health problem in our country and a very high risk condition. As St. Luke’s works toward the Triple Aim of better health, better care, and lower costs, tackling metabolic syndrome supports all three aims.
And we are making great progress. Under the inspired leadership of Dr. Jennifer Shalz, a multidisciplinary team has begun to see if a dedicated clinic can be effective in reversing this condition.
It has been, and I have asked my blog editor, Roya Camp, to share with you the work this multidisciplinary team has been doing and the results of the first wave through the program.
One meal at a time, one lap around the track at a time, one journal entry at a time, Dr. Jennifer Shalz and a small platoon of specialists are helping to improve the odds for a handful of Idaho residents. The all-out experiment is succeeding – and underscoring just how much effort must be brought to bear to shift human health.
Among the significant results:
Participants raved about the program and have committed to supporting more people through the clinic.
In a note to Dr. Shalz and the staff, one participant wrote, “Thank you for the last 12 weeks. They have been nothing short of amazing.
“We started the program with our health in danger, and through all of your efforts we leave the program with new friends, new eating habits, and a new spring in our step.
“… And to St. Luke’s, which has the vision and wisdom to give us a chance and the tools needed to truly change our lives. What a precious gift of a better life has been given to me. I can’t thank them enough.
I bought a little plaque when I first started the program that said, “I’m going to make the rest of my life the best of my life,” and through all of your time and sharing with us, this has come true.
Thanks again for changing my life.”
The physician-directed, 12-week program brought a team of registered dietitians, exercise physiologists, health coaches, and a social worker together to work with 16 men and women to change the dangerous constellation of conditions that collectively are metabolic syndrome.
As many as nearly a third of American adults have a clustering of certain risk factors, called metabolic syndrome, that are associated with a five-fold increase in the development of diabetes, a two-fold increase in development of coronary artery disease and an increase in all-cause mortality, gallstones, asthma, sleep disordered breathing, and some forms of cancer. These risk factors include even borderline high blood pressure and blood sugar as well as cholesterol abnormalities and an increased waist size.
The program, which began in late September and wrapped up in early December, was primarily funded by St. Luke’s Health System, although participants were asked to make a financial commitment so as to be invested in their own results. The thinking is that when the program’s efficacy is demonstrated, it will be included as a defined benefit for appropriate populations.
The evidence-based program includes supervised exercise, extensive education, medical management of risk factors, psychosocial education and support, and nutritional counseling, and is focused on weight loss and risk factor reduction.
The goal? Sustainable behavior change to prevent progression to diabetes or coronary artery disease.
For Denise Tschida, participation in the clinic has been a profound experience.
“It’s meant everything to me. It’s been life-changing, really. I can’t say enough about it,” she said. “What a great group of people to support us.
“I’ve tried losing weight before and changing habits and all of that. I don’t know if it’s a combination of having all these different people involved, but it’s made all the difference in the world,” Tschida said. “I’m sleeping better than I ever have, I’m not having those negative thoughts I used to have, I’m getting in really good shape, I don’t reach for food when I’m stressed … I’m determined that I’m not going to go back to those old ways.”
Tschida and other participants met two evenings a week to learn how to cook, exercise together, practice stress-reduction techniques and engage in a variety of other healthy living practices and behaviors. They sampled tasty, healthy dishes prepared by their team dieticians, learned how to adjust their eating patterns to be more consistent with the principles of the life-prolonging Mediterranean diet, and traded tips on ingredients.
Participants received their financial investment back as they put work into their own wellness. Program attendance, exercise records, journal entries, all meant reimbursements of their initial payments. This, too, was part of the “all-in” approach.
“People tend to participate more if they have a little skin in the game,” Dr. Shalz observed.
Dr. Shalz exercised with the group when she was able to and spent time with participants throughout the three-month program. The constant education, coupled with positive reinforcement for changing health behaviors, she thinks, was critical to a shift in habits.
Dr. Shalz earned her medical degree from Tufts University Medical School and served in the military until 2000, completing her internal medicine residency at David Grant Medical Center at Travis Air Force Base. She became interested in the work of the Institute for Healthcare Improvement and process and quality improvement and went on to work with the Veterans Administration in Chicago, Portland, and then Boise.
She started with St. Luke’s in September 2011, about the time St. Luke’s Heart was considering a metabolic syndrome component because of the number of high-risk patients that ultimately became their patients.
“These patients needed some sort of lifestyle program that would help prevent heart disease,” Dr. Shalz said.
An internist certified in hospice and palliative care as well, Dr. Shalz researched MetSyn programs across the country, including work being done by the University of Michigan with impressive results.
“We could do that here,” she recalls thinking. “We continue to foster a vision of being not only a secondary prevention center but providing primary prevention for high risk individuals.
“It’s all about coaching the whole person and giving them tools, helping them actually do it for themselves and taking them to the next step as they are able,” she said. “This helps them achieve a strong sense of self-efficacy and then they just take off.”
Together, the group has tackled self-doubt, fear, and the desire to achieve sustainable weight loss and healthy habits. For many, past discouragement has been a tough obstacle to overcome.
“Deep down, they find it difficult to think they can make change,” Dr. Shalz said.
Dr. Shalz and other architects of the pilot clinic are working to determine which components are most effective and which are scalable to larger groups of participants. Dr. Shalz is concluding that a successful MetSyn program needn’t be anything fancy, just a classroom, a gym, and some committed participants and professionals.
“I really think it’s doable,” she said.
The fall group saw a reduction in all the markers targeted: weight and blood pressure came down, cholesterol and blood sugar numbers improved, and the health team caught and treated sleep apnea and a variety of other health issues as the program progressed.
The next clinic, a refinement of the fall program, will begin early in 2015. Dr. Shalz can’t wait.
“I feel very privileged. It’s so satisfying to see people take hold of their own health. Every day, I have patients who are over the moon about their personal successes. They feel like their lives have been transformed,” she said. “It’s good to be part of that.
“I feel like I’m thriving here.”
She’s not alone. Tschida recalls her shock at finding she had all the risk factors of metabolic syndrome and connecting that information to the walkers, oxygen tanks, and other symbols of grave illness that she’d seen among patients not taking part in the pilot clinic.
“I didn’t know you put them all together and you have metabolic syndrome,” she said. “It makes me tear up.
“I am so lucky that I got in on this pilot. It’s been the most amazing thing that I’ve ever done.”
David C. Pate, M.D., J.D., is president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.