Lifestyle Medicine   The power       of personal choices!                Stephan Esser USPTA, MD              Institute of...
Goals• Define Lifestyle Medicine• Explore the growth of “lifestyle diseases” in  America today• Evaluate the potential of ...
What is going on   How we got hereWhat WE can do about it
Fun!
56 y/o male        Joe                            High Blood Pressure    Obese                                  HighHigh B...
“A global response to aglobal problem: the epidemic          of overnutrition.” WHOIt is estimated that by 2020 2/3 rds of...
Lifestyle MedicineFinger s, Feet , For ks: – the application of environmental, behavioral,   medical and motivational prin...
Characteristics• Preventive/ Proactive• Associative model of care• Empowering/Optimistic• Wholistic
“It is time we descended from Olympus        and began to address the people….to educate them about the realities of healt...
Classic Medical    Model                  Surgery          Pharmaceuticals
EnlightenedMedical Model                   Surgery                Pharmaceuticals                 Botanicals           Phy...
IdealMedical Model                   Surgery                Pharmaceuticals                 Botanicals            Physical...
The function of protecting and developinghealth must rank even above that of restoring           it when it is impaired.  ...
US Healthcare Today!
Mortality Statistics
Leading Causes of Death in US
Top Ten Causes of Death for Men in the United States
Actual Causes of Death in US
2 of 3
Associated Pathology•   CVD:                            •   Obtstetrics:     – Hypertension                      – Gestati...
Overweight ↑ risk of DM2 by 3 foldObesity ↑ risk by 9 fold
Total Healthcare Spending• $2 TRILLION in 2005, or $6,700 per person• >16.2% of the gross domestic product (GDP)• Projecte...
Financial Expenditures• Chronic Dz ≈ 75% of health care costs  – Acc. to Dept of HHS:     •   CVD and CVA         $351.8 b...
Metabolic Costs• $4 of every $10 spent on prescription drugs  is spent to tx symptoms of  Metabolic Syndrome   – ↑ Cholest...
Waist Circumference > 40” M > 35” W       > 25%    of AmericansTriglycerides > 150    HDL < 40 M or < 50 W   BP ≥ 130/85  ...
Obesity   Waist Circumference > 40” M > 35” WTriglycerides >Dyslipidemia < 40 M or < 50 W                150    HDL   HTN/...
We spend more        yetwe are one of the      sickest   most obesesocieties on Earth!
How did this happen?
Genetic Shift     orLifestyleChoices?
They did not display their parent’s susceptibility to cancer and diabetes….……..the effects of the agouti gene had been vir...
Pima Indians
↑39%Av. of 52 tsp added sugar/person/day in 2000
•IOM: (UL) for salt is 5.8 g/day > 95 percent US Males 31 - 50 > 75 percent of US females 31- 50     regularly in excess o...
↑66%
↑57 lb/capita
↑400%
Michelangelo’s David:12 month 20 city tour of the US
What about Exercise?
US Gov. Reccomendations      150 minutes per wk      30 minutes/day                  +     2-3 days/Strength Tr.      4-5 ...
CDC Exercise Stats• > 60% of adults are not regularly active• 25% are not active at all• 50% of all youth ages 12-21 are n...
• Physical inactivity is more common in:                Women > Men          African American > Whites               Hispa...
Exercise• Reduces risk of  – Heart Disease ≈ 40%  – Obesity: ≈ 30-100%  – Stroke ≈ 50%  – Type 2 Diabetes ≈ 50%  – Hyperte...
Perspective• We eat more  – Sugar, Salt, Meat, Dairy, Fat  – 1970-2000:     •   ↑ 24.5 % C/day ≈         530K/day• We get ...
Wehave a problem      of   epidemic proportions!
What can we do?
What if              We ate       less fat, salt and sugar                andmore fruits, vegetables and grains           ...
Some Say…..– If 10% of adults began a regular walking program,  $5.6 billion in heart disease costs could be saved.– If Am...
What’s the evidence?
Common Misconceptions                    1.                    #              There is   noevidence that a healthy lifesty...
12 year Cohort Study1507 men 832 WomenAges 70-90 years         50% ↓ in all-causeOutcomes: 10 yr all cause mortality4 Fact...
“Not only do persons with better health habitssurvive longer, but in such persons, disability ispostponed and compressed i...
Retrospective Cohort Study       Outcomes: Incidence of CVD events       379,0003 Diabetics to 9 Million non-DM2       Dia...
Misconception 2       #      There are   no good prospective, randomized trials         to prove thatOrganized Lifestyle I...
Finnish Diabetes Prevention Trial    Total 522: 172M 350W    Av. age 55            Risk of    Av. BMI 31    Randomized to ...
Misconception 3 #Prescription Medications           are       more     effective.
Multi-Center Randomized Controlled Trialn=3234 non-diabetics w/ ↑plasma glucose3 Arms: placebo, Metformin (850BID), Lifest...
Misconception 4       #The benefits of lifestyle interventions         don’t last.
Misconception 5      # Lifestyle Interventions            aretoo expensive.
“Compared with the placebo intervention,the cost per QALY was approximately$1100 for the lifestyle intervention and$31300 ...
“After controlling for differences insociodemographics, smoking and comorbidity,  individuals with cardiometabolic risk fa...
Economic Woes
Perspectives• There is significant evidence that:   – Lifestyle dramatically impacts M&M   – Organized Lifestyle Intervent...
Lifestyle Medicine Programs
Duke Rice Diet Program
0.5-3lbs/day
½ lb/day
Perspective• Lifestyle-Associated Diseases are the leading  expenditure and cause of mortality in the  western world• Pers...
Challenges Ahead
Challenge 1#Lifestyle Medicine is not paid for  by many insurance companies.
Challenge 2                 #Lifestyle Medicine is not a respected field of medical    research or practice.
Challenge 3                   #   In clinical training today, students receive insufficienteducation on lifestyle medicine.
Challenge 4                   #        The individual   adds an extra variable to     medical care in LM………each of us has ...
Challenge 5#   You have to walk the talk.An advocate for a healthy diet and    exercise   must do both.
“A global response to aglobal problem: the epidemic    of overnutrition.” WHO   It is estimated that by 2020 2/3 rds of th...
What can we do?
Foremost• Lead by example• Identify personal lifestyle goals• Optimize our own health• Encourage family and friends to do ...
Then• Seek to educate and empower• Through transmission of knowledge and  motivation• Get involved in your circle of influ...
Finally• Advance health on the national and global  level through political action• Get involved
Conclusion• America is facing an epidemic of disease  fostered by lifestyle choices• Lifestyle interventions are the answe...
Together we can make a difference
Thank
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
Lifestyle Medicine: The Power of Personal Choices,  North American Vegetarian Society 2011
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Lifestyle Medicine: The Power of Personal Choices, North American Vegetarian Society 2011

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Learn about the leading chronic diseases in America and how Lifestyle Medicine can radically shift the burden of disease in your life and western society at large.

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  • http://www.cc.gatech.edu/cpl/projects/graphcuttextures/data/rotation-perspective/people-out-persp.gif
  • graphicfreebie.com http://www.howtodraw.ca/images/076fig.png Sodahead.com
  • -- Bull World Health Organ. 2002;80(12):952-8. Epub 2003 Jan 23. Chopra M et al
  • http://www.lifestylemedicine.net.au/health-professionals/index.htm
  • The faucet of preventable disease is overflowing on the floor and as we respond with an acute care, emergent response very few people are reaching for the faucet.
  • Approx. 1,300,000 new cases per year www.cdc.gov/.../mmwrhtml/ figures/m846qsf.gif www.ncbi.nlm.nih.gov/ bookshelf/picrender.fcgi.. http://www.ctahr.hawaii.edu/CS/blogs/sustainable_agriculture/cdc_logo(2).jpg
  • Modifiable behavioral risk factors are leading causes of mortality in the United States. (JAMA, 2000 Mokdad et al. CDC) www.cdc.gov/cancer/ breast/statistics/ http://www.cdc.gov/cancer/Prostate/publications/decisionguide/
  • www.cdc.gov/cancer/ breast/statistics/ http://www.cdc.gov/cancer/Prostate/publications/decisionguide/
  • --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm
  • --http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/pdf/obesity.pdf
  • Fox, Caroline. Et al. Trends in the Incidence of Type 2 Diabetes Mellitus: Circulation 2006:113;2914-2918.
  • http://health.ucsd.edu/news/images/DPP1.jpg
  • -- 6/22/02 radio address :Americans who are obese spend approximately 36 percent more on health care services than the general population. They spend 77 percent more on medications. --Catlin, A, C. Cowan, S. Heffler, et al, &amp;quot;National Health Spending in 2005.&amp;quot; Health Affairs 26:1 (2006): 142-153.2.Borger, C., et al., &amp;quot;Health Spending Projections Through 2015: Changes on the Horizon,&amp;quot; Health Affairs Web Exclusive W61: 22 February 2006. -- http://www.mathematica-mpr.com/health/
  • --AJCN 2007; 85: 1169-1170
  • --http://www.healthierus.gov/STEPS/summit/prevportfolio/power/index.html#we
  • -- Medco Health Solutions
  • --AHA 2004 --States if you have 2 of characteristics =‘s 2 times risk of death from coronary heart dz, if you have 4 of these =‘s you have 3.5 times the risk?
  • --AHA 2004 --States if you have 2 of characteristics =‘s 2 times risk of death from coronary heart dz, if you have 4 of these =‘s you have 3.5 times the risk? -Dysglycemia, HTN, Obesity, and Dyslipidemia
  • 6/22/02 radio address :Americans who are obese spend approximately 36 percent more on health care services than the general population. They spend 77 percent more on medications.
  • Agouti = defect in alpha melanocyte stimulating hormone a secondary molecule increased by increasing leptin levels. Early nutrition can influence DNA methylation because mammalian one-carbon metabolism, which ultimately provides the methyl groups for all biological methylation reactions, is highly dependent on dietary methyl donors and cofactors.[ 21 ] For example, dietary methionine and choline are major sources of one-carbon units, and folic acid, vitamin B 12 , and pyridoxal phosphate are critical cofactors in methyl metabolism. The genome of the preimplantation mammalian embryo undergoes extensive demethylation, and appropriate patterns of cytosine methylation are re-established after implantation.[ 4 ] These DNA methylation patterns must then be maintained over many rounds of rapid cellular proliferation during fetal and early postnatal development. Availability of dietary methyl donors and cofactors during critical ontogenic periods therefore might influence DNA methylation patterns. [ 10 and 16 ] Hence, early methyl donor malnutrition (i.e., overnutrition or undernutrition) could effectively lead to premature “epigenetic aging,” [ 22 ] thereby contributing to an enhanced susceptibility to chronic disease in later life. Vitamin B12, choline, Vitamin B6
  • Gila Reservation Arizona Maycoba, Mexico
  • World’s smallest island country just 8.s sq miles 95% are overweight/obese and 50% have diabetes
  • -- http://www.ers.usda.gov/briefing/consumption/Effects.htm
  • --IOM rec on Na: AI 1.5g/d UL 2.3g/d --http://www.cspinet.org/ --http://www.ama-assn.org/ama/pub/category/16461.html -- http://www.iom.edu/?id=18495&amp;redirect=0 -- Dr. Heikki Karppanen of the University of Helsinki and Dr. Eero Mervaala of the University of Kuopio report that an average 30-35 % reduction in salt intake during 30 years in Finland was associated with a dramatic 75 % to 80 % decrease in both stroke and coronary heart disease mortality in the population under 65 years. During the same period the life expectancy of both male and female Finns increased by 6 to 7 years.The most powerful explaining factor for the favorable changes was the more than 10 mmHg (&amp;quot;point&amp;quot;) decrease in the average blood pressure of the population. A marked decrease in the average cholesterol levels of the population also remarkably contributed to the decrease of heart diseases. The extensive use of drugs contributed less than 10 % of the observed decreases in blood pressure, cholesterol, and cardiovascular diseases. -- http://www.iom.edu/Object.File/Master/20/004/0.pdf http://fnic.nal.usda.gov/nal_display/index.php?info_center=4&amp;tax_level=3&amp;tax_subject=256&amp;topic_id=1342&amp;level3_id=5140
  • --http://www.ers.usda.gov/publications/foodreview/jan1996/frjan96a.pdf
  • http://static.howstuffworks.com/gif/michelangelo-1.jpg
  • -- http://www.cdc.gov/nccdphp/dnpa/physical/index.htm -- http://www.cnn.com/2003/HEALTH/diet.fitness/08/15/cdc.exercise.ap/
  • ----http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/index.htm over half of US adults do not engage in physical activity at levels consistent with public health --http://books.nap.edu/openbook.php?record_id=1627&amp;page=118 IOM: Greater then 1/2 of all US children do not get enough exercise to develop a healthy heart and lungs --http://www.cdc.gov/nccdphp/sgr/intro.htm Daily enrollment in physical education classes has declined among high school students from 42 percent in 1991 to 25 percent in 1995. --Only 19 percent of all high school students are physically active for 20 minutes or more, five days a week, in physical education classes. high school students are physically active for 20 minutes or more, five days a week, in physical education classes.
  • ----http://www.cdc.gov/nccdphp/dnpa/physical/health_professionals/index.htm over half of US adults do not engage in physical activity at levels consistent with public health --http://books.nap.edu/openbook.php?record_id=1627&amp;page=118 IOM: Greater then 1/2 of all US children do not get enough exercise to develop a healthy heart and lungs --http://www.cdc.gov/nccdphp/sgr/intro.htm
  • 6/22/02 radio address :Americans who are obese spend approximately 36 percent more on health care services than the general population. They spend 77 percent more on medications.
  • http://www.google.com/imgres?imgurl=http://www.deliverfreedom.com/blog/wp-content/uploads/2009/11/happy-dog.jpg&amp;imgrefurl=http://www.deliverfreedom.com/blog/lessons-you-can-learn-from-a-dog-to-live-a-fulfilling-life/&amp;usg=__P9wGV1Z55MqChCMQSB9j3Zw-KiE=&amp;h=522&amp;w=522&amp;sz=49&amp;hl=en&amp;start=0&amp;zoom=1&amp;tbnid=pntaOysLWeGPqM:&amp;tbnh=131&amp;tbnw=131&amp;prev=/images%3Fq%3Ddog%26um%3D1%26hl%3Den%26safe%3Dactive%26client%3Dsafari%26sa%3DN%26rls%3Den%26biw%3D1407%26bih%3D681%26tbs%3Disch:1&amp;um=1&amp;itbs=1&amp;iact=hc&amp;vpx=783&amp;vpy=207&amp;dur=1418&amp;hovh=225&amp;hovw=225&amp;tx=97&amp;ty=68&amp;ei=DkHHTKeqB8L68AbBh4yhDw&amp;oei=DkHHTKeqB8L68AbBh4yhDw&amp;esq=1&amp;page=1&amp;ndsp=31&amp;ved=1t:429,r:12,s:0 mixxbuzzers.com http://www.psychologytoday.com/files/u107/cigarette.jpg businesspundit.com
  • -- http://www.cdc.gov/nccdphp/publications/factsheets/Prevention/obesity.htm --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.nhlbi.nih.gov/health/prof/heart/hbp/salt_upd.pdf --http://www.usatoday.com/news/health/2008-02-10-salt-dangers_N.htm -- Intersalt Cooperative Research Group (1988). Intersalt: an international study of electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. BMJ . 297 : 319–328. --The contradictory nature of these findings accords with the unreliability of the methods used in NHANES III and IV (ie, 24-h dietary recall). Twenty-four-hour urinary sodium from complete urine samples is the only accurate way to estimate dietary salt intake, and this was not measured in NHANES III and IV. The large international study—INTERSALT, 2 which had 24-h urinary sodium and BP measured, showed that salt intake is directly associated with BP and the increase in BP with age in more than 10,000 individuals including both hypertensives and normotensives. -- -- http://www.nhlbi.nih.gov/new/press/nov30a99.htm -- Healthy adults living in a temperate climate can maintain a normal sodium balance with as little as 115 mg of dietary sodium per day. In consideration of the wide variation in Americans’ physical activity and climatic exposure, a safe minimum of 500 mg of sodium per day has been recommended.
  • --Am J Clin Nutr. 1999 Sep;70(3 Suppl):532S-538S.
  • Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project.
  • -- compression-of-morbidity hypothesis predicts that the age at the time of initial disability will increase more than the gain in longevity, resulting in fewer years of disability and a lower level of cumulative lifetime disability.
  • --Annals of Internal Medicine 2003: 139:455-459
  • Diabetes confers an equivalent risk to aging 15 years. Due to earlier transition to a high risk category of CVD and other health concerns --Diabetics are 4 times more likely to have CVD --Diabetics have a similar risk of Coronary Heart Disease to those without diabetes who have had an MI
  • --FDDP (N Engl J Med 2001;344:1343-50.)
  • -- J Gerontol A Biol Sci Med Sci. 2006 Oct;61(10):1075-81.
  • ..Intervention group with a 43% reduction in risk P value .0001
  • -- Ann Intern Med. 2005 Mar 1;142(5):323-32.
  • -- Value Health. 2007 Nov-Dec;10(6):443-50. PMID: 17970926 Overweight/Obese/HTN/Hyperlipidemia/Diabetes
  • http://www.newschannel9.com/pictures/s-layoffs.jpg We are all painfully aware of the ongoing challenges in our economy; the subprime mortgage market, job losses, questionable solvency of the SSA, and even fortune 500 companies suffering from excess costs and reduced margins. In fact according to Business week, the only new job market has been the industrial medical complex.
  • --American College of Lifestyle Medicine and ACPM call for preventive…lifestyle med. training
  • --
  • -- Bull World Health Organ. 2002;80(12):952-8. Epub 2003 Jan 23. Chopra M et al
  • Lifestyle Medicine: The Power of Personal Choices, North American Vegetarian Society 2011

    1. 1. Lifestyle Medicine The power of personal choices! Stephan Esser USPTA, MD Institute of Lifestyle Medicine 2011
    2. 2. Goals• Define Lifestyle Medicine• Explore the growth of “lifestyle diseases” in America today• Evaluate the potential of LM interventions• Review some ‘Opport-unacles’• What can we do!
    3. 3. What is going on How we got hereWhat WE can do about it
    4. 4. Fun!
    5. 5. 56 y/o male Joe High Blood Pressure Obese HighHigh Blood Cholestero Sugars l Depression Arthritis of Fatigue the knees
    6. 6. “A global response to aglobal problem: the epidemic of overnutrition.” WHOIt is estimated that by 2020 2/3 rds of the global burden of disease will be attributable to chronic non- communicable diseases, most of them strongly associated with diet. The nutrition transition towardsrefined foods, foods of animal origin, and increased fats plays a major role in the current global epidemics of obesity, diabetes and cardiovascular diseases, among other non-communicable conditions.Sedentary lifestyles and the use of tobacco are also significant risk factors. …….. A concerted multi-sectoral approach, involving the use of policy, education and trade mechanisms, is necessary to address these matters.
    7. 7. Lifestyle MedicineFinger s, Feet , For ks: – the application of environmental, behavioral, medical and motivational principles to the management of lifestyle-related health problemsThe M er Lever s of ast in a clinical setting. – Modalities: • • Dest iny! Diet Exercise • Sleep • Emotional Poise • Reduced toxic exposures
    8. 8. Characteristics• Preventive/ Proactive• Associative model of care• Empowering/Optimistic• Wholistic
    9. 9. “It is time we descended from Olympus and began to address the people….to educate them about the realities of health and disease, to teach them what they can do to helpthemselves and what we cannot do. They must be taught about the marvelous capabilities and the serious limitations of medicine.” Moser, R.H “Knowledge is not Enough.” NEJM 1977
    10. 10. Classic Medical Model Surgery Pharmaceuticals
    11. 11. EnlightenedMedical Model Surgery Pharmaceuticals Botanicals Physical Modalities Mind-Body Interventions
    12. 12. IdealMedical Model Surgery Pharmaceuticals Botanicals Physical Modalities Lifestyle Interventions
    13. 13. The function of protecting and developinghealth must rank even above that of restoring it when it is impaired. -Hippocrates-
    14. 14. US Healthcare Today!
    15. 15. Mortality Statistics
    16. 16. Leading Causes of Death in US
    17. 17. Top Ten Causes of Death for Men in the United States
    18. 18. Actual Causes of Death in US
    19. 19. 2 of 3
    20. 20. Associated Pathology• CVD: • Obtstetrics: – Hypertension – Gestational DM – Congestive Heart Failure – Macrosomia – PVD – Inc. C Section rate – Impotence – Inc. Perinatal Morbidity DIABETES – Inc. Pre/Eclampsia – Claudication • Cancer:• Endocrine: – Prostate – Diabetes – Colon – PCOS – Breast Metabolic Syndrome – Hypothyroidism – Infertility – Endometrial – Renal Cell – Gallbladder• Orthopedics: – Esophageal Adeno. – Osteoarthritis • Other: – AVN • Hyperuricemia, Pancreatitis,• Hepatic: Gallstones, Sleep Apnea, Alzheimer’s, – #1 cause of liver dz in US Dyslipidemia, Metabolic Syndrome
    21. 21. Overweight ↑ risk of DM2 by 3 foldObesity ↑ risk by 9 fold
    22. 22. Total Healthcare Spending• $2 TRILLION in 2005, or $6,700 per person• >16.2% of the gross domestic product (GDP)• Projected to exceed $4 TRILLION by 2015
    23. 23. Financial Expenditures• Chronic Dz ≈ 75% of health care costs – Acc. to Dept of HHS: • CVD and CVA $351.8 billion (2003) • Cancer $171.6 billion (2002) • Diabetes $132 billion (2002) • Obesity $117 billion (2000) • Arthritis $82 billion (1995) • Smoking DMC $75 billion LP $80 billion • Physical Inactivity $76 billion (2000) • Poor Nutrition DMC $33 billion LP $9 billion
    24. 24. Metabolic Costs• $4 of every $10 spent on prescription drugs is spent to tx symptoms of Metabolic Syndrome – ↑ Cholesterol/LDL – ↑ BP – ↑ Blood Sugar
    25. 25. Waist Circumference > 40” M > 35” W > 25% of AmericansTriglycerides > 150 HDL < 40 M or < 50 W BP ≥ 130/85 Fasting Glucose of ≥ 100
    26. 26. Obesity Waist Circumference > 40” M > 35” WTriglycerides >Dyslipidemia < 40 M or < 50 W 150 HDL HTN/CVD BP ≥ 130/85 Fasting Glucose of ≥ 100 Diabetes
    27. 27. We spend more yetwe are one of the sickest most obesesocieties on Earth!
    28. 28. How did this happen?
    29. 29. Genetic Shift orLifestyleChoices?
    30. 30. They did not display their parent’s susceptibility to cancer and diabetes….……..the effects of the agouti gene had been virtually erased.
    31. 31. Pima Indians
    32. 32. ↑39%Av. of 52 tsp added sugar/person/day in 2000
    33. 33. •IOM: (UL) for salt is 5.8 g/day > 95 percent US Males 31 - 50 > 75 percent of US females 31- 50 regularly in excess of the UL.
    34. 34. ↑66%
    35. 35. ↑57 lb/capita
    36. 36. ↑400%
    37. 37. Michelangelo’s David:12 month 20 city tour of the US
    38. 38. What about Exercise?
    39. 39. US Gov. Reccomendations 150 minutes per wk 30 minutes/day + 2-3 days/Strength Tr. 4-5 days a week
    40. 40. CDC Exercise Stats• > 60% of adults are not regularly active• 25% are not active at all• 50% of all youth ages 12-21 are not vigorously active on a regular basis• By age 75 1:3 men and 1:2 women engage in NO physical exercise
    41. 41. • Physical inactivity is more common in: Women > Men African American > Whites Hispanic > Whites Older > Younger Less affluent > More Affluent
    42. 42. Exercise• Reduces risk of – Heart Disease ≈ 40% – Obesity: ≈ 30-100% – Stroke ≈ 50% – Type 2 Diabetes ≈ 50% – Hypertension ≈ 50% – Disability delayed ≈15 years – Colon Cancer ≈ 25-40% – Breast Cancer ≈ 20%-44% – Osteoporosis ≈ 20+%
    43. 43. Perspective• We eat more – Sugar, Salt, Meat, Dairy, Fat – 1970-2000: • ↑ 24.5 % C/day ≈ 530K/day• We get less then ideal – Exercise
    44. 44. Wehave a problem of epidemic proportions!
    45. 45. What can we do?
    46. 46. What if We ate less fat, salt and sugar andmore fruits, vegetables and grains &increased our exercise habits????
    47. 47. Some Say…..– If 10% of adults began a regular walking program, $5.6 billion in heart disease costs could be saved.– If Americans↓ Na intake by 2300mg/day = 3-6 mm Hg ↓ in SBP • 11 % ↓ strokes • 7 % ↓ coronary events • 5 % ↓ total mortality
    48. 48. What’s the evidence?
    49. 49. Common Misconceptions 1. # There is noevidence that a healthy lifestyle decreases M&M or extends a healthy lifespan.
    50. 50. 12 year Cohort Study1507 men 832 WomenAges 70-90 years 50% ↓ in all-causeOutcomes: 10 yr all cause mortality4 Factors: Med. diet, Moderate EtOH, physical exerciseand non-smoking were ass. w ↓ in ACM and cause specific mortality
    51. 51. “Not only do persons with better health habitssurvive longer, but in such persons, disability ispostponed and compressed into fewer yearsat the end of life.”Vita, AJ et al. NEJM 1998; 338:1035-1041
    52. 52. Retrospective Cohort Study Outcomes: Incidence of CVD events 379,0003 Diabetics to 9 Million non-DM2 Diabetics four times more likely to have CVD“Diabetes confers an equivalent risk to ageing 15 years!”
    53. 53. Misconception 2 # There are no good prospective, randomized trials to prove thatOrganized Lifestyle Interventions are effective.
    54. 54. Finnish Diabetes Prevention Trial Total 522: 172M 350W Av. age 55 Risk of Av. BMI 31 Randomized to standard of care or individualized lifestyle counseling Diabetes ↓ 58 % Av. f/u 3.2 yrs (P<0.001)“The reduction in the incidence of diabetes wasdirectly associated with changesN in lifestyle” Engl J Med 2001;344:1343-50
    55. 55. Misconception 3 #Prescription Medications are more effective.
    56. 56. Multi-Center Randomized Controlled Trialn=3234 non-diabetics w/ ↑plasma glucose3 Arms: placebo, Metformin (850BID), LifestyleInterventionLifestyle =7% weight loss/ healthy diet/150min wk exerciseAv. f/u = 2.8yrs ↓ 58% Diabetes Incidence ↓’d by 31% in Metformin and by 58% in Lifestyle Intervention NEJM:2002
    57. 57. Misconception 4 #The benefits of lifestyle interventions don’t last.
    58. 58. Misconception 5 # Lifestyle Interventions aretoo expensive.
    59. 59. “Compared with the placebo intervention,the cost per QALY was approximately$1100 for the lifestyle intervention and$31300 for the metformin intervention.From a societal perspective, theinterventions cost approximately 8800dollars and 29,900 dollars per QALY,respectively. From both perspectives,the lifestyle intervention dominatedthe metformin intervention.”2005 intervention
    60. 60. “After controlling for differences insociodemographics, smoking and comorbidity, individuals with cardiometabolic risk factor clusters missed 179% more work days andspent 147% more days in bed (in addition tolost work days) than those without. Lost workdays and bed days resulted in $17.3 billion annually in lost productivity.”
    61. 61. Economic Woes
    62. 62. Perspectives• There is significant evidence that: – Lifestyle dramatically impacts M&M – Organized Lifestyle Interventions are: • Effective • Cost Efficient • Feasible • Sustainable
    63. 63. Lifestyle Medicine Programs
    64. 64. Duke Rice Diet Program
    65. 65. 0.5-3lbs/day
    66. 66. ½ lb/day
    67. 67. Perspective• Lifestyle-Associated Diseases are the leading expenditure and cause of mortality in the western world• Personal choices can alter this trajectory• We can transform lives
    68. 68. Challenges Ahead
    69. 69. Challenge 1#Lifestyle Medicine is not paid for by many insurance companies.
    70. 70. Challenge 2 #Lifestyle Medicine is not a respected field of medical research or practice.
    71. 71. Challenge 3 # In clinical training today, students receive insufficienteducation on lifestyle medicine.
    72. 72. Challenge 4 # The individual adds an extra variable to medical care in LM………each of us has to perform the treatment.
    73. 73. Challenge 5# You have to walk the talk.An advocate for a healthy diet and exercise must do both.
    74. 74. “A global response to aglobal problem: the epidemic of overnutrition.” WHO It is estimated that by 2020 2/3 rds of the global burden of disease will be attributable to chronic noncommunicable ……if…….Lifestyle is thediseases, most of them strongly associated with diet. Problem The nutrition transition towards refined foods, foods of animal origin, and increased fats plays a major role in the current global epidemics of obesity, diabetes and cardiovascular diseases, among other noncommunicable We Have the Answer conditions. Sedentary lifestyles and the use of What is risk factors. …….. A concerted tobacco are also significant the answer……..?multi-sectoral approach, involving the use of policy, educationand trade mechanisms, is necessary to address these matters.
    75. 75. What can we do?
    76. 76. Foremost• Lead by example• Identify personal lifestyle goals• Optimize our own health• Encourage family and friends to do likewise
    77. 77. Then• Seek to educate and empower• Through transmission of knowledge and motivation• Get involved in your circle of influence
    78. 78. Finally• Advance health on the national and global level through political action• Get involved
    79. 79. Conclusion• America is facing an epidemic of disease fostered by lifestyle choices• Lifestyle interventions are the answer• Plant Based Nutrition is central
    80. 80. Together we can make a difference
    81. 81. Thank

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