The document discusses how telehealth can help with lifestyle interventions for chronic disease prevention and management. It notes that the leading causes of death in the US are largely preventable through diet, exercise, not smoking, stress management and sleep. However, lifestyle changes are difficult, and telehealth could help by making interventions more accessible and convenient compared to in-person visits. The document outlines Fruit Street, a telehealth platform that uses virtual visits, connected devices and an app to help people modify risk factors through a clinical trial. Physician investors support bringing lifestyle medicine and telehealth together to better treat and prevent chronic diseases.

1. Telehealth for Lifestyle
Interventions
Why Telehealth Is The Key to Effective Lifestyle
Interventions
Laurence Girard
CEO & Founder of FrutStreet.com

2. Huntington Hospital ER - Huntington, New York

3. Dr. David Katz - President of American College of Lifestyle Medicine

4. CDC - Leading Causes of Death 2015
Heart Disease: 614,348
Cancer: 591,699
Chronic lower respiratory disease: 147,101
Accidents (unintentional injuries): 136,053
Stroke (cerebrovascular diseases: 133,103
Alzheimer's disease: 93,541
Diabetes: 76,488
Nephritis, nephrotic syndrome, and nephrosis: 48,146
Source: http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

5. Are These Really The Leading Causes of Death?

6. Diseases Are Not Causes, They Are Effects

7. 80% of Premature Deaths in US in 1990 Caused By:
References:
McGinnis JM, Forge WH, Actual causes of death in the United States. JAMA. 1993,270:2207-12
Mokdad AH, Mark JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-45
Poor Diet Tobacco Lack of Physical Activity

8. The Remedy for Premature Death
-Survey research of 23,000 adults in and around Potsdam Germany asked about
four factors in their lives:
-Do you smoke yes or no?
-Do you eat well yes or no? (habitual intake of fruits, vegetables, whole grains)
-Are you physically active on a regular basis yes or no?
-Is your weight well controlled yes or no?
Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European
Prospective Investigation Into Cancer and Nutrition-Postdam study. Arch Intern Med. 2009. Aug 10:169,(15):1355-62

9. Comparison of Unhealthy vs. Healthy Lifestyle
-Group 1 = I don’t smoke, I eat well, I’m physically active, my weight is where it
should be
-Group 2 = I smoke, eat badly, don’t exercise, and my weight is out of control
-Group 1 over the span of their lifetimes had an 80% lesser rate of all major
chronic disease than group 2
-Flip the switch from bad to good on any of these factors and the lifetime
risk of getting any major chronic disease goes down about 50%
Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European
Prospective Investigation Into Cancer and Nutrition-Postdam study. Arch Intern Med. 2009. Aug 10:169,(15):1355-62

10. The “Magic Pill” of Lifestyle
By avoiding smoking, eating well, exercising,
and controlling our weight we can reduce our
lifetime risk of getting any major chronic
disease by 80%
(no side effects)
-Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European
Prospective Investigation Into Cancer and Nutrition-Postdam study. Arch Intern Med. 2009. Aug 10:169,(15):1355-62
-Kvaavik E. Batty GD, Ursin G. Huxley R., Gale CR. Influence of individual and combined health behaviors on total and cause-specific mortality in
men and women. the United Kingdom health and lifestyle survey. Arch Intern Med 2010.170. 711-8
-McCullough ML. Patel AV. Kushi LH. Patel R. Willet WC. Doyle C. Thun MJ, Gapstur SM. Following cancer prevention guidelines reduces risk of
cancer, cardiovascular disese, and all-cause mortality. Cancer Epidemiol Biomarkers Prev. 2011,20 1089-97.

11. The Master Levers of Medical Destiny
Archimedes - “Give me a lever long enough
and I can move the whole world”
Forks Fingers Feet

12. 6 Cylinders of Lifestyle Medicine
Diet Exercise Don’t Smoke
Reduce Stress Sleep Love

13. Gap Between What We Know and What We Do
-There is a major gap between what we know and
what we do with what we know
-We need to translate what we know into what we
routinely do
-Lifestyle modification is hard
-We Need a coach (diabetes prevention program)

14. Fruit Street = Telehealth Software for Lifestyle Interventions

15. Clinician Dashboard to Monitor Diet/Lifestyle

16. Dietary Monitoring Via Telehealth

17. Wearable Device Monitoring via Telehealth

18. Lifestyle Change Requires 9-16 Visits...Who wants
to drive to a dietitian? Schedule online instead

19. Why Are Lifestyle Interventions Difficult?
-Reimbursement for lifestyle interventions is difficult
-Reimbursement for dietitians is limited
-Driving to physical clinics is difficult - weight management centers report missing
50% of their visits
-Patient compliance is challenging, user experience needs to be simple
-Physicians lack time to do lifestyle counseling

20. The Horizon for Telehealth + Lifestyle Interventions
-Telehealth eliminates the barrier of driving for weight management sessions
-Medicare will be reimbursing for the diabetes prevention program in January of
2018 including telehealth
-Self-insured employers will find value in products that can be shown to be
clinically and cost effective (prevent pre-diabetes to go to type 2 diabetes)
-ACOs looking for cost effective solutions in capitated payment settings
-Insurance companies have health coaching programs to help keep their members
healthy (The BUPA Coach Program)
-Dietitians + psychologists do not need to see patients in-person

21. Diabetes Prevention Program Is More Effective Than Metformin for Prevention of
Type 2 Diabetes

22. Evidence for Telehealth Weight Management
Comparison of virtual visits, in-person visits, and self-directed
dieting:
• Virtual and in-person visits were twice as likely to lead to 5%
weight loss at 2 years compared to self-directed dieting
• Virtual visits had better follow up adherence than traditional
in-person visits after 6 months
● VA has ongoing telemove program for weight management
1. Appel, Lawrence J., Jeanne M. Clark, Hsin-Chieh Yeh, Nae-Yuh Wang, Janelle W. Coughlin, Gail Daumit, Edgar R. Miller, Arlene Dalcin, Gerald J.
Jerome, Steven Geller, Gary Noronha, Thomas Pozefsky, Jeanne Charleston, Jeffrey B. Reynolds, Nowella Durkin, Richard R. Rubin, Thomas A.
Louis, and Frederick L. Brancati. "Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice." New England Journal of Medicine N
Engl J Med 365.21 (2011): 1959-968.
2. Yanovski, Susan Z. "Obesity Treatment in Primary Care — Are We There Yet?" New England Journal of Medicine N Engl J Med 365.21 (2011):
2030-031.

23. Fruit Street Clinical Trial for Weight Management
“Effectiveness of an integrated digital health platform for risk factor modification
among patients with cardiovascular risk factors”
-Randomized Controlled Trial with obese patients with cardiovascular risk factors (300
patients)
-Control: Usual care seeing the dietitian in-person physical clinic
-Intervention: Dietitians seeing patients through video visits, taking pictures of food, wireless
scale, Fitbit
-Outcomes: weight, blood pressure, HbA1c, LDL-c, fasting glucose, improvements in PA,
improvements in diet, and complete rate of visits.
-Economic analysis on clinical outcomes will be conducted

24. Fruit Street Health PBC
Fruit Street Health is a public benefit corporation whose social mission is to
“prevent and treat lifestyle related disease using telemedicine, connected
devices, and mobile applications.
Fruit Street has raised more than $6M from 160 physician investors who serve
as physician advisors to the company
Fruit Street is a grassroots movement of physicians that want to improve health
care using technology

25. Financial Backing From Physician Investors

27. Physicians Believe in Lifestyle Medicine +
Telehealth
Throughout the US

28. Fruit Street Telehealth Case Study - Arthur
-Almost 700 lbs patient
-Too heavy for bariatric surgery
-Too heavy for cath lab
-Houston, TX
-Connected to virtual dietitian
-Wore a fitbit
-Download fruit street app
-Took pictures of his food daily
-Received feedback
-weekly video visit
-lost 200 pounds

34. Treating Disease Without Preventing It Is Like Mopping Up Floor Without
Turning Off The Faucet

35. Thank You!
Laurence Girard
CEO & Founder FruitStreet.com
Email: laurence@fruitstreet.com
Phone: 617-981-0920
www.fruitstreet.com