for the challenges Of preventing dis-ease Untapped Tools for the challenges Of preventing dis-ease

Family Physician-Ellensburg WA Consultant-Shared Medical Appointments Byron L. Haney, MD Family Physician-Ellensburg WA Consultant-Shared Medical Appointments Family Health Care of Ellensburg PNWU Associate Professor bhaney@fhcoe.com www.fhcoe.com

Yakima WA 8/25/2018

Obesity Causes Hypertension Dyslipidemia (Lower HDL and elevated LDL/TG) Type 2 diabetes Coronary heart disease (CAD, atrial fibrillation, Stroke Gallbladder disease Osteoarthritis Sleep apnea Some cancers (endometrial, breast, colon, kidney, gallbladder, prostate, and liver) Low quality of life Mental illness (depression, anxiety, and other mental disorders) Body pain and difficulty with physical functioning Complications of pregnancy Menstrual irregularity Stress incontinence Congenital malformation Discrimination (employment, college acceptance…) Obesity Education Initiative, NIH 10/1998

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3 Untapped Tools for Prevention of Disease Shared Medical Appointments (SMAs) Ideal Protein (IP) Providers of Healthcare

Yalom’s Therapeutic Factors SMA’s Why Groups Work? Yalom’s Therapeutic Factors Harnessed

Why Groups Work? Instillation of hope: encouragement that recovery is possible Universality: Feeling of having problems similar to others, not alone Imparting information: helpful to learn factual information from others Imitative behavior: modeling another’s manners and recovery skills Interpersonal learning: Achieving greater self-awareness through group feedback on their behavior and impact on others.

Altruism: Helping and supporting others Group Cohesiveness: Feeling of belonging to and valuing their group. Catharsis: relief of emotional tension by telling their story to a supportive audience, gaining relief from chronic feelings of shame and guilt. Corrective recapitulation of the primary family experience: Identifying and changing dysfunctional patterns and roles one carries out in their family. Existential factors: Learning one must take responsibility for one’s own life and the consequences of one’s decisions. -Yalom I.

DIABETES PREVENTION LITERATURE REDUCTION in the INCIDENCE of TYPE 2 DIABETES with LIFESTYLE INTERVENTION or METFORMIN N Engl J Med February 7, 2002 Diabetes prevention program research group (DPRRG)

DPPRG VS SMA’S (FHC)

IDEAL PROTEIN Ally in the Triple Aim of healthcare Why is it unique and so effective

Chuck and Christina 10 months 11/6/17 - 9/10/18 Chuck 430# to 222# Christina 298# to 162# 208+136 344# Combined

IP Protocol 4 phase weight management solution Science based Reduces carbohydrate and fat Maintains moderate protein intake NOT HIGH PROTEIN Preserves muscle mass Ketogenic: (NOT the KETO DIET) One-on-One Coaching Balanced Lifestyle Education Health Provider Supervised

How Ideal Protein Works Hypocaloric Diet Ideal Protein Phase 1 “Balanced” Diet Vitamins & Minerals Vitamins & Minerals 2000 Calorie Diet Vitamins & Minerals 1200 – 1400 Calorie Diet So instead of eating a typical ‘Balanced Diet’ which only allows us to maintain our current weight or eating a “Hypocaloric Diet” like Nutrisystem or WW, where we are indeed losing lean mass, including muscle, at the same rate as fat, Ideal Protein recommends a temporary “unbalanced diet,” in which we are giving the body the protein it needs to protect muscle so that only fat is targeted. 850 Calorie Diet 1200 – 1400 Calorie Diet 850 – 1000 Calorie Diet 2000 Calorie Diet

OUT COMES Medical Financial Decrease or Eliminate Increase HTN Diabetes Creatinine abnormality LDL elevation GERD symptoms Sleep apnea Major joint pain Elevated triglycerides Increase HDL Financial Decrease or Eliminate Medications CPAP Reduction of per Capita costs 306 Aspirus employees 2013-’15 Self-insured community-directed health system. Dr. Logemann cardiologist Average claims cost decrease per year $916.97 overall $974.71 for female employees $472.88 for male employees Improved Provider Quality Indicators

Our perception is our reality We have a Paradigm Change PROVIDERS Our perception is our reality unless We have a Paradigm Change

BS: 964, A1c: 11.6, TC: 235, TG: 887, HDL: 23, LDL: 121, O2 sat: 78% sleeping, D/C ICU w/o glucometer/ACE/Statin: 7/12/17 metformin 500 BID, Lantus 40U BID, NovoLog 15U AC. Returned to driving truck, d/c insulin, metformin 500 BID; LDL 31, TG 139, HDL 22.

What do we call this sign?

What do we call this Clock?

How Ideal Protein Works Hypocaloric Diet Ideal Protein Phase 1 “Balanced” Diet Vitamins & Minerals Vitamins & Minerals 2000 Calorie Diet Vitamins & Minerals 1200 – 1400 Calorie Diet So instead of eating a typical ‘Balanced Diet’ which only allows us to maintain our current weight or eating a “Hypocaloric Diet” like Nutrisystem or WW, where we are indeed losing lean mass, including muscle, at the same rate as fat, Ideal Protein recommends a temporary “unbalanced diet,” in which we are giving the body the protein it needs to protect muscle so that only fat is targeted. 850 Calorie Diet 1200 – 1400 Calorie Diet 850 – 1000 Calorie Diet 2000 Calorie Diet

BS: 964, A1c: 11.6, TC: 235, TG: 887, HDL: 23, LDL: 121, O2 sat: 78% sleeping, D/C ICU w/o glucometer/ACE/Statin: 7/12/17 metformin 500 BID, Lantus 40U BID, NovoLog 15U AC. Returned to driving truck, d/c insulin, metformin 500 BID; LDL 31, TG 139, HDL 22.

THE CHOICE IS YOURS HOPEISNOWHERE

THE CHOICE IS YOURS HOPE-IS-NOW-HERE HOPE-IS-NO-WHERE