# Presentation: 469107

## Your Prescription to Thrive

**Your Prescription to Thrive**
**How Healthy Eating and an Active Lifestyle Can Be Yours**
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## Neil

- Dear Dr. S,
- I have been having a really hard time sleeping lately.
- Can you give me some sleeping pills?
- Thanks,

**Neil**

**Notes:**
I could show you about 50 slides on healthy eating and exercise. Instead, I’d like to tell you about a couple of my patients.
They’re not unusual ... I see people like this everyday .... 
In fact, you may recognize yourself in these stories.

Meet Neil.  He is 26 and he works for an up and coming software company.  Like most people in their 20s, Neil doesn’t like to see the doctor and he lives and breathes his computer.

About 3 months ago, I get this email from Neil (*free, secure emailing with our patients)

So what do you think I did?  I had him come in to see me,  and I learn that

Neil has a huge make or break project he has been working on the past month- long hours, vending machine meals, no time for that bike club that he used to be passionate about and, although he had started to try to quit smoking, he is now up to a pack a day.  He is also upset that his clothes don’t seem to fit loosely anymore, which to Neil is not cool.

So Neil has 3 big problems: Stress, smoking and weight gain.

## My Advice

**Stress**
**Management**

**Kick the Habit**

**Healthy Eating**
**Physical Activity**

**Notes:**
It is pretty clear that Neil’s stress level is off the charts- and, although as his doctor, my major concern is his smoking, that is how he is dealing with his stress, and I couldn’t just tell him to quit without helping him to find other stress coping solutions.

Quitting smoking is the single most important thing you can do to improve your health and chances for living a longer life. No matter how long you have been smoking, your body begins to repair itself as soon as you quit.  

20 minutes:  your bp, heart rate and the temperature of your hands and feet become normal, 
1 day: your risk of a heart attack begins to decrease.  A few months:  
Coughing, sinus congestion, shortness of breath and fatigue decrease so you have more energy.  
By 10 years, your risk of dying of lung cancer and heart disease is the same as if you had never smoked to begin with!

Here’s what I found:
Neil’s stress level was off the charts
As his doctor, my major concern is his smoking- that was how he was dealing with his stress, but I couldn’t just tell him to quit without helping him to find other solutions.

It became pretty clear to both of us that Neil’s stress level is off the charts- and, although as his doctor, my major concern is his smoking- that was how he was dealing with his stress, and I couldn’t just tell him to quit without helping him to find other stress coping solutions.
The great thing about my job is that I have an entire system designed to help me care for my patients- advice nurses, behavioral medicine classes and support groups, pharmacists and dietitians.  I could get him started in a stress reduction class, mindfulness exercises, smoking cessation program counseling, and a weight management program.  I started to tell Neil about them and he gave me a glazed look.  I realized Neil didn’t feel he had time to come see me- how was he going to find time for other appointments.  So, let me introduce you to Neil’s healthcare team.

## Resources for my Patients

**Resources for my Patients**

**Office Visit**

**Physician’s Home Page**

**E-Mail Your Doctor **

**Classes & Support Groups**

**Multi-Disciplinary Team of Professionals**

**Notes:**
The great thing about my job is that I have an entire system designed to help me care for my patients like Neil – 
Office Visit 
Integrated Electronic Medical Record 
E-Consult
Preventive Health Prompt
E-Rx
Physician’s Home Page
Trusted source of patient information
Access to member convenience tools including online appointment-making and prescription re-fill  
Health Encyclopedia
Healthy Lifestyle Programs
E-Mail Your Doctor 
Direct communication with your physician 
Free of charge - part of being a KP member
Secure and becomes part of your medical record
Convenient and can save you a phone call or trip into the office
Classes & Support Groups
Insert classes/ programs that fit clinical area
Preferred rates through our Healthy Roads program (massage therapy, chiropractic, health products, etc) and Weight Watchers discounts
Multi-Disciplinary Team of Professionals
Health Educators
Dieticians
Health Coaches
Clinical Pharmacists 

I realized Neil didn’t feel he had time to come see me- how was he going to find time for other appointments?  In Neil’s case, we needed a different plan to get him back on the road to health.  So, let me introduce you the variety of resources that are available to support Neil in his pursuit of improved health and well-being.

## Slide 5

**Notes:**
We have a variety of on-line healthy lifestyles programs -available on my website – it’s like a personal virtual coach for Neil- secure, private and convenient- on his own time and readiness level. Neil started with the stress reduction program, and 3 months later- he has signed on for all 4.  I told you he is really into computers.

Neil is riding his bike again, he is packing his meals and bringing to work, and his stress is not completely gone, but much better, and he was able to quit smoking.  And he is sleeping better- without pills.

## Pat

**48 year old**
**Single mom**
**Helps daughter with             child-raising**
**Dental hygienist**
***“******I’m afraid I’m going to have a heart attack or stroke.”***

**Notes:**
This is Pat- she is a 48 yo single mom with a daughter who is also a single mother.  When she is not working full time as a dental hygienist, she is helping her daughter with child-raising.
Her mother has had a stroke and her father died in his 60’s of a heart attack.

## Pat

**High blood pressure**
**High cholesterol**
**Diabetes**
**Overweight**
**7 medications**
***“******I’m afraid I’m going to have a heart attack or stroke.”***

**Notes:**
What I didn’t tell you about Pat is that she has several potentially serious health factors.

Pat is scared . . . She is afraid that if she doesn’t change something soon, she will end up like her parents.

Her fear of a heart attack or stroke is well founded.  With these risk factors, Pat is definitely at a higher risk of heart attack and stroke.

Cardiovascular disease is the number one killer in the United States.

In fact, the risk of a person with diabetes having a heart attack or stroke is the same as someone who has already had one!

While there are some things that she cannot change, like her family history, there are a number of things that can be done to prevent heart attack and stroke, and in Pat’s case, it doesn’t involve adding more medications.  We started with the most important first step to decreasing her risk of developing heart disease, weight management through healthy eating and physical activity.

## Body Mass Index

**Notes:**
Why weight management? 

More than half of all US adults are overweight or obese.  Overweight and obesity is an increasingly common condition, not only in the US, but all over the world. In fact, many health organizations are calling it an epidemic, affecting at least 300 million people!

It is important to know where you stand – do you know your own BMI?

What is a BMI? – It is the most frequently used method to help identify patients who are overweight (25-29) or obese (>30).  And at KP, we think of BMI as another vital sign, just like blood pressure and temperature.  We know that a higher BMI is associated with the risks and problems of chronic medical conditions- like diabetes and heart disease.  And the higher the BMI, the higher the risks.

And you do not have to lose 100 pounds to improve your health.  As little as a 15 - 20 pound weight loss can decrease blood pressure, cholesterol, sugar and your risk of developing heart disease. As a doctor, I often tell patients that a good starting goal is a 10% weight loss over about 6 months- this may be about 1 pound a week.

## My Advice

**   ****Healthy Diet           Exercise**

**+**

**Notes:**
This is what I recommended for Pat, in fact, this is what I recommend for all my patients.  It is important to talk about both- one is not more important than the other.  Calories come in to you as food, and leave you as physical activity.  In order to lose weight, you need less calories in, and more out.

So, is there a best diet?  Low carb or low fat?  All popular diets (if you can stick to it) involve restricting calories, so all to some degree result in weight loss for about the first 6 months of the diet.  In fact, the word diet comes from the Greek word, dieta- which means way of life (not starve yourself.)  One diet does not fit all- the best diet is the one you can stick to, and the one that you can see yourself doing the rest of your life.

For most of my patients, I recommend a Weight Watchers type diet- which has portion control.  This is also the type of diet that is most recommended by major medical organizations – more fresh fruits and vegetables and whole grains and less processed, refined sugar and fatty foods.  An easy way to start is 1⁄2 your plate should be fruits and veggies, 1⁄4 lean protein, and 1⁄4 whole grains. Think before your drink!  A can of soda has 10 tsp of sugar and 150 calories!

Many of my patients say that the hard part is not losing the weight initially, but keeping it off.  What has been proven to help the most?
Eating a diet low in fat
Eating breakfast every day
Monitoring weight (1 x per week)
Consistent physical activity 

## 	Portion Distortion 

**20 Years Ago**

**Today**

**210 Calories**

**How many calories are in**
**today’s portion of fries?**

***610 Calories = 1 hour 45 minutes of walking****** ***

**Notes:**
Some people ask if it is easier to lose weight by increasing exercise instead of dieting.  Here is the problem.

Consistent physical activity (the single best indicator of successful weight maintenance with many additional benefits, increases energy, sense of well-being, better sleep, better heart fitness- even if no weight change!, lowers bp, sugar, bad cholesterol and less aches and pains). Start slowly, gradually increase how long and how often and how hard, find activities you enjoy, aim for 30-60 min most days of week, consistency is most important (same amount of calories burned if you walk or run a mile!). And every little bit adds up- so take those stairs, park at the end of the lot, even fidgeting has been show to burn calories! 

Anything is better than nothing.

Anything that you will stick with is best.

Stopping is not a failure - find something new and fun.

## Resources for my Patients

**Resources for my Patients**

**Office Visit**

**Physician’s Home Page**

**E-Mail Your Doctor **

**Classes & Support Groups**

**Multi-Disciplinary Team of Professionals**

**Notes:**
Pat also has an array of resources and people to help her make changes for her health
Did you know? (Powerbites)
World Health Organization said that KP is the model of chronic medical conditions management.
2004, our Diabetes Management Program received the Best Management Program award from the Disease Management Association of America.
2004, our internet weight management program who one of the most prestigious awards for health improvement programs in the US, the C. Everett Koop National Health Award.
A year later:
Pat lost 30 pounds
Down to 4 medications
She is exercising almost every day - Has more energy and her risk of ending up like her parents, with a heart attack or stroke, is much less than it was a year ago.

## The real trick is to stay alive aslong as you live.

***Ann Landers***

**Notes:**
Everyone should have the ability to thrive-whether it be stress, smoking, weight – at KP, our docs tackle these issues head on.  I tell my patients- I want to help you if you do have a heart attack or stroke, but I would rather help you prevent having one in the first place.

What is your story?  What makes it difficult for you to thrive?

These are some of the ways my colleagues and myself help patients to be the healthy people they want to be.  

You need to pursue your health, no matter where you are, no matter who your doctor or health plan is. 

And if your doc or health plan, or workplace does not offer some of the things you have seen today, then you need to ask them, why not?  

## Your Prescription to Thrive

- Physical activity
- Nutrition
- Know Your numbers

**Notes:**
I’d like to leave you with a prescription to thrive

Write in what you are going to do today, and tomorrow, and next month to make healthy eating and an active lifestyle part of your journey to be the healthy person you want to be.

## 
   Physical activity
Take the stairs whenever possible
Purchase a pedometer; aim for 10,000 steps per day
Display “exercise prescription” in a visible place
If you drive to work or stores, park in a space far away from the door and walk
If you take public transportation, get off a stop early and walk
Walk on your lunch break
Try exercising with friends or a group
Consider strength training for 20 minutes 2-3 times per week
Nutrition	
Pay attention to portions; avoid super-sizing	
When eating out, consider splitting an entrée
Set regular times to eat: 3 meals and no more than 2 snacks per day
Limit saturated and trans fats
Increase daily intake of fruits and vegetables: at least 5, aim for 7-9
Since fiber can increase the feeling of fullness, aim for 2-3 servings of whole grain food per day
Limit sweetened beverages, drink water or nonfat or 1% milk
Know Your Numbers
BMI
Cholesterol
Blood Pressure 	
Blood Sugar						

-    **Physical activity**
- Take the stairs whenever possible
- Purchase a pedometer; aim for 10,000 steps per day
- Display “exercise prescription” in a visible place
- If you drive to work or stores, park in a space far away from the door and walk
- If you take public transportation, get off a stop early and walk
- Walk on your lunch break
- Try exercising with friends or a group
- Consider strength training for 20 minutes 2-3 times per week
**Nutrition****	**
- Pay attention to portions; avoid super-sizing
- When eating out, consider splitting an entrée
- Set regular times to eat: 3 meals and no more than 2 snacks per day
- Limit saturated and trans fats
- Increase daily intake of fruits and vegetables: at least 5, aim for 7-9
- Since fiber can increase the feeling of fullness, aim for 2-3 servings of whole grain food per day
- Limit sweetened beverages, drink water or nonfat or 1% milk
**Know Your Numbers**
- BMI
- Cholesterol
- Blood Pressure
- Blood Sugar	**	**

*Check out my webpage at http://www.kp.org/mydoctor/*

- _Your Prescription to Thrive_

**Notes:**
HANDOUT