Lifestyle coaching in primary care improves physical activity, dietary habits
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Key takeaways:
- Among intervention patients, 90% doubled, tripled or quadrupled their intake of whole plant foods.
- Coaching also improved sleep, HbA1c, cholesterol levels and daily fiber consumption.
DENVER — Integrating lifestyle coaching in a primary care model was feasible and significantly improved several dietary measures and health outcomes, according to data presented at the Lifestyle Medicine Conference.
Prasanga Lokuge, MS, vice president of clinical strategy at VillageMD, and colleagues explained that although there is growing literature on the effectiveness of listyle interventions in preventing chronic conditions, “few models have successfully, sustainably, and at scale integrated this knowledge into the clinical setting.”
So, the researchers evaluated the impact and feasibility of a lifestyle intervention integrated into a clinical setting, where physicians referred patients to a life coach and received weekly virtual 1:1 coaching over 6 months and group sessions after 6 months. The lifestyle intervention aimed to increase consumption of whole plant foods, improve sleep behavior and stress management and increase physical activity.
The analysis included an intervention cohort of 10 patients who were prescribed a healthy lifestyle and accepted the coaching, as well as a comparison cohort of 10 patients who were prescribed but declined coaching.
Among the intervention cohort, Lokuge and colleagues found that after coaching:
- 90% of participants doubled, tripled or quadrupled their intake of whole plant foods;
- 100% reported more than 6 hours of sleep, up from 40% at baseline;
- 100% reported perceiving their level of health as equal to or greater than seven out of 10, up from 45% at baseline;
- daily fiber consumption increased by 50%; and
- erythrocyte sedimentation rate levels decreased by 56%.
Additionally, both the regularity and intensity of physical activity significantly improved, according to the researchers.
Patients in the intervention also lost an average of 2.65% of their baseline weight — compared with 0.26% in the comparison cohort — and had an average reduction in HbA1c of 4.8%.
Finally, the researchers noted that cholesterol levels improved as much as 40% in some patients, which helped to keep them off statins.
Lokuge and colleagues concluded that lifestyle coaching should be used only for patients who need or request it, and the study shows that its implementation in clinical settings “is effective and is a feasible and effective way to integrate lifestyle interventions without disrupting the regular clinical workflow or adding to the workload of physicians.”
Perspective
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In today's world that embraces nonpharmacologic therapies for common medical conditions, evidence-based studies are crucial in helping us sort through exactly which measures are worthwhile for physicians to implement in their practice. This study attempts to not only remind the readers of the importance of incorporating these measures, but to also offer a suggested means of carrying out these plans that may (in certain patients) be both more effective and more feasible for the increasingly overburdened treating physician. In light of the inherent differences among patients, I think it is important for physicians to have multiple plans from which to choose, in terms of educating patients on lifestyle modifications, depending on patient preference, insurance coverage, resources, provider availability, etc. It would seem to be beyond the scope of this study but still very helpful to see more details and examples of the content of these coaching sessions, as well as the true feasibility in each of our practices. That said, I think it is safe to say that it is crucial for all physicians to have effective and efficient protocols in place, ideally with some ability to tailor these treatments as needed, in order to educate their patients on lifestyle modifications to treat these common conditions.
Perspective
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Our primary care specialties carry the word medicine in their names: family “medicine” and internal “medicine.” It’s possible many doctors have a subconscious tendency to forget that for most conditions in the primary care setting, pharmacology is the second-line intervention when lifestyle changes fail. The problem, as identified by the authors, is that lifestyle interventions are heavily underused, and they conclude that simple counseling is not enough. Many of us can relate to the situation where we don’t have the time or energy to hold our patients’ hands through all of the daily, fundamental changes they have to implement to properly manage their chronic diseases. At my clinic, we are fortunate enough to have disease managers who work directly with patients to implement these interventions and act as point staff for patients in between visits. The value and cost savings from these staff are incalculable. I refer everyone who is serious about trying lifestyle changes at the time of their visits. Although I agree with the authors that 1:1 coaching is not for all patients and is difficult to scale, my hope is that data like these can be helpful in garnering more investment for highly trained lifestyle coaching and disease management staff at clinics nationwide.
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Lokuge P, at al. Integrating lifestyle intervention into a primary care clinical model. Presented at: Lifestyle Medicine Conference; Oct. 30-Nov. 1, 2023; Denver.
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