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Give Yourself a Little TLC: Simple Lifestyle Changes Can Help You Avoid Chronic Disease
Dr. Jeffrey Bland, PhD

A little-known and relatively inexpensive tool called a TLC (Therapeutic Lifestyle Change) program has been shown to be effective in preventing, managing, or even reversing, many of our most prevalent chronic conditions.

They're all around you: people suffering from, or at risk of developing, lifestyle-related chronic conditions such as type 2 diabetes, heart disease or arthritis. Perhaps you're one of them. In fact, in the United States, these chronic diseases have reached epidemic proportions.

Consider the following statistics: One in three American adults is obese, and one in five children is overweight and likely to carry their health-related problems into adulthood. Twenty-one million Americans have diabetes, 6 million of whom don't even know they have it. Additionally, one in five people (54 million) has metabolic syndrome, a cluster of conditions that predisposes them to the development of type 2 diabetes, coronary heart disease, stroke and other chronic conditions. One in five people has arthritis; $1.5 trillion is spent annually on the diagnosis and treatment of chronic illnesses; and seven out of 10 people die prematurely due to chronic diseases.

Pretty depressing statistics - and that's only in the United States. Similar statistics have emerged from Canada, Europe, Asia, Australia, South America and developing nations. For example, in Europe, preventable chronic diseases are responsible for 77 percent of all diseases and 86 percent of all deaths. More than a third of Canadians ages 12 and older have one or more chronic health conditions. In 2005, the combined economic losses of China, the Russian Federation and India totaled more than $38 billion as a result of heart disease, stroke and diabetes. In the vast majority of Latin American countries, chronic diseases are now the leading cause of premature mortality and disability. In 2002, they accounted for two out of three deaths. In lower-income countries, the adoption of Western lifestyles has led to a rise in the incidence of chronic diseases. The World Health Organization (WHO) projects that within 10 years, deaths from infectious diseases will decrease by 4 percent, while deaths from chronic diseases will increase by 20 percent.

Alarming as these numbers might be, even more disturbing is that most people with chronic disease suffer unnecessarily, since these are, for the most part, preventable conditions. Simple lifestyle modifications, such as healthier eating and regular moderate exercise, have the potential to significantly reduce the world's chronic disease burden.

Researchers in Canada have estimated that reducing salt intake by less than 1 teaspoon per day would reduce the incidence of high blood pressure by 30 percent and save up to $430 million per year due to a reduced need for physician visits, laboratory tests and medications. Implementing Stanford University's six-week Arthritis Self-Help Course among just 10,000 people with arthritis could save $2.6 million over four years, primarily through reduced physician visits. Reducing systolic blood pressure by as little as 12-13 mm Hg could produce a 21-percent reduction in coronary heart disease, a 37-percent reduction in stroke, a 25-percent reduction in total cardiovascular disease deaths and a 13-percent reduction in overall death rates in the U.S.

The Health Benefits of TLC
In numerous studies, TLC has been shown to be highly effective in helping prevent, manage or even reverse some of our most prevalent chronic diseases, including heart disease and diabetes.

For example, a study published in the American Journal of Cardiology concluded that many patients with conventional risk factors for coronary heart disease can reduce their risk without medications within 12 weeks of starting a TLC program, refuting the notion that intensive lifestyle modification is not worth the effort. A study published in the Journal of the American Geriatrics Society, involving 3,051 men ages 60-79 years with no diabetes mellitus or diagnosis of heart disease, concluded that modification of lifestyle factors, even later in life, has considerable potential for primary prevention of metabolic syndrome. And a randomized, clinical trial of 348 Caucasian, middle-aged adults indicated that a TLC program incorporating various behavior modification tools, such as live lectures, workbooks and professional advice, could reduce the risk factors for cardiovascular disease after six months.

Does Your Doctor Offer TLC?
With so much evidence supporting the value of TLC, why don't more health care providers offer these programs? Much of the answer lies in prevailing attitudes toward wellness and prevention versus treatment of disease. For instance, in a recent study, researchers from Texas A&M University attempted to discover how much time doctors spent talking to their patients about lifestyle issues by videotaping more than 100 medical encounters between primary care physicians and patients ages 65 and older. The findings were startling: During an average 17.5-minute office visit, only 58 seconds were spent discussing physical activity and only 83 seconds were spent discussing nutrition. Less than 10 percent of the entire average visit was spent discussing physical activity, nutrition or smoking cessation.

These attitudes are entrenched in the American health care delivery and financial reimbursement systems, which lean toward the use of high-cost diagnostics, procedures and pharmaceuticals, but place little emphasis on wellness and prevention. To wit: Of the $2 trillion spent annually on health care, 75 percent is for the diagnosis and treatment of chronic diseases. But, its name notwithstanding, the U.S. Centers for Disease Control and Prevention has allocated less than 3 percent of its 2008 budget to chronic disease prevention, even though its own guidelines call for therapeutic lifestyle changes and medical nutrition therapy to reduce the risk for chronic heart disease!

Fortunately, the balance has begun to shift toward a focus on promoting wellness rather than treating symptoms of disease. Medicare has begun to offer prevention-focused benefits such as a one-time physical examination, key screenings and counseling for nutrition and smoking cessation. In the private sector, a recent MetLife survey found more than a quarter of all employers and half of large employers offer some type of wellness benefit. And health care professionals, faced with diminishing reimbursement rates and increasing patient demand for lifestyle modification guidance, might be more willing to offer TLC than in the past.

What You Can Do
Ask your doctor about TLC - it isn't just good for patients, it's also good business for doctors. Your doctor might already be considering it. If not, ask for a referral to another health care professional who practices TLC. You also can ask your employer. Your employer might offer wellness benefits in the form of health insurance coverage or a corporate wellness program. Additionally, ask your tax professional if you can pay for TLC using pre-tax dollars available from an employer-sponsored flexible spending account or federal health savings account.
TLC has been shown to be a powerful tool for the prevention, management, and reversal of many of our most prevalent chronic diseases. Those who participate in a TLC program have the opportunity to protect or regain health for better, more enjoyable living.

Time for a Little TLC
A therapeutic lifestyle changes program (TLC) teaches wellness habits such as healthier eating and regular physical activity, with the goal of achieving health that lasts a lifetime. TLC should not be confused with weight-loss programs or diets. Where these programs generally fail, TLC has been remarkably successful in helping people achieve long-term results. An optimal TLC program should include the following:

  • Professional supervision. If you're considering a TLC programs, work with a licensed health care provider who can assess your current health status, establish goals and develop a step-by-step plan for achieving those goals. Regular follow-up visits will allow progress to be tracked and any necessary adjustments to be made.
  • A team approach. The supervising health care provider also might bring in additional team members such as a dietitian, fitness trainer or other allied health professionals or staff to educate and inspire you regarding diet and lifestyle changes.
  • Long-term health focus. Ideal TLC eating plans go beyond merely counting calories. A sensible nutritional regimen could include lessons on how foods are metabolized, cooking classes, and how you can incorporate nutrition and exercise into your daily routines.
  • Body composition focus. This is a difficult concept for many people to grasp, but it's true: While weight loss might occur, it's secondary to achieving a healthy body composition (lean muscle-to-fat ratio) through healthier eating and exercise.
  • Comprehensive lifestyle counseling. This could include things such as recommendations or referrals for dietary supplements, stress management, adequate sleep and behavior modification.

In This Issue:
Swine Flu? DC Thoughts on Swine Flu Pandemic Planning
Dr. Nicole's Kid Corner: Santa Barbara Birthing Center
Give Yourself a Little TLC
Healthy Cream of Broccoli Soup


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