The Well-Being Journal

The Future of Healthcare: Lifestyle Medicine and Heart Disease

Adam Farina

The cost of healthcare has long been at the forefront of our nation’s fiscal challenges, impeding our competitiveness in the global economy and generating financial hardship for our citizens and institutions. Healthcare expenditures in the U.S., for example, consume a larger percentage of our GDP – 17% - than they do in any other country in the world. And despite our exorbitant spending, our return on that investment - as measured by the health status of our citizens - is alarmingly low.

The potentially ill-fated Affordable Care Act was implemented, in part, to address this very issue by paying providers based on results rather than on number of procedures performed. Though the act represents a step in the right direction, it is not enough – further work must be done if America is to have a healthcare system that is sustainable, affordable, and equitable for all of its citizens.

One way for us to take the next step towards a healthier and more cost-effective future is by focusing on behavioral waste – costs resulting from lifestyle choices such as bad eating habits, smoking, poor adherence to health plans, substance abuse, and limited stress management. These habits are not only costly (between $303 and $493 billion per year), they’re deadly; heart disease, obesity, diabetes, and certain types of cancer have all been traced back to the choices we make in our everyday lives. Although that may sound discouraging, it ought to be empowering. Everyday habits can be reversed, and with them, so can the costs and diseases they create. That is the aim of lifestyle medicine, the competency that will help determine the future of healthcare in America.

Whereas drugs and surgery tend to focus on treating the symptoms of chronic diseases, lifestyle medicine targets the behaviors that are root causes of them – thus creating a feedback loop of sustainable health-care rather than revolving door sick-care. Led by pioneers such as Dr. Dean Ornish, President and Founder of the nonprofit Preventive Medicine Research Institute, a growing body of evidence demonstrates the clinical and financial effectiveness of lifestyle medicine. Specifically, Dr. Ornish has proven in over 25 peer-reviewed studies that lifestyle medicine:

  • Reverses the progression of even severe coronary heart disease, generates more reversal after five years than after one year, and leads to 2.5 times fewer cardiac events.
  • Reverses the progression of type 2 diabetes, high cholesterol levels, hypertension, and obesity;
  • Slows, stops, or reverses the progression of early-stage prostate cancer;
  • Beneficially changes the expression of your genes in over 500 genes in three months;
  • Lengthens telomeres, thereby beginning to reverse the cellular aging process.

These unprecedented clinical effects are grounded in similarly transformational financial ones. To illustrate these impacts, let us examine lifestyle medicine’s impact on heart disease in America.

Heart disease is currently the leading cause of death in the United States, and 90% of it is attributable to lifestyle-related activity. Furthermore, it accounts for 17% of all health expenditures in the United States and its costs are expected to triple to $818 billion by 2030. Simply put, there is no aspect of the healthcare industry that needs lifestyle medicine more than heart disease does – and in 2011, Medicare recognized that need. It did so by deciding to reimburse for 72 hours of a new benefit category, Intensive Cardiac Rehabilitation (ICR), which covered – for the first time – lifestyle medicine programs such as Dr. Ornish’s program, Ornish Lifestyle Medicine™. Since that time, other commercial payers have followed Medicare’s lead and decided to cover the program, thus establishing lifestyle medicine as a viable clinical treatment alternative for cardiac disease.

These votes of confidence from Medicare and other commercial payers have not gone unfulfilled by Ornish Lifestyle Medicine – far from it. By the second quarter of 2016, the program had over 1500 participants nationwide, and their results actually exceeded those predicted by clinical trials. Over the course of the nine-week program, the average participant’s weight decreased by 5.9%, cholesterol decreased by 20.5%, triglycerides decreased by 12.1%, blood pressure decreased by 6.15%, and depression score decreased by 53.5%.

Along with these superior clinical outcomes, Ornish Lifestyle Medicine has reduced long-term costs for providers – thus making the program extremely valuable as the industry seeks to reduce behavioral waste and transition to a fee-for-value payment model. A study conducted at a large commercial health plan, for example, determined that offering Ornish Lifestyle Medicine resulted in an average savings-per-participant of $17,687 over a three-year period (based on the value of the dollar in 2000). Providers and patients also benefit from the program’s attendance rate, 93.5%, which clearly outstrips that of other, more-traditional methods for combatting heart disease. For providers, this rate means more reimbursable hours, and therefore, more revenue; for patients, this rate means life-changing clinical outcomes, reduced readmissions, and lower long-term costs.

In short, this program has created a new paradigm for how we treat heart disease in America; it brings about a synergy between the interests of providers and consumers in an often zero-sum healthcare industry, and it does so by targeting the very same behavior patterns that generate the majority of our country’s behavioral waste: nutrition, stress, exercise, group support, and smoking. This approach extends beyond heart disease as well; as Dr. Ornish’s research demonstrates, lifestyle changes bring about similar results for patients with prostate cancer, obesity, diabetes, and other chronic diseases as they do for patients with heart disease.

The use of lifestyle medicine to treat heart disease starkly contrasts the methodology of the rest of our healthcare system. A cartoon that Dr. Ornish likes to show during his presentations illustrates this very point; in the cartoon, a janitor is trying to mop up water on the floor of a bathroom, but the faucet is still running and the sink is still overflowing while he does so. “Wouldn’t it make more sense,” Dr. Ornish asks, “if we just turned off the faucet?” That’s the difference between our current healthcare system and lifestyle medicine; lifestyle medicine turns off the faucet - it corrects the behaviors that cause chronic diseases and behavioral waste - whereas our current healthcare system simply keeps trying to mop up the floor.

We must, therefore, follow the heart disease industry’s lead and expand the use of lifestyle medicine. Doing so would directly limit chronic disease and behavioral waste in America, and bring us one step closer to a healthcare system that makes sense for patients, providers, and the country alike.

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Topics: Lifestyle Change ACA Ornish Lifestyle Medicine lifestyle medicine Dr. Ornish Intensive Cardiac Rehab Heart Disease Dean Ornish

Power of Yoga to Improve Cardiovascular Risk

Amy Katz

Is yoga good for your heart? It could be as healthy for your heart as cycling.

According to a new study in the European Journal of Preventive Cardiology, yoga may be as beneficial as more traditional physical activities such as walking or biking in reducing the risks of cardiovascular disease.

Investigators from the United States and Netherlands conducted a systematic review of 37 randomized controlled trials, which included 2,768 subjects. The aim of the analysis was to examine whether yoga is beneficial in managing and improving cardiovascular disease risk factors and whether it could be an effective therapy for cardiovascular health.

The study compared those who practiced yoga with those who didn’t. Those who practiced yoga had:

  • Lower blood pressure
  • Lower LDL (bad cholesterol)
  • Lower body mass index (BMI)
  • Increased HDL (good cholesterol)

Results showed that risk factors for cardiovascular disease improved more in those practicing yoga than in those not taking part in any aerobic exercise. In fact, yoga had an effect on risk factors comparable to aerobic exercise.

The study’s authors write, “This finding is significant, as individuals who cannot or prefer not to perform traditional aerobic exercise might still achieve similar benefits in [cardiovascular] risk reduction.” They go on to observe that “Yoga has the potential to be a cost-effective treatment and prevention strategy given its low cost, lack of expensive equipment or technology, potential greater adherence and health-related quality of life improvements, and possible accessibility to larger segments of the population.”

The prevalence and cost of cardiac disease is growing. As the number 1 cause of death in America, heart disease accounts for some 600,000 deaths per year. Indeed, 40 percent of the U.S. population is expected to have some form of cardiovascular disease in the next 20 years, according to the American Heart Association. The cost of heart disease in healthcare services, medications, and lost productivity tops $109 billion per year, according to the Centers for Disease Control.

The American Heart Association still recommends 150 minutes of aerobic exercise per week, but this study could lead to yoga as a recommended therapy for patients with risk factors for cardiovascular disease.

Linking yoga to cardiovascular health is not a new concept—for over 30 years, Dr. Dean Ornish has recommended yoga for reducing stress. In fact, the Dr. Dean Ornish Program for Reversing Heart DiseaseTM includes yoga as one of the fundamental activities for reversing heart disease. To learn more about the Ornish program, please visit www.undoitwithornish.com.

Topics: Prevention Science and Research Health Status Ornish Lifestyle Medicine

Dr. Dean Ornish on Sustaining Lifestyle Changes

Sandy Cummings

Dr. Dean Ornish has been a part of the Healthways family for not quite a year now. As he travels the world, discussing both the impact of positive lifestyle changes and the best ways to go about about making sure those changes can be sustained, I'm often struck by how consistent and powerful his messages are.

For example, in this HuffPost video, where he says, "Fear, shame and guilt are not sustainable."

Or in this Parade article, which leads off with his reassuring, "Your genes are not your fate."

And then, when comparing lifestyle change to traditional medical approaches: "These simple lifestyle changes work even better at a fraction of the cost, and the only side effects are good ones," which he shared recently in Everyday Health.

Dr. Ornish is at the forefront of a movement to change our nation's emphasis on "sick care" -- work so powerful, it's becoming the cornerstone of healthcare reform initiatives, as this article in USA Today describes.

Whether you're grappling with chronic disease or simply living a life that somehow feels like it's missing the mark, having a clear path to well-being improvement makes a big difference. I hope you'll spend a few minutes with Dr. Ornish via this coverage and start walking down that path.

Topics: Healthy Living Well-Being In the News Healthcare Health Community Prevention Wellness Healthways Chronic Disease Ornish Lifestyle Medicine

What You Need to Know About Trans Fats

James Kanka

Dr. Dean Ornish succinctly sums it up in a quote printed in both the Wall Street Journal and USA Today:

"Trans fats increase the shelf life of foods but decrease the shelf life of humans."

Last Thursday the U.S. Food and Drug Administration ruled that trans fats are unsafe in food. Trans fats, originally engineered as a "healthier alternative" to saturated fats, by using oils, have since been universally acknowledged as bad for you — contributing to as many as 20,000 heart attacks a year.

The FDA has yet to issue a ban on trans fats in foods, but restaurants and food companies have already begun reworking their recipes. Dr. Dean Ornish advised McDonald's and PepsiCo on removing trans fats from their foods years ago.

So, while trans fats may already be disappearing from the food you eat, this ruling shines a spotlight on the importance of eating right. Mothers everywhere have been telling their children to do so since the dawn of time, but now organizations are doing the same, and new research is backing them up. In a recent Healthways study, employees who ate healthy all day were 25% more likely to report higher job performance and were absent less.

When companies invest in the health and well-being of their employees, it's a win-win situation. Just another reason we are excited at Healthways to make Dr. Dean Ornish's 30-plus years of diet expertise and lifestyle change accessible to millions.

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Topics: In the News Workplace Well-Being Business Performance Health Prevention Trans Fats Productivity Government FDA Diet Ornish Lifestyle Medicine