NYC Health & Hos­pi­tals de­signs plant-based diet pro­gram to help pa­tients with chronic dis­ease

Modern Healthcare - - Best Practices - By Maria Castel­lucci

In the past few years, a grow­ing num­ber of stud­ies have shown that plant­based di­ets can help pre­vent and even re­verse chronic con­di­tions like heart dis­ease, Type 2 di­a­betes and obe­sity.

As an ex­am­ple: a 2015 meta-anal­y­sis in the Jour­nal of the Amer­i­can Heart As­so­ci­a­tion found peo­ple who adopted a veg­e­tar­ian diet low­ered their choles­terol lev­els, which can re­duce the risk of heart dis­ease.

Backed by this ev­i­dence, as well as ad­vo­cacy from Brook­lyn Bor­ough Pres­i­dent Eric Adams, NYC Health & Hos­pi­tals/Belle­vue was mo­ti­vated in Novem­ber 2017 to de­velop the Plant­based Life­style Medicine Pro­gram, which of­fers pa­tients with chronic dis­eases sup­port ser­vices to tran­si­tion to and stick with eat­ing veg­e­tar­ian. The pub­lic health sys­tem has in­vested $400,000 for the pilot pro­gram, which of­fi­cially kicks off Jan. 16 with more than 300 pa­tients.

In­ter­est in the pro­gram is much higher than the hos­pi­tal ex­pected. The pilot— and fund­ing—was orig­i­nally de­signed for 100 pa­tients. “Now that we have seen the re­sponse, we are go­ing to do our best to reach as many pa­tients through the fund­ing pe­riod,” said Dr. Michelle McMacken, an in­ternist at the health sys­tem and di­rec­tor of the pro­gram.

The pilot pe­riod is slated to run un­til Oc­to­ber. Only pa­tients with Type 2 di­a­betes, pre-di­a­betes, high blood pres­sure, high choles­terol, ex­cess weight or heart dis­ease can par­tic­i­pate. Pa­tients with those con­di­tions were tar­geted be­cause that’s where ev­i­dence most strongly shows plant-based di­ets can help re­verse or lower sever­ity.

Through the fund­ing, NYC Health & Hos­pi­tals hired a full-time health coach and di­eti­tian. Four physi­cians, in­clud­ing McMacken, are also part of the pro­gram.

Ini­tially, physi­cians will con­duct a full med­i­cal as­sess­ment of each pa­tient, in­clud­ing a dis­cus­sion of dis­ease his­tory and drug reg­i­men. They’ll also re­view the pa­tient’s per­sonal health goals and any so­cial bar­ri­ers that could hin­der par­tic­i­pa­tion. The physi­cian, health coach and di­eti­tian then cre­ate a plan tai­lored for the pa­tient’s spe­cific needs.

McMacken said it will de­pend on each pa­tient, but they will likely meet with a doc­tor ev­ery two months to re­view progress in the pro­gram and to de­ter­mine if any med­i­ca­tions can be ad­justed or stopped. “I’ve found in my per­sonal ex­pe­ri­ence when pa­tients change their diet ex­plic­itly to a plant-based diet they re­quire fewer med­i­ca­tions,” she said.

Pa­tients will likely meet or speak on the phone with the health coach and di­eti­tian ev­ery two weeks. Both the coach and di­eti­tian are trained chefs, so they can pro­vide recipes and of­fer cook­ing classes to pa­tients, keep­ing in mind pa- tients’ cul­tural pref­er­ences and fi­nan­cial bar­ri­ers.

McMacken said the pro­gram will fo­cus on af­ford­able healthy food op­tions like lentils, beans, chick­peas and root veg­eta­bles. Al­though McMacken was un­able to pro­vide the in­surance makeup of the 300 par­tic­i­pants, Belle­vue has a large Med­i­caid pop­u­la­tion. The pro­gram can be cov­ered by in­surance. For unin­sured pa­tients, pay­ment is ar­ranged on a slid­ing fee scale based on in­come.

One par­tic­i­pant, Ar­lene Marie Ka­role, 53, is ea­ger to have ad­di­tional sup­port as she tries to eat health­ier. Ka­role was di­ag­nosed with breast can­cer in 2015 and al­though she’s in re­mis­sion, it was a wake-up call to make life­style changes. She learned about the pro­gram through Twit­ter. “I’m look­ing for­ward to the coach­ing,” she said. “It’s very dif­fer­ent to have a coach, some­one work­ing with you, tak­ing your blood work.” Ka­role said she would like to lose 30 pounds.

Along with help­ing pa­tients change their diet, the health coach will also fo­cus on other life­style is­sues like sleep habits, stres­sors, phys­i­cal ac­tiv­ity and smok­ing.

McMacken said the pro­gram was de­signed in part by look­ing at prac­tices at other hos­pi­tals. A grow­ing num­ber of fa­cil­i­ties have adopted sim­i­lar pro­grams, in­clud­ing Barnard Med­i­cal Cen­ter in Wash­ing­ton, D.C. It con­ducted Na­tional In­sti­tutes of Health-funded clin­i­cal trials, one of which found Type 2 di­a­betes pa­tients on a ve­gan diet were more likely to re­duce the need for med­i­ca­tions than other pa­tients. “I have no doubt that what­ever (out­comes) Belle­vue is look­ing to meet, it will,” said Su­san Levin, a Barnard di­eti­tian.

To test the pro­gram’s ef­fec­tive­ness, McMacken will mon­i­tor how par­tic­i­pants’ clin­i­cal out­comes change, in­clud­ing blood pres­sure, blood sugar and weight loss. The long-term fea­si­bil­ity of the pro­gram and bar­ri­ers to ef­fec­tive ex­e­cu­tion will be ex­am­ined as well.●

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