In one of my favorite sections of David McCullough's biography of John Adams, the author relates a vivid scene of Adams and Benjamin Franklin about to share a room in Newark, N.J., and not being very happy about the prospect.
They argued over whether to keep the window open or not. Adams, saddled with a head cold, didn't want any part of the chilly night air. Franklin enthusiastically sought out the fresh air. Franklin won; the window was left open through the night.
Adams may have been reluctant about the window, because he had a history of colds. He was also into a bit of self-diagnosing. "You know I cannot pass a spring or fall without an ill turn and I have one of these for four or five weeks—a cold as usual," Adams wrote to his wife, Abigail, according to historians. "Warm weather and a little exercise with a little medicine, I suppose, will cure me as usual."
Franklin had his own ailments. He may have had diseases linked to his diet, with biographer Walter Isaacson noting he had gout and kidney stones.
What if Adams and Franklin had been under the care of a lifestyle management coach and physician? Adams would have certainly been encouraged to keep exercising, and he might also have been helped with a strategy to combat his perpetual colds, such as washing his hands more often. And a coach might have introduced the idea that fresh air is pretty good. (Adams, too, had stress issues. I'll get to that later).
As for Franklin, a lifestyle management coach might have led him toward cutting back on certain foods and preventing the gout to begin with.
Today, there is increasing debate about physicians entering into lifestyle management for patients, and seriously, not about whether rooming house windows should be left open or closed. But there are other areas, of more consequence that come into play, including stress, and especially eating habits.
Gout is still an issue in this country, which it was in Franklin's day, as it is often linked to diet. But obesity and the spread of diabetes are becoming of far more concern in modern day America than in colonial times.
And unlike Adams, who sometimes tried to figure out his own health plan, more patients now are turning to physicians for their long-term maladies linked to diet. And the physicians, trapped by time, and in some cases uncertainty involving nutrition, are finding that adding a lifestyle coach to a practice is both good business and good for patients. Others, however, say that lifestyle coaching generally may not be long-lasting enough to truly help patients over the long haul.
John W. Wilson, a family practioner in Daly City, CA, uses a lifestyle educator to help with his practice because he doesn't have the time to handle nutrition issues faced by his patients. He uses a FirstLine Therapy® program, developed by Metagenics of San Clemente CA, in which a lifestyle educator is appointed as a patient coach to do health assessments, to help patients lose weight, lower blood pressure and deal with metabolic syndrome, diabetes, cardiovascular disease and other chronic conditions. Medical foods are also included under the plan to augment diet and exercise.
Wilson says he sees more patients with commorbidities in his practice. "We've got a terrible obesity problem in this country and diabetes issues aren't far behind," he says.
While traditionally trained, Wilson says he was always interested in alternative approaches, including holistic methods, to help patients "but never found evidence to support it."
As he cared for more patients with chronic conditions, he says he was "prescribing more and more medications, and there was more unknowns and I wasn't seeing great results." He says he would suggest patients "eat better, but I didn't have a structured way of dealing with nutrition."
"I had to intervene in a different way," Wilson says. Metagenics states that clinical trials have shown that it developed a medical food that enhances cardiovascular disease risk lowering benefits of a Mediterranean-style low glycemic-load diet.
Wilson hired a lifestyle educator because "I didn't have the time to do it myself. I know I don't have an hour to spend on an initial visit unless I stop seeing other patients," he says.
Generally, Wilson says his patients are seeing better results. "They feel better and are getting lower medication in the process," he says. "They are seeing themselves gaining lean mass and losing fat."
While he works on the "decision-making and treatment plans," the lifestyle educator he hired is handling nutrition education for his patients. "The patients have been excited about it," he says. "They come in with low expectations and they start seeing how quickly they start feeling better on the eating plan."
Wilson says data from his program has shown fiscal success for his practice. Under the program, about 250 patients have enrolled over the past two years, he says. Without providing exact numbers on ROI, Wilson says his income went up by $50,000 to $70,000 with a lifestyle educator working twice a week, which he says is a good return given the minimal overhead involved.
Nationwide, there has been much discussion over the value of intensive lifestyle intervention versus drugs for certain illnesses.
During this year's Endocrine Society annual meeting, it was reported that at least one physician reported that intervention was a better front line intervention than drug therapy for prediabetic conditions. There are also reports indicating that the efficacy of lifestyle intervention can reduce the incidence of type 2 diabetes.
But Sunder Mudaliar, MD, an associate professor of clinical medicine at the University of California, San Diego School of Medicine, said "lifestyle intervention is effective, but its efficacy wanes over time; it is durable, but its durability goes down over time," according to Endocrine today.
Alas, we are all human, dealing with consistency, and constancy over a long period, to maintain wellness.
Adams walked up to several miles a day, but he still had stress to deal with.
In 1781, while ambassador to England, a doctor who had been with Adams spoke of his "inexpressible anxiety" and the "strain bore down upon his appearance every bit as much as it did his personality," according to John E. Ferling, in his John Adams: A Life. Adams himself described his "nervous" state, Ferling wrote.
Franklin, who often partied in Paris, did not always live in moderation, but as a writer he could advise otherwise.
"Be temperate in Wine, in eating, Girls and Sloth, or the Gout will (seize) you and plague you both," he wrote in Poor Richard's Almanack, published in 1734.
Even without life management coaching, both lived long lives. Franklin died at 84. Adams lived to be 90, the longest living president.
Indeed, in colonial times, there wasn't a life management coach in sight. But neither were there office cubicle, Triple Whoppers the size of small boulders, or sugar-laden soft drinks the size of farm silos.
Joe Cantlupe is a senior editor with HealthLeaders Media Online.
