Lifestyle Medicine Can Address Diabetes Disparities

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Type 2 diabetes is one of the top health conditions impacting California—with a greater impact than either coronary artery disease or chronic obstructive pulmonary disease.

Sadly, those who live in poor neighborhoods or have lower levels of education are more likely to have type 2 diabetes. This is in part due to disparities in social determinants of health, such as access to fresh food, quality health care and safe recreational facilities.

However, we can minimize the harmful effects of these disparities by designing programs that offer accessible, evidence-based interventions that empower people to take control of their own health.

A new approach to medicine—that takes into account a person’s way of life, culture and neighborhood—is helping.

Terry Gilliland

Lifestyle medicine is a clinician-guided approach that encourages patients to make healthy lifestyle changes, which can prevent, treat and even reverse some chronic diseases, such as type 2 diabetes, hypertension, heart disease and more. Changes patients can make include switching to a healthy diet, implementing regular physical activity, getting adequate sleep, managing stress and stopping using tobacco, among other non-drug interventions. Lifestyle medicine offers a safe, clinically effective and non-invasive approach to many chronic conditions.

At Blue Shield of California, one of the largest health insurance plans in the state, we’ve implemented lifestyle medicine programs so that more people can access interventions that are proven to help them reach their health goals.

One of these programs is our Diabetes Prevention Program, a statewide initiative with in-person and online programs in both English and Spanish. Launched in 2017, this program is a covered benefit for most Blue Shield members, meaning they can participate in the lifestyle coaching at no additional charge. Certain members also receive a free Fitbit fitness tracker or wireless scale to help them stay on track with their physical activity goals, and members may also be able to join a Weight Watchers program at no charge. We hope these types of programs can help reduce the impact these disparities have on the health of our communities.

To date, more than 13,600 of our members are enrolled in the program. On average, these members have lost 3.5 percent of their body weight by changing their diets and increasing their physical activity within a structured, supportive program. According to the Centers for Disease Control and Prevention and the National Institutes of Health, this level of weight loss results in a staggering 38 percent decrease in the risk of developing type 2 diabetes. These members are also achieving and sustaining elevated levels of physical activity, averaging 150 minutes of activity each week.

Most importantly, this program is making a difference in the lives of these members. One participant wrote: “I am off my high blood pressure medicine and pre-diabetes meds. I am well on my way to achieving my weight loss and health goals. Beyond grateful!”

We’re proud of the results the program achieved in 2017, but there is still much work to be done. In 2018, we are on track to more than double our Diabetes Prevention Program enrollment and are partnering with the American College of Lifestyle Medicine to provide training for providers.

Disparities indeed exist in the prevalence of type 2 diabetes, with a neighborhood’s socioeconomic status and education levels playing an outsized role in the likelihood residents will develop the disease. Knowing this, we must all work together to minimize the harmful effects of these disparities, and support policies that can move us toward a future where all Californians have access to high-quality, affordable health care.

Terry Gilliland is senior vice president and chief health officer at Blue Shield of California.

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