Our last blog touched on an important and timely subject: the risks and challenges of treating type 2 diabetes linked to childhood obesity.  The twin (and closely correlated) epidemics are well documented, but the newer phenomenon of the synergistic effect on children is truly frightening.  It’s not only frightening from the emotional viewpoint that it’s impacting a particularly vulnerable population, but also to the medical community that must recognize, evaluate and treat these patients.

As a follow up to our last blog, today’s article expands on the issue from the perspective of the medical community.  It is written by guest author, Susan Gorgalini, a US writer and researcher.  Ms. Gorgalini begins, “Although major health organizations are scrambling to meet the deadline for ICD-10, my project medicalbillingandcodingcertification.net contains a wide range of resources to help those caught in the transition. Together, some of these have been referenced by the likes of University of Connecticut, The Daily Beast, and other reputable sources. Today’s blog discusses the wide range of medical billing and coding issues, technicalities, and debates would be of interest to readers.”

Medical Difficulties of Treating Obesity-Linked Diabetes in Children

There are 318 codes for diabetes that one would need to know to work an entry level clerk job in a doctor’s office. As the disease continues to grow and develop, so too will the number of codes, policies and prevention programs aimed at understanding and controlling an epidemic that threatens 1 in 3 children born in the year 2000.

Recent findings suggest that obesity-linked diabetes is harder to treat in children than it is in adults. While a slight majority of adolescent patients seem to experience success with their diabetes treatments, too many do not. More research may be performed in years to come that will further address possible treatment plans for kids and teens, but in the meantime, prevention remains the best course of action.

A four-year study funded by the U.S. National Institute of Diabetes and Digestive and Kidney Diseases, among other groups, indicated that type-2 diabetes is more difficult to treat in adolescents from the ages of 10 to 17 than in adults. It was one of the first childhood diabetes studies of its kind. Researchers found that 52%of children using metformin to treat their diabetes had treatment failure. Combining metformin with lifestyle changes did not improve results much. The best results–a 61% success rate–were experienced in patients taking metformin combined with Avandia.

While obesity-linked diabetes is still a fairly rare occurrence, the growth rate of type-2 diabetes in children is enough to alarm many medical experts. It was hardly ever seen in children prior to the 1990s. Between 2002 and 2005, however, roughly 3,600 new cases were discovered per year. The climb in numbers over the past decade, paired with this most recent study, has doctors and parents more concerned than ever before.

Presently, individualized, aggressive treatment is the best that can be done for kids already diagnosed with type-2 diabetes. Each patient must work with parents and doctors to establish a medical treatment plan that offers them the best chance of staying off insulin therapy. While difficulties do exist, it is important to note that treatment does work for many adolescent patients, even if that number of patients is lower than in adults. Part of the difficulty may simply lie in compliance. Children may have a harder time remembering to or accepting that they need to take daily medications for their diabetes. Adolescents whose parents are actively involved in their treatment have a better chance at success than those who are left to their own devices.

Aside from aggressive treatment, prevention seems to be the only option. As an obesity-linked disease, type-2 diabetes will not likely develop in children who are at a healthy weight. Slowing the growth rate of childhood obesity may help slow the growth rate of adolescent type-2 diabetes as well.

The importance of prevention has prompted some to call for obesity reduction policies on a national scale. Recent programs, such as Michelle Obama’s “Let’s Move” initiative, are aimed at reducing childhood obesity rates. The effectiveness of these policies are limited, but whether this is due to lack of time, too much national involvement, or not enough national involvement has yet to be determined. It may help to have food companies, advertisers, and other organizations join these efforts, but prevention, like treatment, is only possible if patients are committed at the individual level.

Since research on obesity-linked diabetes in children is still scarce, more studies should be performed to thoroughly define the problem and assess the best courses of action for young patients. Until there is more research on the matter, it is difficult to determine what recourse young diabetes patients can take in treating the disease. Prevention through the maintenance of healthy weight will certainly help individual adolescents from developing the disease, but it is difficult, at present, to determine the effectiveness of nationwide pushes toward the reduction of childhood obesity. The best hope for kids is for doctors and parents to work together at fighting against childhood obesity and obesity-linked diabetes.

Click for more information on nutrition and diabetes issues that would be of interest to clinicians working with this population.

Much has been made of the obesity epidemic in America, but the scariest part of the story may be the ballooning impact of obesity on our nation’s children. Childhood obesity rates are rising at a faster pace than the overall population and showing no signs of abating. The usual suspects are the same for childhood obesity: fast food, inactivity and, in general, the lack of a healthy lifestyle. But as the consequences are becoming better understood, one of the more significant risk factors of childhood obesity is the increasing incidence of type 2 diabetes. Besides the usual challenges of having type 2 diabetes, a new study adds another worry: the disease progresses more rapidly in children than in adults and is harder to treat. “It’s frightening how severe this metabolic disease is in children,” said Dr. David M. Nathan , an author of the study and director of the diabetes center at Massachusetts General Hospital. “It’s really got a hold on them, and it’s hard to turn around.”

In a recent article outlining the study on the relationship between childhood obesity and type 2 diabetes, it’s noted that while still uncommon, the rate of increasing cases is dramatic and alarming. And while diabetes rates have risen in tandem with the obesity epidemic, new medications and awareness has improved the lives of patients including a 50% increase in life expectancy after diagnosis . But these benefits haven’t carried over to the young type 2 diabetes patient, according to the article:

“Why the disease is so hard to control in children and teenagers is not known. The researchers said that rapid growth and the intense hormonal changes at puberty might play a part.

The study followed 699 children ages 10 to 17 at medical centers around the country for about four years. It found that the usual oral medicine for Type 2 diabetes stopped working in about half of the patients within a few years, and they had to add daily shots of insulin to control their blood sugar. Researchers said they were shocked by how poorly the oral drugs performed because they work much better in adults.

The results of the study and an editorial were published online on Sunday by The New England Journal of Medicine .

The findings could signal trouble ahead because poorly controlled diabetes significantly increases the risk of heart disease, eye problems, nerve damage, amputations and kidney failure . The longer a person has the disease, the greater the risk. So in theory, people who develop diabetes as children may suffer its complications much earlier in life than previous generations who became diabetic as adults.”

The association between childhood obesity and type 2 diabetes shouldn’t come as a surprise. The phenomenon of the obesity epidemic in general has given rise to a whole host of related medical, economic and social issues, and they are all amplified in youth. Busy schedules and overworked parents make a healthy lifestyle difficult to maintain, and kids today often trade outdoor activities for computer games and television. Schools are cutting back on physical education and extra-curricular sports and are only beginning to address cafeteria choices that resemble fast food outlets more than offering a healthy meal selection. In a society that professes healthy lifestyles and a large dose of obsessive sports fans it seems strange that we have developed a culture that fosters obesity and inactivity. Perhaps we all need to take an assessment of how our lives might change to promote a more healthy lifestyle for ourselves and our children.

There are many perceived culprits to the national obesity epidemic in the U.S. High fat foods (think “fast food”), lack of physical activity, high fructose corn syrup, more desk jobs, to name just a few. And while all of these are certainly contributing factors to the problem, questions are being asked in the medical community whether there’s not an even more basic explanation: a significant increase in daily sugar intake. The average American consumes 130 lbs of sugar a year. And much of this consumption is without our knowledge. It’s not spoonfuls of sugar in our coffee or sprinkles on our breakfast cereal, it’s added sugar in the processed foods that make up a large part of our diet. And all that excess sugar that isn’t converted to energy is instead converted to fat which in turn increases our risk of disease, such as diabetes, cardiovascular disease, and cancer. Worse, since sugar consumption begins early in life, childhood obesity is increasing at a higher rate than the overall population meaning the obesity epidemic is likely to remain with us for a long time and possibly get worse.

It wasn’t always this way. While obesity has been around as long as humans have walked the earth, the obesity epidemic is a somewhat recent phenomenon. As a percentage of the general population, obesity rates were pretty constant until the ’80s. It was then that a number of things changed: more people eat out more frequently, often eating cheap fast food. Around the same time nutritionists began focusing on fat as the primary culprit to healthy eating. As a result, food companies and restaurants replaced fat with sugar to maintain taste. Obesity rates began to soar. In 1990, no state reported an obese population over 15%. By 2010, no state reported less than 15% of the population was obese, with many states over 30%! And this includes on those who are obese. At least an equal number of people are overweight, many on their way to obesity.

So what does this mean if we’re a country of fat people eating too much sugar? To begin, chronic disease such as diabetes, cancer and cardiovascular disease are directly related to obesity. Healthy lifestyle and other disease are also at risk, but the big three have a direct correlation with obesity. 80-90% of patients with type II diabetes are obese. Being overweight places extra stress on your body in a variety of ways, including your body’s ability to maintain proper blood glucose levels. In fact, being overweight can cause your body to become resistant to insulin. If you already have diabetes, this means you will need to take even more insulin to get sugar into your cells. And if you don’t have diabetes, the prolonged effects of the insulin resistance can eventually cause you to develop the disease. Obesity is also associated with increased risks of cancers of the esophagus, breast (postmenopausal), endometrium (the lining of the uterus), colon and rectum, kidney, pancreas, thyroid, gallbladder, and possibly other cancer types. And finally, obesity is a chronic metabolic disorder associated with cardiovascular disease and increased morbidity and mortality. It is apparent that a variety of adaptations/alterations in cardiac structure and function occur as excessive adipose tissue accumulates, even in the absence of comorbidities.

Yes, increased sugar intake leading to an obesity epidemic has a profound impact on the health of many Americans and on our national healthcare policies, too. An ever increasing overweight society will place enormous fiscal pressures on our government and insurance companies. The only way to reverse this course is for Americans to recognize the problem, and educate themselves on how they can improve their health through healthy eating, increased physical activity and an overall healthy lifestyle. With a little help from everyone, we can overcome the obesity epidemic.

For more information on subjects related to this article, consider the following:

- Nutrition, Weight Management and Cardiovascular Disease

- Weight Issues in Diabetes

We all begin this life with a clean slate and a healthy heart and then it’s all downhill from there. Keeping the slate clean is for another column, but we can do something to maintain a healthy heart: proper nutrition, weight management and exercise. Everyone knows we should exercise regularly and keep our weight in check, but the balance between good nutrition and weight management isn’t as well known. Learning the basics of proper nutrition can ease the challenge of weight management, thus, significantly reducing the risk of heart disease.

Essentially there are two rules to a heart healthy diet: decreasing saturated fat intake and reducing sodium levels. While there are always some sacrifices to making lifestyle changes like one’s diet, if you can create a few rules to live by you can master the process. First, have a short list of foods to never eat. These should include food like processed meats, fried foods, high fat daily products and white flour. Next, a list of foods you should eat in small amounts such as nuts, low fat daily products and even alcohol (preferably red wine). Don’t be fooled by conflicting “studies” that suggest either never consuming these items or doing so in larger amount than seem rational. Moderation is your friend. Finally, there are foods you literally can’t eat too much of such as fresh fruit and vegetables.

Good nutrition sometimes means more than just food.  Unfortunately, even proper diets often don’t provide enough trace minerals, vitamins, fiber and other nutrients that are essential in building and maintaining a healthy heart.  Consider supplement to meet these needs.  A minimum supplement menu would include a multi-vitamin, Omega-3 and a fiber source.  There are many quality choices available for all three.  Just make sure the vitamin includes niacin and B-complex (most do) and the Omega-3 is mercury free (and ideally sourced from wild fish).

Start simple by easing out the never to eat foods and monitoring the moderate consumption.  The supplements are easy to start.  Good nutrition is a habit not a trend, and must be developed over time to the point where it feels weird to deviate from it. But soon you’ll be on your way.  And good nutrition leads to weight management and a healthy heart and a long and active life.

For more information on weight management, proper nutrition and a healthy heart, check out the following educational courses:

- Nutrition, Weight Management, and Cardiovascular Disease

- Exercise Prescription for a Healthy Heart

- Laboratory Assessment for Nutritional Status

It’s amazing how simple it could be to solve the crisis of spiraling healthcare costs. If everyone would simply commit to smoking cessation, a healthy eating and daily exercise, our total healthcare costs would be a fraction of the current $1 trillion a year. Why is it so hard to get people to do the right thing, particularly when they’d feel better, enjoy life more (and more life), and save money? Who’s against these things? Obviously, it’s not that easy, but is it really that hard? Complying with this healthy lifestyle would also significantly reduce the resultant comorbidities such as cardiovascular disease, pulmonary disease, obesity and diabetes, just to name a few. Treating these diseases rather than preventing them is how our entire healthcare system now works, and that’s why costs are so high in the first place.  But we can do something about it by living a healthy lifestyle.

Start with the healthy diet. We all know of the obesity epidemic in the U.S. Over a third of Americans are obese and another third are overweight. This is a phenomenon that correlates closely with trends in eating out, the use of corn syrup in processed foods, and the prevalence of relatively cheap snacks. But for the first time in decades the obesity trend seems to be slowing down, albeit from a dangerously high level. Increased awareness of nutritional food values through education and better labeling, public pressure on fast food offerings, and pushes for improved school cafeteria food are all examples of successful methods to move people to make better choices for a healthy lifestyle. Read those labels, and if you have children, get involved in efforts to improve school meals.

Exercise is the next step to that healthy lifestyle. Fewer than 20% of Americans meet met the Physical Activity Guidelines for both aerobic exercise and muscle-strengthening (anaerobic exercise) physical activity. Perhaps the word “exercise” is the wrong way to motivate people to increase physical activity. While regular visits to the gym might help, that’s hardly the only way to successfully get into better shape. Simply walking is a great exercise and a great first step to begin increasing physical activity, and anyone can do it. The secret is finding something you enjoy doing and establishing a routine to add physical activity into your daily schedule. Whether it’s “exercise” or just “a walk”, the results can be life changing.

The final leg to a healthy lifestyle is smoking cessation. The consequences of smoking simply can’t be overstated. Virtually all diseases are caused by or exasperated by smoking. Smoking cessation products and methods are increasingly popular, as well as public policies that cut back or eliminate access to smoking areas. Campaigns to stop marketing to children, high taxes on cigarettes and general peer pressure against smokers are all helping to reduce their numbers. If you still smoke, or live around second hand smoke, offer them smoking cessation options and encourage them to quit.

It’s that simple. Make these changes and you’re be contributing to reducing healthcare costs, improving the health of society as well as enhancing a healthy lifestyle for yourself.

Learn more about Nutrition, Healthy Lifestyles and Exercise

We’ve known for some time now that too much salt is bad for us.  But “too much” can be a sneaky amount.  If your diet includes lots of pizza, cheeseburgers and deli sandwiches you’re going to have high sodium levels (though high sodium levels may be the least of your problems).  According to a recent article in CNN Health, “nine out of ten adult Americans eat too much salt each day.”  And, of course, high sodium levels lead to a “higher risk of heart disease and stroke” which shouldn’t be much of a surprise, particularly when we think of the foods that we know contains lots of salt.  But bread, poultry and cheese?  Yes, it’s the other stuff on the list, the foods we’ve been lead to believe are included in a healthy diet, that are surprising.  What are we supposed to do here?

Turns out the culprit lies less in the base food, say chicken, then in the way it’s prepared and served, as well as the all important serving size.  For example, a basic broiled skinless chicken breast (yum!) is fine (58 mg), but an original recipe KFC breast contains a whopping 1,060 mg of sodium!  Since The Institute of Medicine recommends 1500 mg of sodium per day as the Adequate Intake level for most Americans, that’s over 65% of the suggested daily limit for the average American in just one item of one meal!  Bread is another seemingly benign source of sodium.  A slice of oat bran bread can be as low as 100 mg of sodium but a cup of seasoned bread crumbs is over 2,100 mg.  Even a standard homemade sandwich with two slices of white bread begins with over 300 mg with just the bread.  Throw in a slice of American cheese and 3 oz of processed turkey and that “healthy diet” sandwich is pushing half your daily allowance. 

And who really eats 3 oz of anything anymore?  Americans have super-sized their portions of all foods at all meals.  As a society we take for granted the significantly larger serving sizes that now appear on our plate that just a generation ago.  We eat off larger plates, shoveling food with bigger utensils, while guzzling larger drinks of questionable food value.  Eating larger amounts of foods with high sodium content just exasperates the problem.

Finally, the trend of eating out more often has lead to a decline in the healthy diet.  Restaurants and fast food outlets know people see value in larger servings, and at the same time their sole objective is maximizing taste at the likely expense of a healthy diet.  And fast food is the biggest culprit.  Sodium content in all restaurant food significantly exceeds food prepared at home. 

While we live in a time where it seems most foods present one health hazard or another, reducing sodium is pretty simple.  It’s not the table salt we sprinkle so sparingly on our food at home.  It’s processed foods and eating out.  Get to know what those foods are and how to eat around them.  It may take a little more work but it will be so worth the reward!  Learn more about nutrition and sodium in one of the educational courses listed below.

- Nutrition and High Blood Pressure

- Laboratory Assessment of Nutritional Status

Between Medicare, Obamacare, polarized politics and the sky high budget deficit, healthcare reform is as much an oxymoron as it is a description of the fastest growing segment of both personal and governmental budgets. Regardless of where you stand politically on the subject, almost everyone agrees the current state of healthcare is bad, eroding, unaffordable and unsustainable. One of the most pressing issues in healthcare today is a national nursing shortage. This, during a time when many universities are reducing resources for their nursing schools and immigration policy is making it more difficult for qualified foreign nurses to begin careers here in the U.S. It would seem to be the perfect time for former nurses to consider returning to the profession through nursing reentry programs or “refresher courses”, but that doesn’t seem to be the case. What is thwarting these seasoned professionals from taking advantage of this great opportunity to return to nursing?

It would seem a natural for health professionals to return to the workforce. Many former nurses want to return because they have to. The Great Recession has taken a toll on the middle and working classes of America, and for most nurses this was the best paying job they have held. But there seems to be a number of reasons nursing reentry hasn’t played a bigger part of solving the nursing shortage. Rather than reaching out to help this valuable pool of health professionals make their reentry easy, many hospitals choose instead to take new graduates from nursing schools. It might be because they are up-to-date with new technologies and skills, but cynics suggest it’s because they are easier to mold and less likely to stand up for themselves in a profession where being tough is required for self-preservation from domineering doctors and administrators.

Many nurses are also fearful of the challenges and changes that have taken place since they last practiced. This is a legitimate concern but one that is shared by anyone returning to old fields of play. And that’s what nursing reentry courses are designed to do–fill in the knowledge gaps between past and present. This presents yet another anxiety for many returning nurses: the cost of nursing reentry courses and concerns about meeting all criteria to return without the guarantee of a job waiting at the end of the process. Most programs comprise of two segments: classroom and “clinicals.” The former is pretty straightforward, taking a series of courses, often online, and costing as much as $2,400 for an average of 160 hours.  Online continuing education courses can sometimes apply, too.  The clinicals require working in a clinical environment for a state required number of hours. While some programs offer assistance in finding a position (unpaid), it’s almost never guaranteed, and with many hospitals actually laying off health professionals (exasperating the nursing shortage), it can be very difficult finding placement. Without fulfilling the clinical component, an aspiring nurse may be left in the cold and out the cost of courses.

While healthcare reform is a moving target, many components of the likely outcome offer a variety of solutions that may reduce the nursing shortage. First, nursing schools are likely to receive funding to address this issue at the grassroots level. This may also help with nursing reentry programs. Healthcare reform also focuses on specific areas like primary care, palliative care and geriatric nursing, all of which could benefit healthcare professionals disproportionately that specialize in these areas. Finally, if the politically charged insurance mandate results in all (or most) Americans being covered by health insurance it would figure there would be an increase in services and thus require more health professionals in the system. But whether healthcare reform passes or not, eventually the economy will improve, nursing schools will add more students and more healthcare professionals of all stripes will be back to work. At least we can hope. After all, while healthcare reform may remain an oxymoron, any industry working with the health insurance industry is sure to succeed.

Whether you’re counting calories in food, monitoring your blood sugar, or just maintaining healthy eating habits, reading food facts on nutrition labels is one of your most powerful tools…or so you may think. It turns out that the Food and Drug Administration (FDA), the federal agency responsible for protecting and promoting public health and food safety, isn’t so much a powerful regulating organization as much as a referee trying to oversee a tug-of-war between consumers and food producers. And consumers are losing that battle through inaccurate nutrition labels that break rules the FDA isn’t enforcing.

The FDA doesn’t play an active role in creating nutrition labels for food. That’s left up to individual companies to test and compile their nutritional facts through a “self policing” policy. Not only does the FDA leave this critical role up to the producers, but it allows a margin of error up to 20% on the calorie counts and other values of packaged foods found on nutrition labels. Furthermore, “errors” in excess of 20% are rarely enforced. The ” FDA does not have the resources to analyze products upon request.” Instead, random (and rare) “audits” of nutrition facts, or response to reported violations, are the only way a producer can expect problems from the FDA. And even then, the FDA’s inspection and enforcement is “minimal and disorganized,” according to the Government Accountability Office (GAO) in a 60-page repor t last January titled, “Food Labeling: FDA Needs to Reassess Its Approach to Protecting Consumers from False and Misleading Claims.” (For a terrifying, unrelated story about the FDA’s lack of enforcement, read “FDA Knew of Contaminated Baby Wipes “, a story about repeated, validated complaints of contamination over a five year period resulting in no enforcement).

Back to the GAO report, the findings showed almost 1 in 4 (24%) of nutrition labels were inaccurate. Now if that means a few extra calories that’s one thing (ex: Wonderbread with 70% more total fat than labeled ), but if you’re on a sodium restricted diet (ex: Ritz Crackers with 36% more sodium ), or a diabetic watching blood sugar, these little oversights take on a whole new dimension of seriousness!

The last time food labeling was addressed was 1990. But rising concerns about food safety and accurate food labeling has resulted in threatened legislation, but the food industry has once again gotten ahead of the regulatory ball and introduced its own version of “improvement.” The resulting changes are called “Facts Up Front ” and involve moving the label area to a more promonent spot on the front of packaging. Also, larger and clearer label information in included. The core problems remain, however, as there is no corresponding oversight or enforcement improvement from the FDA, and the basic information is still determined by the food producers. It remains to be seen if this improves the accuracy of nutrition labels.

For healthcare professionals wanting more information on nutrition labels and diabetes see, “Nutritional Principles and Practices for Persons with Diabetes ”

Health coaching is defined as “guiding others to address their health and, if need be, make behavioral changes to improve health” through a healthy lifestyle. The traditional role involves a coach, usually a healthcare professional and patient working together to set goals, identify obstacles and monitor progress. Goals may include issues such as weight management, healthy eating or smoking cessation. Each of these examples often has a variety of methods to achieve success, but it’s usually left to the individual to implement, leading to frustration and, too often, failure. Having a health coach to act as a motivator, monitor and guide can make all the difference to creating a healthy lifestyle.

But let’s say it’s impractical to have regular face-to-face health coaching. Does one really need someone in person to promote healthy eating or smoking cessation? Is it still possible for the relationship to succeed if the conversation is, say, over the phone (ex: “Instead of fast food restaurants tonight, how about picking up a Ready-to-Cook meal from Fresh & Green” or “are you using your Nicorette?”). A new study from the New England Journal of Medicine says absolutely!

Scope, the Stanford University medical blog concluded, “Remote weight loss interventions, such as online or phone counseling health coaches, are as equally effective as programs requiring face-to-face contact, according to findings presented this week at the American Heart Association’s annual meeting in Orlando, Fla.”

Participants in the study were divided into three groups. The first group received health coaching over the telephone, email, and Internet, while the second received phone and email support as well as in-person coaching. The third group received only an initial coaching session and no further support.

After 24 months, both groups one and two (which received continued coaching) were very successful! Group one lost an average of 10.12 pounds, while group two lost an average of 11.22 pounds.

Having access to in-person sessions might have given group two a slight advantage over the phone and email-only group, but both groups who received on-going coaching fared better than the third group, which only lost an average of 1.76 pounds!

Even phone and email coaching alone helped people lose more than five times the weight they were able to lose without a Health Coach. That’s a pretty compelling statistic, if you ask us!

It’s really great news for people who live in remote areas, or just don’t have time for in-person counseling. They can still reap many of the positive benefits of having a Health Coach to motivate, support, and guide them towards a healthier lifestyle.

Have you ever received phone coaching? If you are a Health Coach, do you have phone-only clients, and do you find it to be a successful coaching method? With the realities of today’s busy schedules, but easy communication, it’s actually easier than ever to provide long distance health coaching.

A new and more nuanced version of health coaching is the Clinical Health Coach. This takes the concept of health coach to another level to address more than a healthy lifestyle, instead it provides health coaching for patients with chronic diseases (diabetes, COPD, CVD, etc.). For example, a person with diabetes may have a clinical health coach who guides them to maintain healthy eating habits and weight management strategies. This assistance can prove invaluable to a diabetic in managing their disease. And, while there are no studies yet regarding clinical health coaching and distance relationships between coach and patient, it appears the benefits would be similar. Reinforcement of overall wellness habits and maintaining a healthy lifestyle can be effectively promoted via telephone of other communication. It might even be more useful considering patients often need immediate reinforcement which might be available by phone, email or text, when an appointment might be a week away and too late to intervene when assistance is needed now.

Finally, with health care reform of some type inevitable, and the need to utilize more preventive and affordable methods to achieve wellness and a healthy lifestyle, health coaching and clinical health coaching can prove to be a key component of our future healthcare solution. Changing the way we view wellness from one of preventive medicine and integrative health rather than treatment of chronic disease, we are moving to a state of better everyday health and wellbeing. Is health coaching a part of your practice, and if not, could distance health coaching be made a part of it? It not only might help your patients, but improve your practice, too, by improving patient relationships and satisfaction, and most importantly, improve overall wellness.

Click here to learn more about Clinical Health Coaching

After receiving emotional feedback from a recent article on the relationship between health care costs and healthy lifestyles, or more accurately, lack thereof, I decided to write a follow up on the trend of employers imposing financial penalties through increased health insurance costs for employees who smoke or otherwise don’t meet certain health standards.

A recent article in the New York Times, “More Companies Penalizing Workers for Unhealthy Habits“, states “19% of 248 major U.S. employers” now charge more health insurance for employees who are considered higher risk due to lack of healthy lifestyles. That number is expected to double next year. Some of the country’s largest employers are among those making the changes to their employees’ health insurance, including Home Depot, PepsiCo, Safeway, Lowe’s and General Mills. Wal-Mart, the nation’s largest private employer, hits smokers with a $2,000 surcharge for their health insurance. These are trends that are hard to ignore. And it’s not just smokers who are under the gun to take more personal responsibility for their health care. Obesity, high blood pressure, high cholesterol and “pre-diabetes” are ailments also on the radar as they add as much as 25% more to health care costs over employees with healthy lifestyles and are healthier.

Government has tried to do its part with healthcare reform through the Affordable Care Act. This law includes reducing limits to the health insurance surcharges that companies may impose. Current regulations allow companies to charge up to 20% of health care costs to employees who fail to meet specific standards. This portion rises to 30% by 2014 and eventually tops out at 50%. The Affordable Care Act does require that companies offer avenues for employees to improve healthy lifestyles by offering programs such as smoking cessation, wellness programs and weight loss options to improve good nutrition. In addition, more companies offer gym memberships or other opportunities to increase physical activity to promote healthy lifestyles and improved health. Some family health insurance plans even provide options for family preventive care through childhood obesity awareness programs and online nutrition courses.

No matter what the good intentions may appear to be through improving employee health care, the objective driving this shift is to offload the ever increasing burden of employee health care costs to employees, and it’s coming with a backlash from employees and their advocates. There remains an open debate as to whether obesity may be genetic, and therefore the added surcharges are viewed as punitive. And what about the smoker who is addicted to nicotine, should they be charged higher health insurance costs when they are unable to quit? There’s also the potential for unintended consequences such as employees who opt out of company health insurance programs due to the higher costs. Cynics point out that this may be an added incentive for companies to push employees unable to change lifestyle choices out of their plans and onto the general public. Either way, society is going to pay for those unable or unwilling to change their ways. It’s just a matter to who pays.

Are you a healthcare professional interested in learning more about Healthy Lifestyles? 

Diabetes & Obesity Innovations

Laboratory Assessment of Nutritional Status