AAFP Chapter Leaders Reflect on Lifestyle Medicine Efforts
Feb. 2, 2024, News Staff — The Academy rolled out a series of new lifestyle medicine resources on topics such as diabetes care, healthy eating and youth suicide prevention in January, all created by family physicians and staff from the Connecticut, Idaho and Illinois chapters through a funding opportunity from the Ardmore Institute of Health.
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AAFP News recently asked these leaders to share what they learned in the process and what members can look forward to next.
Suicide Prevention: ‘We’re Going to Save Lives’
In Idaho, where suicide is one of the state’s leading causes of death in young people and firearms are used in more than 60% of suicides, Idaho AFP staff and a cohort of several family physicians partnered with health systems, foundations and other organizations across the state.
While reducing teen suicide rates was the chapter’s primary goal, the Idaho AFP also wanted to give family physicians tools to address mental health, highlight connections between social isolation and lifestyle medicine, and target youth at increased risk. Ultimately, the chapter created two guidebooks: one aimed at helping youth and their families prevent or reduce self-harm, and one that offers clinicians screening recommendations, training, safety planning guides and other resources.
The chapter also distributed resources at multiple events across the state, including 60 gun safety locks and 90 postcards for members to send teens who were waiting to receive mental health care. In addition, IAFP members conducted 62 screenings, handed out 47 patient resource packets and engaged with 22 health care colleagues.
“The gun safety piece was really critical,” said Liz Woodruff, M.A., executive director of the Idaho AFP. The chapter worked with North Carolina family physician Sanjay Batish, M.D., FAAFP, who has researched gun violence among young people, to help IAFP members find ways to talk about gun safety with their patients. “It was really uncomfortable for them, but because of our resources, they were able to do it. I think that by getting started on having those kinds of conversations, especially in rural communities, we’re going to save lives.”
The project was a success overall, Woodruff said, and it gave organizers three key takeaways, the first being that addressing mental health stigma in communities and families can be challenging.
“Our first event was a 90-person sports physical screening in July, and of the 90 parents who were asked if it was OK to screen their teens, only 18 agreed to the screening,” Woodruff explained. “The parents weren’t necessarily prepared to be asked that question, it wasn’t necessary for them to be asked that question, and they didn’t have to give consent.
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“It taught us that talking about mental health isn’t necessarily a priority in these communities, and that there’s likely some mental health stigma that makes it difficult for parents, families and communities to have these conversations. That’s an area we need to focus on in the future.”
Another takeaway, Woodruff said, is that physicians need accessible and consistent resources.
“Many of our doctors want to do this work, but because they have such demanding clinical schedules, they feel lost without having resources. So these resources were really beneficial,” she said.
The third takeaway was that teens need easier access to mental health services, which can come through creative solutions such as telehealth libraries.
Feedback from chapter members was largely positive. One member mentioned lifestyle medicine information in the patient packets was an opening to talk about strategies for improving mental health, Woodruff said, and others found it extremely helpful to be able to review local resources with patients.
Now organizers are looking into translating the patient packets into Spanish, bringing more practices into the project and adding resources for special populations. In May, physicians from the pilot project will speak at the chapter’s upcoming annual conference, where attendees will receive the packets.
Healthy Eating: ‘We’ve Learned So Much’
In Connecticut, chapter member and immediate past president Kathleen Mueller, M.D., FAAFP, and Deputy Vice President Mary Yokose modified an existing nutrition program from Mueller’s practice into Diets Don’t Work: Real Food for Better Health, an educational curriculum for family physicians to offer in their own practices.
“We wanted to help family physicians have the resources and tools necessary to do group visits so that we can bill insurance, educate a group and have a group collaborative atmosphere, which is so important when you’re learning something new,” Mueller said, adding that she also wanted patients to understand that small, long-term nutritional changes rather than short-term changes in dietary habits can have a lasting difference in health.
The curriculum is based on Good and Cheap: Eat Well on $4/Day by cooking instructor and author Leanne Brown. It consists of three group visits held over six weeks, with a follow-up visit with a family physician at 12 weeks; additional resources include sample recipes, handouts on the benefits of fiber and a link to the MyFitnessPal app.
Initially, some practices experienced barriers to implementing the curriculum. Some physicians and office managers expressed concerns about being able to bill insurance for reimbursement; others mentioned lack of available space, potential disruptions in patient flow and difficulty obtaining permission to conduct group sessions.
Mueller said many practices found workarounds, such as repurposing break rooms for group visits. She also remains optimistic, noting that three practices started implementing the curriculum in January and others have received permission to hold group sessions later in the year. Many participating practices have already collected baseline measurements from patients, and the chapter is working with researchers at Yale Medical School to conduct an overall assessment of the curriculum.
“In another year or so, we’ll know whether we’ve been able to create and collaborate with small communities of patients who are focused on healthy eating,” she said. “One of the things we're hoping to uncover is whether or not group visits allow a more intimate connection with their family physicians and whether they improve satisfaction overall.
“It'll be really interesting to pull the data in,” Mueller continued. “We’ll be assessing the data and refining the program, depending on what other barriers we find, as we go forward. It's been a real pleasure, and we've learned so much.”
Lifestyle Medicine and Diabetes: ‘We’ve Really Reached These People’
The Illinois chapter took a two-pronged approach. The first was a series of CME sessions featuring Illinois AFP member Christina Wells, M.D., M.B.A., M.P.H., Dip. ABLM, and subject matter expert Meagan Grega, M.D., FACLM, Dip. ABFM, Dip. ABLM, designed to educate family physicians on lifestyle medicine and diabetes management. The second involved a community outreach effort in which members engaged directly with the residents of a predominantly Black neighborhood in south Chicago.
Kate Valentine, vice president of education and meetings with the Illinois AFP, said the outreach took place at a local church, and consisted of six sessions held virtually and in person. Participants received the Diabetes Undone curriculum, which has prerecorded videos, a workbook and a plant-based cookbook.
The chapter hoped 15 people would sign up for the free workshop. In fact, more than 30 people registered and as many as 20 attended every session, where they watched the Diabetes Undone videos together.
“Christina Wells, our champion for all things lifestyle medicine, led every session,” Valentine said. “She talked through the videos, answered questions, followed up and reinforced eating habits and simple things that you can do to get extra exercise.”
Two dietician students from the University of Illinois at Chicago also presented and talked with participants one-on-one, answering individual questions. In addition, a chef from a local vegan soul food restaurant, Majani, demonstrated making healthier meals at two sessions, followed by a group meal at the end.
Health and lifestyle assessments indicate that the sessions had a positive effect, Valentine said. The average weight of attendees was 198 pounds at baseline; by the end of the workshop, it was 190. In addition, average waist circumference decreased by 2 inches and hemoglobin A1c levels decreased an average of 1.4 points.
Valentine added that participants increased their fruit and vegetable intake, exercised more, and reduced the consumption of sweets and sugar-sweetened beverages.
She also said that Wells still meets with many of the participants regularly to work together and maintain a sense of community.
“I feel like we’ve really reached these people,” Valentine said.