Whether you’re running a marathon or trying to make healthy lifestyle choices, you’re more likely to achieve your goals if you do it with a friend. That’s the idea behind the Lifestyle Medicine program at Middlesex Health, the only one of its kind in Connecticut.
Led by Dr. Mahima Gulati, a board-certified endocrinologist who is also the first endocrinologist in the state to be board certified in lifestyle medicine, the program enrolls a group of eight to 10 people for shared medical appointments over a number of weeks, determined by the patients’ individual needs.
During the 90-minute sessions, people with chronic conditions – like diabetes, high blood pressure, and high cholesterol – speak with the doctor briefly and have their vital signs recorded. They then come together to learn strategies for improving their lifestyles and, in turn, becoming healthier. The group meets once a month.
Dr. Gulati explains that in a traditional 15- or 20-minute office visit, no doctor can possibly cover all the aspects of lifestyle that affect chronic disease. But if you extend that appointment to 90 minutes, patients will learn much more.
For example, a registered dietician will talk to the group about how to order groceries online and offer tips for using Instacart. The group offers patients an opportunity to discuss their obstacles to healthy eating and finding the time and motivation for exercise with not only their provider or dietitian, but also with one another.
Sometimes, the agenda includes education about how to get a better night’s sleep, how to reduce stress, and incorporating mindfulness and meditation into one’s healthy habits. If it’s an issue for the group, abstaining from smoking, illicit drugs, and using alcohol in moderation is also discussed.
Middlesex started the Lifestyle Medicine program in November 2019. Group medical appointments are an underused method of helping more people more effectively, Dr. Gulati says.
“Obesity and diabetes are the conditions putting people at risk for severe COVID-19,” Dr. Gulati says. “At a body mass index of 28, our risk of severe COVID-19 doubles. That’s twice the risk of someone who has a BMI of 25 or less. The average American has a BMI of 29. Some 42.7 percent of us are obese and close to 70 percent of Americans are overweight or obese. Diet is critical in the fight against obesity and diabetes.”
Many people are in a rut of eating high-calorie foods and don’t eat enough vegetables. Dr. Gulati and her team encourage patients to keep an open mind and tap into their curiosity about new foods.
“Before the pandemic, we used to meet face-to-face in a conference room and try new recipes and taste relatively less consumed foods like tempeh, jicama, kale, tofu, parsnips, and chia seeds in our cooking class,” Dr. Gulati says. “We cooked very simply with a microwave and used paper plates and disposable cutlery.”
However, since the pandemic began early last year, “we have been meeting over Zoom, which has had some advantages. It’s helping people who don’t have much social interaction as well as others who can’t take time off work to join the meeting. Overall, patients love the program. One of our patients, who lost a very significant amount of weight over the last year, told us she was able to successfully divorce her love of butter. Nobody wants to be alone when making changes. It’s so much easier if you have a supportive team.”
Although the group can’t meet for an in-person cooking lesson, the participants asked to do a virtual teaching kitchen. Dr. Gulati and two dieticians will conduct this virtual cooking demonstration soon, and prepare a nutritious salad in their offices with some wholesome ingredients while the patients simultaneously make the same meal at home. All of this will be coordinated on Zoom. Everyone will get to create a healthy recipe while interacting and exchanging notes virtually, and they will then be able to enjoy their healthy, colorful salads.
“With culinary medicine, we don’t have to compromise taste,” Dr. Gulati says. “Healthy food can be unapologetically delicious.”
Dr. Gulati describes her own diet as nearly 100 percent plant based. She accomplishes her goals by meal prepping and planning. Breakfast is typically fruit and Ezekiel bread with a dab of walnut butter, along with green tea or black tea with a splash of soy milk. Lunch, often on the run, might be hummus with almonds or a salad with berries and greens like spinach or kale. She sips green tea throughout the day. Dinner, the main meal of the day, consists of a salad with a rainbow of veggies that might include beets, tomatoes, eggplant, and cucumbers, along with a nice, large bean soup. Dessert is a sweet potato topped with dates and nuts or some dark chocolate.
“I’ve really tried to cut back on added sugar, so I substitute dried fruit,” she says. “I try to exercise most days. I recently got a fitness tracker and try to keep up with friends. Sometimes I’ll just do basic planks or a seven- to 10-minute workout. I like to run on trails in the summer. With full-time work and kids, it’s not easy.”
Does she ever eat junk food? “Absolutely! I’m human, and no human is 100 percent perfect,” she admits. “What helps me stay on track, though, is my group of Lifestyle Medicine friends, who I text routinely. We all stay accountable to each other in terms of our diets and exercise. So, no one strays from their good habits for weeks on end.”
Physical activity is another big topic for the Lifestyle Medicine group appointments. Patients are asked to set SMART goals. The acronym stands for specific, measurable, achievable, relevant, and time bound. During meetings, Dr. Gulati, or a dietitian, leads the group in seven minutes of movement. During the rest of the week, patients plan their own exercise routines, even if that just means starting out with a 10-minute walk each day.
Like any medical appointment, meetings of the Lifestyle Medicine group are covered by insurance and the meetings are entirely confidential. And just being in the group provides social accountability for its members. Anyone over the age of 18 is welcome to sign up. People from all over the state join because there’s nothing like it anywhere else.
The American Board of Lifestyle Medicine launched in 2017, and Dr. Gulati became board certified in 2018. She was among the first few endocrinologists in the entire country to be board certified in this subspecialty.
“We get referrals from people who looked us up online from as far as 60 miles away,” Dr. Gulati says. “People want this. They don’t like to take expensive drugs. People want to get off drugs because they might get side effects like fatigue, headaches, moodiness, and poor sleep.”
She adds, “There’s also a crisis of isolation and loneliness during the pandemic. Everyone is swamped with childcare, and elderly people are looking to talk; it’s a big outlet for people. We have a member in her 80s who is like a grandmother to us all. We love her because she is supportive.”
Diet and exercise are the obvious lifestyle factors that account for lower numbers on the scale and favorable results in tests of blood pressure, glucose, and cholesterol. But what about sleep? Stress?
“Most people underrate sleep hygiene,” Dr. Gulati says. “The eight hours of sleep at night really set the stage for the remaining 16 hours of the day. One study showed that if people suffered sleep deprivation, their glucose tests became abnormal within less than a week. Sleep is critical. In 2019, the World Health Organization declared night shift work as a group 2A (“probable”) carcinogen. In other words, people who don’t sleep enough have a high risk of cancer. You’re not letting the body do what it was meant to do.”
Stress is another topic in the Lifestyle Medicine group. More than 50 percent of all medical office visits are related to stress, Dr. Gulati says.
“Stress is killing the world,” she says. “In modern times, we have forgotten how to respond to stress. Kids who are inundated with social media show rising rates of depression.”
To counteract stress, Dr. Gulati recommends learning to meditate, spending time in nature, and switching off screens. Nurturing friendships and building solid, high quality relationships with other people at our workplaces, in neighborhoods, and in our community at large will help stem loneliness, another 21st century pandemic. Joining a Lifestyle Medicine group that meets on Zoom is one way to connect and meet new, like-minded people.
Dr. Gulati was drawn to Lifestyle Medicine as a way of taking care of herself and her family. She compares it to “putting my own oxygen mask on first. A lot of healthcare professionals are prone to stress and burnout, and need to take the time to connect.”
And it’s never too late to make a change. “Life is about beginning again. No matter how many years you have been stuck, you can always begin again,” she says. “If you haven’t exercised in a year, you can always begin again. That’s the whole point of Lifestyle Medicine. To begin fresh in this moment.”
Alix Boyle writes about health and home and real estate from her home on the Connecticut shoreline. The natural beauty of the shoreline makes her feel like she’s on vacation every day.