Diabetes

Role reversal: Physician participates in diabetes prevention program

We hear about patients in diabetes prevention programs (DPP) and how they can get involved. But what if the roles were reversed and the physician participated in a DPP? For AMA member Brent Williams, MD, MPH, that’s just what happened. By joining a lifestyle-change program on his own, he has been able to share his experience with his patients.

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The AMA’s Diabetes Prevention Guide supports physicians and health care organizations in defining and implementing evidence-based diabetes prevention strategies. This comprehensive and customized approach helps clinical practices and health care organizations identify patients with prediabetes and manage the risk of developing type 2 diabetes, including referring patients at risk to a National Diabetes Prevention Program lifestyle-change program based on their individual needs.

After struggling with his weight for a long time, Dr. Williams’ motivation increased after receiving an email from his insurance company about participating in a DPP. The email said, “You’re eligible to apply for this free of charge. Are you interested?”

This gave Dr. Williams—an internist and director of the Global Health and Disparities Path of Excellence at the University of Michigan Medical School in Ann Arbor—the motivation he needed to join Omada Health’s DPP lifestyle-change program in the summer of 2018. He has lost about 20 pounds—and kept it off—since starting the program.

From participating in Omada Health’s DPP, Dr. Williams has learned several important factors that not only impact his health but help him to reach his patients.

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Long lasting results

“As far as the long-lasting effects it’s had, my behavior on eating has changed fundamentally and I still retain probably about 80% of the behavioral change around eating,” said Dr. Williams.

“The activity piece has been a harder throw for me. I was doing better a year ago with getting adequate exercise and steps than I am now,” he said. “I just recently reset my goals to a lower level in order to make them attainable and I am still working at getting those goals met on a weekly basis.”

The evidence is clear

Every weekend, Dr. Williams reads the different scripts provided by the program. For him, the readings were crucial because the insights and lessons tap the psychology of human behavior change.

“The constant emphasis on making change positive and not painful, and finding a way to do that in a very practical way,” he said. “Those made a difference for me. I followed the script in terms of keeping track of my daily weight and—for the first several weeks—reporting all the food that I ate.”

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Craving versus hunger

A big lesson learned for Dr. Williams was the difference between craving and hunger. While it might sound simple, he felt he could never control his eating prior to learning this critical distinction.

“I started this habit of asking myself—whenever I was craving some piece of food—whether I’m hungry or it’s just a craving,” he said. Dr. Williams learned through coaching that craving is experienced in the mouth and hunger in the stomach.

“I didn’t have any of that when I was trying to do it on my own. I was just doing it by willpower,” said Dr. Williams. “The key thing that happened was that the cravings decreased. It wasn’t just an intellectual awareness, but it was some kind of internal circuitry that got triggered and the cravings got better.”

A story to share

“My teaching scripts [with patients] are more drawn from direct experience of what worked for me in the DPP rather than drawing from a script or teaching something that I learned somewhere else,” said Dr. Williams. “By both incorporating the principles of the DPP and telling them a story about me, I think that those are two things I hope enhance the effectiveness of whatever brief counseling I could do in the office.”

Having completed the DPP, he shared some tips for physicians to keep in mind:

  • Supportively assess a patient’s level of preparedness for change.
  • Find a way to celebrate where the patient is right now.
  • Don’t blame the patient. Ask what values they are maximizing.
  • Open the door to talking about behavior change down the road.

It’s important to establish strong patient rapport as patients move toward readiness for lifestyle changes.

“Lay the groundwork by accepting and valuing” patients, said Dr. Williams.