If you want to get healthy, you just might not want to go to a doctor. You might instead, go to church. The power of community to create health is far greater than any physician, clinic or hospital. You are more likely to be overweight if your friend's, friend's friend is overweight than if your parents are overweight. Your social networks may matter more than your genetic networks. But if your friends have healthy habits you are more likely to as well. So get healthy friends.
In the fall of 2010, I had dinner with Rick Warren, the pastor of the 30,000 strong Saddleback Church in Southern California. He came to see me to get healthy - and he got religion about health. Over a healthy dinner of beet and cabbage autumn soup and a salad, he described his extraordinarily successful experiment for sustained personal growth and change. Rick encouraged his congregation to form 5,000 small groups that met every week in their community to study, learn and grow together.
In a flash, in that moment, I envisioned using those same small groups as a means of creating healthy lifestyle change. Out of that meeting, with Drs. Mehmet Oz and Daniel Amen, we created The Daniel Plan, a roadmap for physical and spiritual health and renewal that would be delivered through the small groups. Rick named it "The Daniel Plan" after the first health support group created by Daniel and his friends who resisted the temptation of the King's rich food and were healthier for it.
On the day we launched The Daniel Plan at Saddleback Church on January 15, 2011, over 8,000 people signed up to participate in small groups, track their progress and be part of a research study. Within a week over 15,000 had signed up. The groups are supported by a weekly curriculum, learning objectives, videos, webinars, seminars and online support. In the first year the congregation has already lost over 250,000 pounds and it changed the entire culture of the church almost overnight.
Community: The Best Medicine for Change
The seed of this idea started in my mind when I went to Haiti after the earthquake in January, 2010. Paul Farmer and Partners in Health have created a powerful and successful model for treating drug resistant tuberculosis and AIDS in the most impoverished nations in the world. The brilliance of the vision wasn't coming up with a new drug regimen or building big medical centers, but from a very simple idea: The missing ingredient in curing these patients was not a new drug, but the community. They needed someone to "accompany" them to get healthy. Recruiting and training over 11,000 community health workers across the world he proved that the sickest, poorest patients with the most difficult to treat diseases in the world could be successfully treated. The community was the treatment.
The same vision can be applied to our current diabesity epidemic. Solutions are not coming from governments, health care institutions or corporations. What has been proven to work over and over, in different settings--workplaces, community centers, faith-based centers, schools--is building a community-based support system to guide people toward sustainable behavior and lifestyle change.
The cure for obesity and diabetes is not a mystery, just as the most effective drug regimen for tuberculosis or AIDS is not a scientific mystery. Knowing how to effectively get it to the individual has eluded most experts. But the data is in about lifestyle change, we know how to deliver the information and make it stick. We have to help each other, not look for outside solutions from large institutions.
What the Research Shows: Community Support Works Better then Medication
Here's what the data show to date with more studies coming in every day. Community is more effective than any medication, even though many still use less than optimal and outdated nutritional advice and lifestyle interventions. I believe much more could be accomplished by translating the latest science into effective treatments and community-based support groups as I have done in my new book The Blood Sugar Solution.
The landmark 2002 study based on the Diabetes Prevention Program(i) and a ten year follow up study(ii) sponsored by the National Institutes of Health proved that lifestyle intervention is much more powerful than any other treatment such as medication to prevent diabetes in those with prediabetes. With regular lifestyle support and education, participants lost 5 percent of their bodyweight and reduced their risk of diabetes by 58 percent. This lifestyle-based approach was also proven very effective in the large Finnish Diabetes Prevention Study.(iii)
The current Look Ahead Study funded by the National Institutes of Health is a 13-year study of 5,000 people comparing an intensive group lifestyle change program for diabetes prevention and treatment has been show to be remarkably more effective in lowering weight, cholesterol, blood sugar, and blood pressure than conventional medical care.(iv) Once this study is completed, it will completely change our way of thinking about how to treat disease. Group models of intensive lifestyle change like the one modeled by Dr. Dean Ornish for heart disease(v) and prostate cancer,(vi) are more effective and will save more lives and more money than using medication and surgery for diseases caused by lifestyle and environmental factors.
Many other community-based programs have been proven to work better than our current conventional treatment approach based on one on one counseling visits with diabetic educators or registered dietitians.
- The Montana Cardiovascular Disease and Diabetes Prevention Program(vii)proved diabetes prevention research could be applied successfully in real world setting in groups of 8 to 30 people supported by a trained health care team. Education was delivered in 16 weekly classes and optional twice a week exercise classes. The average weight loss was 7 percent of body weight, and blood pressure, cholesterol, and blood sugar all dropped significantly.
- The Healthy Living Partnerships to Prevent Diabetes (HELP PD)(viii) study in North Carolina trained community health workers (patient's peers) to support long-term lifestyle change. The community health workers received a 36-hour training program given by registered dietitians. It's a train the trainers model. These community health workers help groups of patients succeed in a 16-week core curriculum using videos, handouts, a treatment manual, and a toolkit. After the initial 16 weeks of meetings, there is weekly phone support for 8 weeks and monthly support for 18 months. The program addresses not only nutrition, exercise and lifestyle, but ways to transform obstacles to behavior change rooted in beliefs and attitudes about self-efficacy and self-care. The initial results of this National Institute of Health sponsored study of 300 people found that the people who had the usual care of individual counseling lost only 1 percent of their body weight compared to 7 percent of body weight for people who were in community health worker supported groups. The cost to deliver this program was only 400 a year.
- The DEPLOY study(ix)successfully partnered with local YMCA's, trained their staff and started group programs based on the Diabetes Prevention Program.
- Group programs have also been delivered with success via a large academic hospital.(x)
- The Logan Healthy Living Program(xi) successfully used telephone delivered support for dietary and physical activity to socially disadvantaged patients with Type 2 diabetes and high blood pressure. They provided a workbook and 18 calls over 12 months.
- The Healthy Lifestyle Change Program (xii) in California found that in more than 400 developmentally disabled participants with obesity or at high risk for diabetes they could achieve significant improvement in weight, waist circumference and an increase in physical activity in a seven-month, twice weekly group education program. What was most remarkable was that peer "mentors" led this group intervention.
- The PATHWAYS study(xiii) delivered a 14-week weight loss program aimed at diabetes prevention for African American women at risk for diabetes delivered through churches and led by lay health facilitators (or community health workers). The women lost an average of 5 percent of their body weight, enough to reduce their risk of diabetes by 58 percent.
- In other studies scientists also effectively implemented a group model for diabetes prevention and weight loss using both volunteer health care professionals(xiv) and lay people(xv) in African American churches.
- Group school lifestyle change programs in the poorest, most overweight states like Mississippi have shown significant improvements in weight, body, fat, fitness level and eating habits.(xvi)
Building Connection and Community to Create Health
This movement is starting to spread. Doctors frustrated with the failure of medication to treat their patients with chronic illness, obesity, and diabetes are starting small groups with eight to 30 patients and meeting weekly to teach them about nutrition, cooking, shopping, exercise, stress management and more.
Two Portland doctors came up to me after a lecture I gave and told me about their program for poor undocumented Hispanic women with chronic symptoms, obesity, and diabetes. For very little money (about $15 per person), they successfully guided these women to health in a program they called Reclamado su Salud (or reclaim your health) using the program based on The Blood Sugar Solution (which I have taught at many medical conferences). Their group of 20 women met weekly for five classes, then every two weeks for a total of eight three-hour classes. The weight loss ranged from five to 20 pounds, blood pressures dropped an average of 10-20 points and depression and inflammation scores dropped significantly.
Much can be done with a little help from your friends.
These examples represent just the beginning of what is possible when we work together. We are social beings and thrive with connection. I met with human resource and benefits executives at Google to advise them on creating a healthy workforce. A survey of their "Googlers" discovered that most of them wanted more ways to connect with each other.
Social networks and groups are spontaneously sprouting as a support system for lifestyle change. Facebook and Twitter cannot only help facilitate democratic revolution in countries like Egypt, they can link communities together in a common purpose to reclaim their health. Think "Occupy Health Care" or "Wellness Spring."
With the shift in health care policy prohibiting insurers from excluding sick patients (or cherry picking), canceling insurance and the mandate for universal coverage, they can no longer shift responsibility for prevention and health promotion. Large insurers like United Health Care(xvii) and CIGNA are scrambling to create innovative community based programs to address the tsunami of disease and costs they can no longer avoid.
This community based group approach solves many enormous obstacles to reversing this epidemic faced by the health care system. Even though doctors are the main place where people receive health care with diabesity, they have no training in lifestyle change, lack the time, resources, and support team, and they do not get paid for helping patients create sustainable lifestyle change. Currently physicians and health care organizations have nowhere to refer patients and have no clear, well documented proven solution to provide their patients. Telling their patients to eat better and exercise more is just not enough.
You need to build yourself a support system to succeed long term. You need a team working together toward the same goals. It might be just one person, a self-guided support group, one led by a health coach, wellness champion or community health worker, or a health professional, or even an online community that can support, encourage and guide you.
I strongly recommend you develop this kind of community for yourself for two reasons.
- Success requires it. As we have seen, studies show that the best way to overcome diabetes and obesity is through groups and community support.
- Our world needs it. If we don't do something about the diabesity epidemic, our world will suffer for it. Remember, projections suggest that by 2020 half of the population will have prediabetes. We have to work together to avert this disaster.
Start by finding people who will do the program with you. Create a small group, even if it is just one friend, who can support you through the process. Ask your friends, family, coworkers, and spiritual community members to join you. You can still be successful following this program by yourself, but it will be more fun, powerful and sustainable when done with others in community.
My new book The Blood Sugar Solution, which comes out at the end of February is a personal plan for individuals to get healthy, for us to get healthy together in our communities and for us to take back our health as a society. Obesity and diabetes is a social disease and we need a social cure.
My personal hope is that together we can create a national conversation about a real, practical solution for the prevention, treatment, and reversal of our diabesity epidemic.
To learn more and to get a free sneak preview of the book go to www.drhyman.com.
To your good health,
Mark Hyman, MD
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(ii) Diabetes Prevention Program Research Group, Knowler WC, Fowler SE, Hamman RF, Christophi CA, Hoffman HJ, Brenneman AT, Brown-Friday JO, Goldberg R, Venditti E, Nathan DM. 10-year follow up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study. Lancet. 2009 Nov 14;374(9702):1677-86.
(iii) Ilanne-Parikka P, Eriksson JG, Lindström J, Peltonen M, Aunola S, Hämäläinen H, Keinänen-Kiukaanniemi S, Laakso M Valle TT, Lahtela J, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group. Effect of lifestyle intervention on the occurrence of metabolic syndrome and its components in the Finnish Diabetes Prevention Study. Diabetes Care. 2008 Apr;31(4):805-7.,
(iv) Look AHEAD Research Group, Wing RR. Long-term effects of a lifestyle intervention on weight and Lahtela J, Uusitupa M, Tuomilehto J; Finnish Diabetes Prevention Study Group.cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010 Sep 27;170(17):1566-75.
(v) Ornish D, Scherwitz LW, Billings JH, Brown SE, Gould KL, Merritt TA, Sparler S, Armstrong WT, Ports TA, Kirkeeide RL, Hogeboom C, Brand RJ. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998 Dec 16;280(23):2001-7.
(vi) Ornish D, Magbanua MJ, Weidner G, Weinberg V, Kemp C, Green C, Mattie MD, Marlin R, Simko J, Shinohara K, Haqq CM, Carroll PR. Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proc Natl Acad Sci U S A. 2008 Jun 17;105(24):8369-74.
(vii) Amundson HA, Butcher MK, Gohdes D, Hall TO, Harwell TS, Helgerson SD, et al. Translating the diabetes prevention program into practice in the general community: findings from the Montana Cardiovascular Disease and Diabetes Prevention Program. Diabetes Educ 2009;35(2):209-4. 216.
(viii) Katula JA, Vitolins MZ, Rosenberger EL, Blackwell C, Espeland MA, Lawlor MS, Rejeski WJ, Goff DC. Healthy Living Partnerships to Prevent Diabetes (HELP PD): design and methods. Contemp Clin Trials. 2010 Jan;31(1):71-81.
(ix) Ackermann RT, Finch EA, Brizendine E, Zhou H, Marrero DG. Translating the Diabetes Prevention Program into the community. The DEPLOY Pilot Study. Am J Prev Med 2008;35(4):357-363.
(x) McTigue KM, Conroy MB, Bigi L, Murphy C, McNeil M. Weight loss through living well: translating an effective lifestyle intervention into clinical practice. Diabetes Educ 2009;35(2):199-204. 208.
(xi) Eakin EG, Reeves MM, Lawler SP, Oldenburg B, Del Mar C, Wilkie K, Spencer A, Battistutta D, Graves N. The Logan Healthy Living Program: a cluster randomized trial of a telephone-delivered physical activity and dietary behavior intervention for primary care patients with type 2 diabetes or hypertension from a socially disadvantaged community-rationale, design and recruitment. Contemp Clin Trials. 2008 May;29(3):439-54.
(xii) Bazzano AT, Zeldin AS, Diab IR, Garro NM, Allevato NA, Lehrer D; WRC Project Oversight Team. The Healthy Lifestyle Change Program: a pilot of a community-based health promotion intervention for adults with developmental disabilities. Am J Prev Med. 2009 Dec;37(6 Suppl 1):S201-8.
(xiii) McNabb W, Quinn M, Kerver J, Cook S, Karrison T. The PATHWAYS church-based weight loss program for urban Aftrican-American women. Diabetes Educ 2001; 27(2):231-238
(xiv) Quinn MT, McNabb WL. Training lay health educators to conduct a church-based weight-loss program for African American women. Diabetes Educ 2001;27(2):231-238
(xv) Boltri JM, Davis-Smith YM, Seale JP, Shellenberger S, Okosun IS, Cornelius ME. Diabetes prevention in a faith-based setting: results of translational research. J Public Health Manag Pract 2008;14(1):29-32.
(xvi) Greening L, Harrell KT, Low AK, Fielder CE. Efficacy of a School-Based Childhood Obesity Intervention Program in a Rural Southern Community: TEAM Mississippi Project. Obesity (Silver Spring). 2011 Jan13.
(xvii) United Health Center for Health Reform and Modernization, The United States of Diabetes, November 2010 (accessed online)
Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.
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