Change in cardiometabolic risk factors in a pilot safety-net plant-based lifestyle medicine program

Abstract

IntroductionInterventions emphasizing healthful lifestyle behaviors are proliferating in traditional health care settings, yet there is a paucity of published clinical outcomes, outside of pay-out-of-pocket or employee health programs.MethodsWe assessed weight, hemoglobin A1c (HbA1c), blood pressure, and cholesterol for 173 patients of the Plant-Based Lifestyle Medicine Program piloted in a New York City safety-net hospital. We used Wilcoxon signed-rank tests to assess changes in means, from baseline to six-months, for the full sample and within baseline diagnoses (i.e., overweight or obesity, type 2 diabetes, prediabetes, hypertension, hyperlipidemia). We calculated the percentage of patients with clinically meaningful changes in outcomes for the full sample and within diagnoses.FindingsThe full sample had statistically significant improvements in weight, HbA1c, and diastolic blood pressure. Patients with prediabetes or overweight or obesity experienced significant improvements in weight and those with type 2 diabetes had significant improvements in weight and HbA1c. Patients with hypertension had significant reductions in diastolic blood pressure and weight. Data did not show differences in non-high-density lipoprotein cholesterol (non-HDL-C), but differences in low-density lipoprotein cholesterol (LDL-C) were approaching significance for the full sample and those with hyperlipidemia. The majority of patients achieved clinically meaningful improvements on all outcomes besides systolic blood pressure.ConclusionOur study demonstrates that a lifestyle medicine intervention within a traditional, safety-net clinical setting improved biomarkers of cardiometabolic disease. Our findings are limited by small sample sizes. Additional large-scale, rigorous studies are needed to further establish the effectiveness of lifestyle medicine interventions in similar settings.

Patient-Reported Outcomes from a Pilot Plant-Based Lifestyle Medicine Program in a Safety-Net Setting

“…Most salient in our findings, however, is the overall positive pattern of improvement in the consumption of healthy plant-based items individually, as well as the comprehensive healthy plant-based diet improvement from baseline to 6 months. In addition, a previous article documented that PBLM program participants experienced clinical improvements that are closely associated with healthful diet changes including weight loss, and reductions in HbA1c and blood pressure [ 37 ], providing further evidence of this study’s overall positive findings for healthy diet improvement.…”

“…As anticipated, continuous assessments and adjustments were made throughout the pilot period to adapt to the realities of working within a complex healthcare setting, as well as to meet the evolving needs of the participants. Significant improvements in clinical cardiometabolic outcomes, including reductions in weight, hemoglobin A1c, and diastolic blood pressure, have been previously reported from this pilot program [ 37 ].…”

Hyperlipidemia Prevention and Management Utilizing Lifestyle Changes

“…Another limitation was the small sample size; however, this is possibly the first lifestyle medicine program to publish clinical results within a traditional health care system. 33 A meta-analysis reviewing behavioral counseling programs intended to improve diet, increase physical activity, and decrease sedentary behavior was conducted between February 2021 and February 2022. 34 This meta-analysis of 113 RCTs (N = 129,993 participants) evaluated programs focusing on healthy nutrition and physical activity (33%), healthy diet only (19%), and physical activity alone (48%) with duration of programs 6 months or less and an average of 7 meetings for counseling.…”

“…21 Lifestyle medicine interventions have been shown to decrease weight, blood pressure, lipids, blood glucose, and cardiac events. 33 In 2023, the American College of Lifestyle Medicine invited an expert panel of primary care providers from multiple disciplines (physicians, physician assistants, nurse practitioners, and clinical psychologists) to develop expert consensus statements regarding integrating lifestyle medicine practices into the primary care setting. These statements have been published as the Lifestyle Medicine for Optimal Outcomes in Primary Care.…”

“…For example, a Plant-Based Lifestyle Medicine Program, an in-hospital program designed to increase healthy lifestyle choices, was created for adults with BMI greater than 25, type 2 diabetes, prediabetes, hypertension, coronary artery disease, and/or hyperlipidemia. 33 The program consisted of education based on the 6 pillars of lifestyle medicine, individual meetings with health care providers (physician, registered dietician, and health coach), group classes, and peer support. Results showed that participants with baseline hyperlipidemia (n = 86) had a 60.5% improvement in non-HDL and LDL levels after participation in the program.…”