Telehealth for Lifestyle

Interventions Why Telehealth Is The Key to Effective Lifestyle

Interventions

Laurence Girard

CEO & Founder of FrutStreet.com

Huntington Hospital ER - Huntington, New York

Dr. David Katz - President of American College of Lifestyle Medicine

CDC - Leading Causes of Death 2015

Heart Disease: 614,348

Cancer: 591,699

Chronic lower respiratory disease: 147,101

Accidents (unintentional injuries): 136,053

Stroke (cerebrovascular diseases: 133,103

Alzheimer's disease: 93,541

Diabetes: 76,488

Nephritis, nephrotic syndrome, and nephrosis: 48,146

Intentional self-harm (suicide): 42,773

Source: http://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

Are These Really The Leading Causes of Death?

Diseases Are Not Causes, They Are Effects

80% of Premature Deaths in US in 1990 Caused By:

References:

McGinnis JM, Forge WH, Actual causes of death in the United States. JAMA. 1993,270:2207-12

Mokdad AH, Mark JS, Stroup DF, Gerberding JL. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-45

Poor Diet Tobacco Lack of Physical Activity

The Remedy for Premature Death

-Survey research of 23,000 adults in and around Potsdam Germany asked about

four factors in their lives:

-Do you smoke yes or no?

-Do you eat well yes or no? (habitual intake of fruits, vegetables, whole grains)

-Are you physically active on a regular basis yes or no?

-Is your weight well controlled yes or no?

Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European

Prospective Investigation Into Cancer and Nutrition-Postdam study. Arch Intern Med. 2009. Aug 10:169,(15):1355-62

Comparison of Unhealthy vs. Healthy Lifestyle

-Group 1 = I don’t smoke, I eat well, I’m physically active, my weight is where it

should be

-Group 2 = I smoke, eat badly, don’t exercise, and my weight is out of control

-Group 1 over the span of their lifetimes had an 80% lesser rate of all major

chronic disease than group 2

-Flip the switch from bad to good on any of these factors and the lifetime

risk of getting any major chronic disease goes down about 50%

Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European

Prospective Investigation Into Cancer and Nutrition-Postdam study. Arch Intern Med. 2009. Aug 10:169,(15):1355-62

The “Magic Pill” of Lifestyle

By avoiding smoking, eating well, exercising,

and controlling our weight we can reduce our

lifetime risk of getting any major chronic

disease by 80%

(no side effects) -Ford ES, Bergmann MM, Kroger J, Schienkiewitz A, Weikert C, Boeing H. Healthy living is the best revenge: findings from the European

Prospective Investigation Into Cancer and Nutrition-Postdam study. Arch Intern Med. 2009. Aug 10:169,(15):1355-62

-Kvaavik E. Batty GD, Ursin G. Huxley R., Gale CR. Influence of individual and combined health behaviors on total and cause-specific mortality in

men and women. the United Kingdom health and lifestyle survey. Arch Intern Med 2010.170. 711-8

-McCullough ML. Patel AV. Kushi LH. Patel R. Willet WC. Doyle C. Thun MJ, Gapstur SM. Following cancer prevention guidelines reduces risk of

cancer, cardiovascular disese, and all-cause mortality. Cancer Epidemiol Biomarkers Prev. 2011,20 1089-97.

The Master Levers of Medical Destiny

Archimedes - “Give me a lever long enough

and I can move the whole world”

Forks Fingers Feet

6 Cylinders of Lifestyle Medicine

Diet Exercise Don’t Smoke

Reduce Stress Sleep Love

Gap Between What We Know and What We Do

-There is a major gap between what we know and

what we do with what we know

-We need to translate what we know into what we

routinely do

-Lifestyle modification is hard

-We Need a coach (diabetes prevention program)

Fruit Street = Telehealth Software for Lifestyle Interventions

Clinician Dashboard to Monitor Diet/Lifestyle

Dietary Monitoring Via Telehealth

Wearable Device Monitoring via Telehealth

Lifestyle Change Requires 9-16 Visits...Who wants

to drive to a dietitian? Schedule online instead

Why Are Lifestyle Interventions Difficult?

-Reimbursement for lifestyle interventions is difficult

-Reimbursement for dietitians is limited

-Driving to physical clinics is difficult - weight management centers report missing

50% of their visits

-Patient compliance is challenging, user experience needs to be simple

-Physicians lack time to do lifestyle counseling

The Horizon for Telehealth + Lifestyle Interventions

-Telehealth eliminates the barrier of driving for weight management sessions

-Medicare will be reimbursing for the diabetes prevention program in January of

2018 including telehealth

-Self-insured employers will find value in products that can be shown to be

clinically and cost effective (prevent pre-diabetes to go to type 2 diabetes)

-ACOs looking for cost effective solutions in capitated payment settings

-Insurance companies have health coaching programs to help keep their members

healthy (The BUPA Coach Program)

-Dietitians + psychologists do not need to see patients in-person

Diabetes Prevention Program Is More Effective Than Metformin for Prevention of

Type 2 Diabetes

Evidence for Telehealth Weight Management

Comparison of virtual visits, in-person visits, and self-directed dieting:

• Virtual and in-person visits were twice as likely to lead to 5% weight loss at 2 years compared to self-directed dieting

• Virtual visits had better follow up adherence than traditional in-person visits after 6 months

● VA has ongoing telemove program for weight management

1. Appel, Lawrence J., Jeanne M. Clark, Hsin-Chieh Yeh, Nae-Yuh Wang, Janelle W. Coughlin, Gail Daumit, Edgar R. Miller, Arlene Dalcin, Gerald J.

Jerome, Steven Geller, Gary Noronha, Thomas Pozefsky, Jeanne Charleston, Jeffrey B. Reynolds, Nowella Durkin, Richard R. Rubin, Thomas A.

Louis, and Frederick L. Brancati. "Comparative Effectiveness of Weight-Loss Interventions in Clinical Practice." New England Journal of Medicine N

Engl J Med 365.21 (2011): 1959-968.

2. Yanovski, Susan Z. "Obesity Treatment in Primary Care — Are We There Yet?" New England Journal of Medicine N Engl J Med 365.21 (2011):

2030-031.

Fruit Street Clinical Trial for Weight Management

“Effectiveness of an integrated digital health platform for risk factor modification

among patients with cardiovascular risk factors”

-Randomized Controlled Trial with obese patients with cardiovascular risk factors (300

patients)

-Control: Usual care seeing the dietitian in-person physical clinic

-Intervention: Dietitians seeing patients through video visits, taking pictures of food, wireless

scale, Fitbit

-Outcomes: weight, blood pressure, HbA1c, LDL-c, fasting glucose, improvements in PA,

improvements in diet, and complete rate of visits.

-Economic analysis on clinical outcomes will be conducted

Fruit Street Health PBC

Fruit Street Health is a public benefit corporation whose social mission is to

“prevent and treat lifestyle related disease using telemedicine, connected

devices, and mobile applications.

Fruit Street has raised more than $6M from 160 physician investors who serve

as physician advisors to the company

Fruit Street is a grassroots movement of physicians that want to improve health

care using technology

Financial Backing From Physician Investors

Physicians Believe in Lifestyle Medicine +

Telehealth

Throughout the US

Fruit Street Telehealth Case Study - Arthur

-Almost 700 lbs patient

-Too heavy for bariatric surgery

-Too heavy for cath lab

-Houston, TX

-Connected to virtual dietitian

-Wore a fitbit

-Download fruit street app

-Took pictures of his food daily

-Received feedback

-weekly video visit

-lost 200 pounds

Treating Disease Without Preventing It Is Like Mopping Up Floor Without

Turning Off The Faucet

Thank You!

Laurence Girard

CEO & Founder FruitStreet.com

Email: laurence@fruitstreet.com

Phone: 617-981-0920

www.fruitstreet.com