In an era of soft drink bans and restrictions on junk food ads, students at the Johns Hopkins University schools of medicine and nursing are recommending a different approach to aid the more than 170 million Americans who are overweight or obese. By publicly committing to basic tenets of healthy living — regular exercise, eating a balanced diet and managing stress — future nurses and physicians are challenging peers and practicing medical professionals to model healthy behaviors for their patients.
Supporters of the grassroots initiative called The Patient Promise say the initiative is more than an exercise in ethics or idealism — it’s their response to a growing body of evidence that suggests that personal health habits of clinicians may play a powerful role in the health of their patients.
“There’s a strong link between what doctors do themselves and what they tell their patients to do,” says Erica Frank, M.D., M.P.H., an advisor for The Patient Promise who is also a professor at the University of British Columbia in Vancouver. “If we pay more attention to physicians’ health, we’ll have a patient population that is healthier,” Frank, whose research focuses on the personal and clinical prevention habits of physicians, tells The Wall Street Journal in an interview.
While the students are just launching a formal effort to encourage clinicians across the country to sign on to The Patient Promise — philosophically and electronically — more than 250 practicing or aspiring health providers have already accepted the pledge via thepatientpromise.org. Signers, who can request periodic e-mail reminders, are asked to personally commit to practicing healthy lifestyle behaviors similar to those they ask patients to adhere to, ranging from getting at least a half-hour of physical activity daily to moderating their intake of alcohol and other potentially harmful substances.
“The Patient Promise transcends the coach-pupil relationship in which a clinician is merely telling a patient how to live his or her life,” explains David Gatz, a first-year medical student who helped found The Patient Promise with fellow first-year medical student, Shiv Gaglani. Gaglani continues, “Instead, by committing to The Patient Promise, clinicians now can invite their patients to join them as partners on a shared journey towards better health.”
First-year medical student and single mother Veronica Hocker, who was an early signer of The Patient Promise, says it has challenged her to live healthier. Hocker, who began the academic year with a body mass index (BMI) that placed her in the obese category, became passionate about making lifestyle changes after taking a week-long medical course on obesity in December — the same class that inspired Gaglani and Gatz to create The Patient Promise.
“Medical school and motherhood are overwhelming in and of themselves, without being constantly fatigued and low on self-esteem,” Hocker says. “I wanted to show others that health is a priority by first making it a priority in my own life.” Motivated to set an example for her son and build confidence in prescribing a healthy lifestyle for future patients, Hocker began watching her diet and incorporating weekly spin classes, yoga and jogging into her packed schedule. As a result, she shed nearly 30 pounds in less than five months. “With my increased energy and self-esteem, I enthusiastically try to motivate others to make similar changes in their lives,” she says.
A recent report by the Institute on Medicine (IOM) underscores the staggering physical and financial toll of obesity-related chronic disease. The clinician-directed approach of The Patient Promise is one prevention strategy recommended by the IOM to address the epidemic level of Americans who are overweight or obese.
National weight-related trends are reflected among health care providers. According to “Checking Up on the Doctor,” a Health Journal article published in May 2010, 63 percent of male physicians are overweight or obese, compared to about 72 percent of U.S. adults. Similarly, a 2011 article from The Journal of Nursing Administration states that 55 percent of nurses are overweight or obese.
The students’ rationale of first addressing the habits of physicians and nurses stems from recent research, including a study from the Johns Hopkins Bloomberg School of Public Health published in the May issue of Obesity. Author Sara Bleich, Ph.D., an assistant professor and an advisor for The Patient Promise, found that overweight or obese physicians were less likely to diagnose and discuss the health risks of obesity with their patients than their normal-weight peers.
Student supporters hope to get at least 1,000 students and clinicians to commit to the promise by the end of the summer.
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