"We try to balance the prescriptive nature of health care and medicine with the sense that people have autonomy and agency and should be directing their own health," says Cam Clayton, resident physician and co-founder of the PLM Coach program.

Image Credit: Michelle Gamage, Local Journalism Initiative

Medical students at the University of British Columbia are offering free, online preventive-health coaching sessions to all adults in the province.

Many British Columbians do not have a family doctor. When people are able to see a doctor, it’s because they want help with an existing problem, says Nicole Ketter, co-president of the UBC Prevention and Lifestyle Medicine Coach program, a collaboration between the research lab of Brodie Sakakibara at UBC and the Prevention and Lifestyle Medicine Club at the UBC faculty of medicine undergraduate medical program.

“We have a bit more time to focus on preventive care and making those lifestyle changes that can’t really be offered as easily through a doctor’s appointment,” Ketter said.

Preventive health and programs like this fill “a really important gap in the current health-care landscape that we have really been scratching our heads over,” said Cam Clayton, resident physician and co-founder of the PLM Coach program.

“We all agree that exercise, dietary change and stress management are behavioural and lifestyle things foundational to health and longevity, but we do a poor job of supporting that in the current structure of the health-care system.”

Taking a proactive approach to health care is important because once a person develops a chronic condition, there are “downhill side-effects where, often, once you get the one, it increases your risk of developing another. There’s a bit of a snowball effect,” Ketter said.

That doesn’t mean that PLM coaches will lecture you on why you should go to the gym more.

“We try to balance the prescriptive nature of health care and medicine with the sense that people have autonomy and agency and should be directing their own health,” Clayton said.

How it works

When clients sign up, they are asked to reflect on their health goals and identify what they want to work towards. The coach then helps create a step-by-step plan for how to achieve that.

The coach will be able to see only the information the client provides, Ketter added, so they’ll focus only on areas the client identifies as being important to them. The coach will not be able to access their health records, and the sessions are confidential.

A client will be paired up with a coach for about six one-hour online sessions. The online intake form asks for clients to be 30 years old and to have at least one chronic health condition, but Ketter said these requirements are “loose.”

The program’s current clients can generally be lumped into three groups, Ketter said: younger people who want to implement coping skills to support their mental health; young parents whose kids are now three to five years old and who are looking to re-prioritize their own health; and older adults who have recently retired and are looking to address chronic conditions related to older age.

However, “we take anybody and we see everybody,” she added.

Currently about 110 clients have gone through the program and there are between 20 and 25 coaches. Coaches generally work with a single client at a time, Ketter said.

Lifestyle interventions as medicine

Most chronic conditions are affected by the way we live, including the food we eat, the way we work and how active or sedentary we are, Clayton said.

People have the most success long-term if they are choosing to make lifestyle changes and receive the proper support to do so, rather than if they’re told to do something, he said.

Conditions such as diabetes, heart disease, certain cancers and multiple sclerosis can be “really, really helped by managing or changing your lifestyle towards one that’s more oriented towards exercise and certain dietary patterns,” he added.

Another program using lifestyle interventions as medicine is LifestyleRx, a diabetes prevention program. Type 2 diabetes is a disease where “you can make massive strides in decreasing someone’s average blood sugar” through diet and exercise, Clayton said. Decreasing carbohydrate intake and doing strength building and “standard cardio” can reduce blood sugar spikes and build muscle, which acts as a “glucose vacuum,” Clayton said.

“They have good data showing that they’re successful at reducing and sometimes reversing Type 2 diabetes with strictly lifestyle-oriented approaches and getting people off their medications,” he said.

Medications for chronic diseases can come with a hefty price tag.

According to the national health charity Diabetes Canada, in 2023 a British Columbian with Type 2 diabetes can expect to pay between $388 and $4,985 per year for medication and supplies, depending on their income and insurance coverage.

Lifestyle changes can also bolster mental health.

“Dancing appears to be the most potent antidepressant form of movement and exercise that integrates social connection, fun and play and improves your cardiovascular system,” Clayton said.

Exercise is “at least equal and perhaps superior” to other treatments for mild to moderate depression, he added. “Probably if you could get somebody who is severely depressed to exercise, that might help too, but often they need more support and it’s tough to engage at that level when you’re so crushed by mental health.”

Ketter noted that while a coach can help set someone up for strong mental health, they are not able to offer counselling or talk therapy because the coaches are still students. Coaches are also not able to offer specific medical advice, she added. Clients are encouraged to still ask any questions they might have and the coach will let them know what they can help with and what should be referred to a different health-care provider.

It’s also important to note that there’s much more than planning that goes into how healthy a person can be.

Social determinants of health, such as income, education, where you grew up and where you work, can have big impacts on your health. In general in Canada, the higher your income, the better your health. A data mapping tool called the Health Inequalities Data Tool shows that the lower your income, the more likely you are to get cancer or heart disease, and the lower your education, the lower your life expectancy.

Social inequities also play a big role in a person’s health. For example, Indigenous people can face high rates of racism when accessing health care and can be exposed to higher levels of pollution than urban populations because large industrial projects tend to be built close to Indigenous communities.

A meaningful experience for clients and coaches

The idea for the program emerged from the social isolation common at the peak of the COVID-19 pandemic.

Clayton and research collaborator Michelle Yang adapted an earlier program they’d created to offer a video-based health promotion program aimed at older adults to connect them with medical student coaches who could offer ongoing health promotion.

When they evaluated the updated program, they received glowing reviews from clients and coaches alike.

“The med students who participated as coaches said it was a really meaningful experience for them and their development as clinicians,” he said. “A lot of the time in the first couple of years in medical school, you don’t actually get much contact with patients. For a lot of them it was their first longitudinal experience working with folks on their health, and that can be quite a powerful experience.”

“Based on that really positive feedback from patients and students, we were like, ‘This probably should just be a thing,’” Clayton said.

— This story was originally published by The Tyee

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