dventists around the world have been experimenting for decades with how to best deliver the biblical principles of healthful living to populations that urgently need new lifestyle practices. Adventist Review editor Bill Knott recently sat down with Dr. Wes Youngberg, director of the Lifestyle Medicine Clinic with the Rancho Family Medical Group in Temecula, California, to talk about the innovative program Youngberg helped to launch in the U.S. territory of Guam.
KNOTT: How did a boy from the snows of Michigan end up
running a wellness clinic on a tropical island in the Pacific?
YOUNGBERG: I had encouraged a colleague, Dr. Gerard McLane, to consider setting up a clinical preventive care program when he moved to Guam in the early 1990s as a medical missionary at Guam Seventh-day Adventist Clinic. That was the beginning of a structured, full-time lifestyle medicine program on Guam. After being there two years Gerard called me and said, “Wes, how about taking my place in Guam?” Of course, I laughed! I didn’t think our young family was ready for a move of that kind. But we started praying about it, and God clearly opened and closed the right doors. Little did we know we would stay on Guam for 14 years.
The Guam Clinic was already a good-sized institution from what I’ve heard, with a surgery center, dental and eye departments, and a primary care department. What was the lifestyle medicine program like when you arrived?
Dr. McLane and his wife, Kathy, had already made a huge impact on Guam by teaming up with the governor’s wife and running a vegetarian cooking school at the governor’s mansion. I was able to see referral patients and further develop group intervention programs designed to help patients understand what they could do to improve their clinical situation and decrease their risks. Then the medical directors suggested we branch out to add a full-fledged wellness center to the other programs. We brought in Dr. Charles Brinegar, a leading diabetes expert, to help us launch that initiative, while I served as the Wellness Center’s first director. We joined forces and established a very comprehensive lifestyle medicine emphasis to support what he and the other physicians were doing on the medical side. We then recruited Dr. Keith Horinouchi, a lifestyle and nutritional medicine specialist from Hawaii.
Neither the larger clinic nor the Wellness Center were residential facilities, from what I’ve heard. Isn’t that a bit unusual for lifestyle medicine programs?
We initially developed programs for patients to come in for one to two hours at a time to experience an intensive program dealing with their medical condition or their health risk factors. They would attend that program for anywhere from four to ten weeks, all on a community outpatient basis. There was no live-in component, and so our costs and overhead expenses were minimal.
What are the advantages to that kind of arrangement?
The ideal situation for a wellness center of the kind we launched is to be affiliated with some type of medical group or a group of health professionals who already have a functional structure, a medical group building, or offices of some kind. Their patient base is the primary audience for the wellness programming that will be done. Patients are walking through the doors for regular primary care purposes. All that’s needed beyond that is to have a consult room and a classroom that can seat anywhere from 10 to 30 people. Those are the main requisites for starting a lifestyle medicine program anywhere in the world—just work with the system that’s already in place and expand it, using those criteria.
That sounds like a model that could be replicated in other places around the globe, where there may not be a lot of capital for bricks and mortar.
You’re right—it can be done in a hospital setting where you have a lot of patient flow going in and out. You can operate a wellness program like this in a regular medical group setting. Or you can even do it, as some doctors do, in a hotel setup where all you have is an office, a central location, and an arrangement with the hotel to use their conference room space for groups, along with access to their recreational facilities. The key when starting a lifestyle medicine program is making sure you hire somebody well trained in the discipline. It’s a specialty niche. You need somebody who isn’t just competent but who excels, so that it will attract people to the program. Other specialists or primary care providers will then feel comfortable referring their patients. The primary care providers are delighted with their patients’ health improvement, and those of us who see our mission in life as promoting a healthful lifestyle feel like we’re making a lasting contribution to people’s lives.
At the end of the day, then, you win supporters in the medical community for wellness and lifestyle medicine by actually providing hard evidence that their patients are making significant improvements in measurable factors they’ve been monitoring.
Yes, that’s the key. The program has to be comprehensive enough to make a difference in the patients’ lives. In many locations, especially in churches, well-intentioned persons will launch programs that are one-time hour-and-a-half presentations of a topic. That may generate a lot of interest, but it’s not a program that’s going to get results, because there’s no evaluation, there’s no real intervention; it’s just information. So the key is to move away from the traditional health-education approach where information is just being disseminated. You need a program that involves pretesting, intervention, posttesting, reevaluation, and further intervention. People with chronic conditions such as diabetes, hypertension, and heart disease typically see their physician every three months. That’s where the program developed at the Guam Adventist Wellness Center really shone, because it met the needs of patient and physician alike.
As it matured our lifestyle medicine program typically tracked with patients for nearly six months, gradually decreasing the frequency of their meeting schedule as they showed evidence—including in their lab results—that they were grasping and applying the principles of diet, exercise, and life management we were showing them. From a schedule that began with a five-day-a-week regimen, including a buffet dinner and two take-home meals each day, we graduated them to an every-other-week support meeting that helped them to maintain the new behaviors they had learned and to continue succeeding. The challenge of residential programs is that they’ll do wonderfully during the ten days to three weeks that they’re in the program, but then they go back to an area where they have no support structure and they’re left to their own devices. Our program in Guam allowed us to provide follow-up indefinitely, even for years, after they completed the six-month program.
What results were typical of persons who tracked with you for these multimonth programs?
About a third of the patients would pass through the program, be interested, and do well for the first two weeks, and then the cares of this life and the challenges with the family or at work would distract them and they’d slowly go back to their old lives. Another third would get good marks and do moderately well over time. The results weren’t quite as good as they were during the first month of the program when they were really, really consistent, but they got significant long-term benefits. The final third really caught the vision. They saw the potential challenges down the road. They saw the red flags, and they realized that they couldn’t live the way they had been, that they were at high risk of serious health consequences. So they purposed to be very consistent, continued to do their medical tests, and continued to reach even better results than they had initially, because the body continues to adapt and improve based on long-term lifestyle intervention.
You sound like a man who finds a lot of joy in watching other people enjoy healthier and more balanced lives.
If I knew of something more fun than this, I’d be doing it.
Wesley Youngberg, D.P.H., M.P.H., CNS, is director of the lifestyle medicine clinic with the Rancho Family Medical Group in Temecula, California.