Health Achieved Through Lifestyle Transformation (HALT): The Power of Lifestyle to Reverse Chronic Disease


Rajiv Misquitta, MD, FACP; Rachel Kitazono, PsyD; Lisa Edwards, RD, MBA

Objective: To assess the effectiveness of a multidisciplinary lifestyle program on improving health metrics related to heart disease and diabetes using existing resources at Kaiser Permanente South Sacramento.
Design: We sought out patients with diabetes or coronary artery disease for participation. Patients initially engaged in an 8-week lifestyle program that focused on a low-fat, whole-foods, plant-based diet; exercise; and stress reduction. The program was later expanded to a 20-week evidence-based behavioral change program along with weekly follow-up classes. This program was led by a physician. Health educators taught the classes with psychologist support. Cooking demonstrations were included in the classes. We surveyed outcomes from 4 cohorts of patients.
Main Outcome Measures: We collected data from the electronic medical record on weight, lipids, blood pressure, diabetes control (hemoglobin A1c [HbA1c]) and exercise. We also collected survey data on dietary compliance using a food frequency survey and mental health measures using the short form (SF-20) survey.
Results: Program attendance in all 4 cohorts ranged from 78% to 92%. Average minimum weight loss at 6 months was approximately 16 lbs. For cohort 1, average weight loss at 1 year was 24 lbs. In all cohorts, there was a trend towards reduction in blood pressure, low-density lipoprotein cholesterol, HbA1c, role functioning, body pain, health perceptions, physical functioning, and reduction of medications for diabetes. Spousal participation in the program was a predictor of success. Three patients fully reversed their diabetes.
Conclusion: This is an example of a successful, multidisciplinary program focused on behavior modification that has the potential to reduce medication costs, improve quality metrics for heart disease and diabetes, and reduce obesity and associated sequelae. HALT uses existing resources that are readily available. We have demonstrated the reversal of diabetes in some patients, a feat that cannot be done with medications.


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