Primary care physicians Dr. Barbara A. Brown and Dr. Lynn B. Kossow have added a new dimension to their practice at 731 Alexander Road: Princeton Lifestyle Medicine.
“Lifestyle medicine interventions, including diet, exercise, smoking cessation, and stress reduction, have been shown to help prevent and/or reduce the incidence of many diseases, such as diabetes, high blood pressure, high cholesterol, and obesity,” explain the doctors. “There is now an ever-growing body of evidence showing the effectiveness of lifestyle interventions for lowering the rise of developing chronic diseases, as well as for assisting in the management and possibly the elimination of many existing chronic conditions.”
An important aspect of lifestyle medicine is that it is evidence-based. Drs. Brown and Kossow emphasize that a substantial amount of scientific evidence exists demonstrating that positive life-style changes can indeed make important differences in one’s health. This is not holistic or alternative medicine, they add.
“It is estimated that lifestyle factors, such as chronic stress, poor diet, obesity, physical inactivity, lack of connectiveness and support, cigarette smoking, and excess alcohol consumption, result in a 72 percent increase in deaths from heart attacks and strokes and a 44 percent increase in deaths due to cancer,” notes Dr. Kossow. “Research has shown that physician counseling about these lifestyle factors can help patients reduce the incidence, and reverse or slow down the progression of these diseases.”
Several medical institutions are now including lifestyle medical education opportunities. Among them are the Harvard Institute of lifestyle Medicine (affiliated with Harvard Medical School), the American College of Lifestyle Medicine, the Institute of Lifestyle Medicine, and the Cleveland Clinic.
The goal is to reduce or eliminate many prevalent diseases by helping patients adopt changes for the long-range that will benefit their health. The idea is not a quick fix, but a sustained, on-going focus on exercise, healthy diet, and stress management.
For example, weight is an issue for many people today, notes Dr. Brown. “People can lose 10, 20, 30 pounds on a diet, and then gain it all back. This happens frequently. They are basically still doing the same thing. What we do is take time with the patients to help them understand what underlies the problem and together, with them, devise a change in their lifestyle.”
The active engagement and participation of the patient is crucial, emphasizes Dr. Kossow. “The idea isn’t that I am going to tell them to exercise 30 minutes a day. That’s obviously not working. Instead, we delve deeply into what is making it difficult for them, and then, the idea is to come up with a plan they feel they can stick to and enjoy. Perhaps they can squeeze in 10 minutes of exercise during their lunch hour. But I don’t know about their lunch hour. They do, and so, together, we can come up with a plan.”
Dr. Brown agrees: “We are not telling them what to do. We are asking them what they feel they can do.”
No doubt, many physicians advise their patients to eat healthy diets, engage in exercise, stop smoking, and adopt stress-relieving techniques. What is different about lifestyle medicine is the time element, the opportunity to spend more time with a patient, points out Dr. Kossow. “There is never enough time today. A typical office visit is often 15 minutes, and the doctor is often rushing to diagnose and prescribe treatment. There is little time to talk with the patient about the underlying problems.”
Indeed, time vanishes quickly today. Our increasingly high tech society emphasizes speed. Everyone is rushed, and this affects many areas of one’s life — from time management to eating. As Dr. Kossow reports, “There are many difficulties today. An example is that so many people are in a hurry, so they emphasize take-out or fast food instead of preparing a healthy meal at home.”
Board-certified in internal medicine and a graduate of the University of Pennsylvania School of Medicine, Dr. Kossow has practiced for more than 20 years. In addition, she is an attending physician at the University Medical Center of Princeton at Plainsboro and an assistant clinical professor of medicine at the Robert Wood Johnson School of Medicine.
A graduate of the Robert Wood Johnson School of Medicine, Dr. Brown is also board certified in internal medicine, practicing for 19 years. She is an attending physician at the University Medical Center of Princeton at Plainsboro and a clinical professor of medicine at the University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School.
Both physicians are members of the American College of Physicians as well as the American College of Lifestyle Medicine.
Practicing together for 16 years, they wanted to find a way to spend more time with a patient in order to discover in detail what he or she is facing, and to help the patient truly engage in positive lifestyle changes.
“We have really been trying to do this for years, but were always so limited by the amount of time we could spend with a patient,” notes Dr. Brown. “We decided to take a course at the Harvard Institute of Lifestyle Medicine, and this led us to add this concept to our practice. Now, we can focus on a different way of helping patients. We work as healthcare coaches, asking patients what it is they want to change, and counseling them.”
With positive lifestyle choices, there can be less reliance on medications. When appropriate, however, Dr. Brown and Dr. Kossow prescribe medicines, as well as all needed vaccinations.
A patient who enrolls in the Princeton Medicine Lifestyle program pays an initial fee of $1,000, which is not covered by insurance, but can be paid in installments. In addition to a medical evaluation, this entitles the patient to specialized care and counseling. As the doctors explain, “In order to practice lifestyle medicine, we will need to spend significantly more time with each of our lifestyle patients. We will begin each program with an initial one-hour consultation. This will help us to understand your lifestyle, including your eating habits at home and in restaurants, your work habits, exercise habits, and the factors influencing the amount of daily stress you experience.
“We need to understand details about your life in order to customize a comprehensive individual lifestyle medicine program that will work for you. We will then add extra time to your non-urgent follow-up visits and yearly physicals to support you through any individual obstacles you may encounter, and to help you sustain these changes as you succeed over time. We will also be available to you via email and telephone on weekdays to help you with the lifestyle changes you are choosing to make.”
So far, most of the lifestyle medicine patients are those whom the doctors have been treating in their regular practice. However, the Princeton Lifestyle Medicine program is open to everyone, including individuals who are seen by other primary care physicians.
“This is much more personal medicine,” notes Dr. Kossow. “We help each patient understand that lifestyle changes can profoundly affect their health and that it is based on scientific evidence. I love the close relationships I develop with patients, and it is wonderful when I see the different generations in the same family: grandparents, parents, and kids after they are 18. What I really love about the practice of medicine are its challenges and mysteries. I want to help people live healthy lives, and we find that the patients are thrilled when we are now able to spend a lot more time with them, and that we can come up with a plan to benefit their health.”
Dr. Brown echoes that view. “I love the medical relationship and partnership with patients, and getting to know them as people. And one of the awesome things about practicing medicine is that there is always something new.”
In the case of lifestyle medicine, it may be a new approach to the practice of internal medicine today; however, its underlying concept goes back to the very beginnings of medicine, to the days of Hippocrates, who said: “Let food be your medicine … and walking is man’s best medicine.” Some ideas do stand the test of time!
Princeton Lifestyle Medicine offers hours by appointment. (609) 655-3800. Website: www.princetonprimary