NYC Health & Hospitals designs plant-based diet program to help patients with chronic disease

In the past few years, a growing number of studies have shown that plant-based diets can help prevent and even reverse chronic conditions like heart disease, Type 2 diabetes and obesity.

As an example: a 2015 meta-analysis in the Journal of the American Heart Association found people who adopted a vegetarian diet lowered their cholesterol levels, which can reduce the risk of heart disease.

Backed by this evidence, as well as advocacy from Brooklyn Borough President Eric Adams, NYC Health & Hospitals/Bellevue was motivated in November 2017 to develop the Plant-based Lifestyle Medicine Program, which offers patients with chronic diseases support services to transition to and stick with eating vegetarian. The public health system has invested $400,000 for the pilot program, which officially kicks off Jan. 16 with more than 300 patients.

Interest in the program is much higher than the hospital expected. The pilot—and funding—was originally designed for 100 patients. “Now that we have seen the response, we are going to do our best to reach as many patients through the funding period,” said Dr. Michelle McMacken, an internist at the health system and director of the program.

The pilot period is slated to run until October. Only patients with Type 2 diabetes, pre-diabetes, high blood pressure, high cholesterol, excess weight or heart disease can participate. Patients with those conditions were targeted because that's where evidence most strongly shows plant-based diets can help reverse or lower severity.

Through the funding, NYC Health & Hospitals hired a full-time health coach and dietitian. Four physicians, including McMacken, are also part of the program.

Initially, physicians will conduct a full medical assessment of each patient, including a discussion of disease history and drug regimen. They'll also review the patient's personal health goals and any social barriers that could hinder participation. The physician, health coach and dietitian then create a plan tailored for the patient's specific needs.

McMacken said it will depend on each patient, but they will likely meet with a doctor every two months to review progress in the program and to determine if any medications can be adjusted or stopped. “I've found in my personal experience when patients change their diet explicitly to a plant-based diet they require fewer medications,” she said.

Patients will likely meet or speak on the phone with the health coach and dietitian every two weeks. Both the coach and dietitian are trained chefs, so they can provide recipes and offer cooking classes to patients, keeping in mind patients' cultural preferences and financial barriers.

McMacken said the program will focus on affordable healthy food options like lentils, beans, chickpeas and root vegetables. Although McMacken was unable to provide the insurance makeup of the 300 participants, Bellevue has a large Medicaid population. The program can be covered by insurance. For uninsured patients, payment is arranged on a sliding fee scale based on income.

One participant, Arlene Marie Karole, 53, is eager to have additional support as she tries to eat healthier. Karole was diagnosed with breast cancer in 2015 and although she's in remission, it was a wake-up call to make lifestyle changes. She learned about the program through Twitter. “I'm looking forward to the coaching,” she said. “It's very different to have a coach, someone working with you, taking your blood work.” Karole said she would like to lose 30 pounds.

Along with helping patients change their diet, the health coach will also focus on other lifestyle issues like sleep habits, stressors, physical activity and smoking.

McMacken said the program was designed in part by looking at practices at other hospitals. A growing number of facilities have adopted similar programs, including Barnard Medical Center in Washington, D.C. It conducted National Institutes of Health-funded clinical trials, one of which found Type 2 diabetes patients on a vegan diet were more likely to reduce the need for medications than other patients. “I have no doubt that whatever (outcomes) Bellevue is looking to meet, it will,” said Susan Levin, a Barnard dietitian.

To test the program's effectiveness, McMacken will monitor how participants' clinical outcomes change, including blood pressure, blood sugar and weight loss. The long-term feasibility of the program and barriers to effective execution will be examined as well.