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One Physician’s Journey

By Elisabeth Fontaine, MD

My passion as a physician has always been to keep my patients healthy, and my vision is to develop a Lifestyle Medicine Clinic as a transformative adjunct of the wellbeing visit, to teach individuals about the importance of their health.  In redefining the norm as being healthy, we will need to stop the stigmatization of obesity, overweight and chronic disease and transition to the simple desire to feel good.

I started in the direction of my interest with a degree in Physical Education and a Master in Exercise Physiology. Then, captivated with the approach as a provider of health, I became a physician — first as an OB/GYN but more recently as the Medical Director of Lifestyle Medicine (Northwestern Medical Center, a community hospital in St-Albans, VT). As a medical doctor who has seen the demographic characteristics of my patient population change over time, I have witnessed the change in health of my patients within the last decade and have become an advocate of returning to health, or even better, to remain at health.

The rise in chronic disease and related healthcare spending in the United States and in many other countries around the world is unsustainable. Eighty percent or more of all healthcare spending in the U.S. is tied to the treatment of conditions rooted in poor lifestyle choices.

My work as an OB/GYN was fulfilling and extremely busy. But over time, because I could witness some significant changes in my patient’s health, I decided to voice my concern to them.  I first used the proper channel and encouraged them to see their primary care physician. However, they would return to me on medications but without any attempt to make lifestyle modifications. That was the reality check.   So I started using my knowledge in nutrition and exercise to help them reverse or improve their health.

At the time, I was involved with the American Heart Association for the Go Red for Women luncheon. What a fantastic event, regrouping over 500 women. It was a great occasion to demonstrate how lifestyle changes could impact the health of individuals.  I spearheaded a 12-week program on lifestyle education and exercise called BetterU.  We saw significant improvement of our patient’s health. But we also faced the inevitable… the return to their habits and chronic disease.

Sustainability is a very difficult goal to accomplish. I struggle with it.  Besides, there is so much more to it than what people eat and how they move. The entire social environment of my patients was insecure. I trained myself and my team to become health coaches and to not only coach the individual but to also “coach a village.” We were learning not to tell them what to do but to listen to what they wanted to do. What was needed for them to be their best self?  Eventually, these coaches became embedded in the community to support individuals in their effort of remaining healthy.

This prior work was a great bridge with our Community Committee on Healthy Lifestyle that was officially started in Vermont in June 2015: RiseVT.  RiseVT is a community collaborative to embrace healthier lifestyles, improve the quality of life and lower healthcare costs where we live, work, play and learn. A movement began to happen as more people talked about what we were doing.  We had health advocates working at the school level, in the community and at the worksite.  Early results were taking place. The story was evolving and becoming real.

As part of the visionary group in RiseVT I became aware of a European group that had great success with decreasing childhood obesity: EPODE (Ensemble prevenons l’obesite des enfants: Together let’s prevent childhood obesity).  The EPODE model enables communities to implement effective and sustainable strategies to prevent childhood obesity.  EPODE methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases. Their early studies allowed them to identify 4 critical factors that form the four main pillars of the EPODE methodology. The first is political commitment from the local community, to the state and federal level. The second is public-private partnerships that secure sufficient resources to fund of the operation and assure its sustainability. The third is planning, coordinating actions, and providing the social marketing and support services at community level. The last pillar uses evidence from numerous sources to guide the implementation of the EPODE interventions and evaluate outcomes. Implementing them in our local initiative was bold but the impact is now bringing us to a state level stakeholder group and I have the chance to work with this team in order to scale up RiseVT toward reducing childhood and adult obesity.

As all this developed in our short period of time and on a restricted budget, the leadership team at Northwestern Medical Center went from non-believer to discussing our place as a top priority in their strategic planning.  The Lifestyle medicine team developed.  My first task was to work on our mission and vision yet in order to operationalize all of this I needed a detailed plan to guide our journey that would allow flexibility while redefining a new concept of wellbeing without stigmatization. This was a new territory for most of us; it is transformational.

I joined the American College of Lifestyle Medicine and eventually started a clinic. It has not been an easy task. There were few believers at first and lots of resistance from my fellow physicians, which is still present. There was a lot of frustration on my part as things were going too slow.  Our lifestyle is killing us and we are watching the wave taking us without reacting.  I realized that despite of my passion and vision I was not able to make people follow me. To make my endeavor a reality I needed more than just passion.  So I began to learn mindfulness.  I learned to listen better, I practiced empathy, and I learned to understand and appreciate my resistors.

Having no background in either business or leadership, I started working with people who had these qualities and shared my vision. But I did not see the results that I was hoping for.  I soon realized that I needed to learn how to be a leader and develop my own business plan.

My definition of a “Leader” was one of authority: a person who holds a dominant or superior position within his or her field, and is able to exercise a high degree of control or influence over others.  But this was not anything I could stand for. I then had the chance to meet a person who offered some clarity. A true leader has a vision and a passion, is motivated and relentless, works for the better good of others, and is dedicated to something that is bigger and better than themselves, while still maintaining a strong level of humility. I became interested in knowing more.

The biggest impact happened when I read the “Pebble in the Pond” (from the Leadership Program in Integrative Healthcare at Duke) and Good to Great by Jim Collins. Both have an amazing story and were eye opening on leadership. That knowledge basically gave me the permission to see myself having some qualities of a leader that would allow my role as caregiver or provider to be inclusive. We are talking about mindfulness, ownership, appreciative inquiry, multiplier leadership and many other skill sets…. I am grateful for having all this knowledge coming to me but how different my practice would have been as a physician or even as a simple human being if I had been exposed to this earlier in my career.  Let’s teach others.


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