Mental health is often viewed as a category in its own right when considering patient care. However, mental health and physical health are intricately linked. And as a practicing endocrinologist, I see firsthand how the two are intertwined. In the past, I have worked with patients whose diabetes was out of control and whose underlying anxiety or other mental health concerns prevented them from focusing on managing their diabetes. Focusing on building trust and addressing mental health concerns is often an essential first step before discussing diabetes management in more detail.
Multidimensional chronic disease management programs must include a mental health component, as there is an increasing emphasis on providing care that is more aligned with the health of the whole person. During my career, I have focused a lot on treating obesity with an emphasis on mental health and helping people make sustainable lifestyle changes to prevent downstream effects such as diabetes. I have spent a lot of time. My own experience and industry data support a more holistic approach to managing chronic disease, time and time again.
Why chronic care management is becoming increasingly complex
The prevalence of both chronic diseases and mental health conditions is increasing for a number of reasons. Eating healthy food has become harder and more expensive, our jobs today are more sedentary and we’re in front of screens more than ever, and that’s putting a strain on our health. It has a direct impact. Sleep, mental health, and activity. The chronic disease epidemic is an overwhelming problem that requires change at many levels and will require empowering broader groups of individuals. Change is also needed at the societal level. We can do more to ensure that individuals and their care teams have access to meaningful health guidance in this complex world.
Consider how we manage obesity, a disease that is often closely linked to the management of diabetes. There are many potentially serious complications and conditions that result from obesity. In recent decades, driven by organizations such as the American Medical Association and other patient advocacy groups, we have begun to think of obesity as more of a chronic disease than just a behavioral condition. This change reframes the way we treat obesity, rather than seeing it as vanity or a lack of willpower. Although advances have been made in the scientific and clinical understanding of obesity, quality obesity treatment and management involves multiple considerations, and managing expectations for all of them can be difficult. While there are lifestyle behaviors that you technically have control over (nutrition, activity, sleep, stress), they are heavily influenced by the social determinants of health. There is interaction with health care providers for appropriate testing and treatment, but timely access to quality health care providers may be limited. There are also insurance coverage issues that greatly impact the appropriate treatment of obesity. And, of course, there are also issues related to stigma, which can exacerbate existing mental health issues. Similar multifaceted challenges exist in other chronic diseases such as diabetes.
Successful long-term chronic care management requires a comprehensive approach
We find that the most successful chronic care management programs focus on four key health behaviors that are the pillars of healthy lifestyle changes for individuals: nutrition, physical activity, sleep, and stress. I did. Self-monitoring (e.g., regularly weighing yourself and logging your diet) is also important to draw connections between behaviors and health outcomes.
It is also important to provide people with access to the clinical support they need and access to health care providers with the most appropriate clinical experience. Returning to the case of obesity, this includes physicians specifically trained to remove bias in treatment approaches and physicians well-educated in GLP-1 and how to safely administer a wide range of anti-obesity drugs. may be included. Medication adherence support is also beneficial for many people with chronic illnesses, helping them understand when medication is right for them.
Everyone benefits from basic health education on principles around nutrition, physical activity, sleep and stress, layered with flexible, personalized care. It’s not just calories that are important, nor is it just diet and exercise. Part of the big change is understanding that there are many more behavioral components to weight loss and weight regulation. There is no one-size-fits-all approach to weight loss, and that applies to all chronic health conditions, such as diabetes.
Chronic disease management is long-term. Building skills that last a lifetime requires ongoing effort. By applying technologies such as machine learning and AI, digital tools can personalize the experience by providing targeted reminders and increasing engagement.
Taking mental health support one step further
Through integrated mental health care, mental health issues are addressed as a foundational component or alongside chronic care management. However, it is most beneficial for patients to receive mental health support that is tailored to the specific chronic care management challenges they are experiencing. For example, this could mean specific psychiatric support for diabetes distress, or cognitive behavioral therapy-based support for challenges related to weight management such as body dysmorphia, ‘all-or-nothing’ thinking, or bulimia. It may look like.
Flexibility of approach
There is a saying in nutrition that the best diet is the one you can stick to. Nutrition aside, when we think about approaches to lifestyle modification in general, we all have different preferences, needs and possibilities. Flexibility in the individual approach is essential not only to improve outcomes but also to ensure patients adhere to their treatment plan. When considering combining cultural preferences, social factors, physical and mental health considerations, no two patients are the same, so flexibility in approach, tools and support is required. Two different people with the same condition may have two completely different focuses. Treating an obese person who suffers from emotional eating will be very different from treating someone with a movement disorder.
Virtual care and digital tools can help fill a critical gap by providing daily support for behavior change that is typically difficult to achieve with just a one-off visit. Treating chronic conditions is not just about the number on the scale, blood sugar levels, and BMI; it’s important to take a holistic approach to a patient’s mental health and overall wellness. Providing chronic care management and mental health support in tandem is critical to successful health outcomes.
Employers and health plans should look for programs and solutions that are flexible when it comes to treatment options and address these four fundamental pillars. Successful management of chronic diseases depends on empowered individuals, accessible high-quality health care teams, and a strong foundation of healthy behaviors.
Photo: Alexandra Florian, Getty Images
Dr. Tejaswi Kompala leads clinical strategy for cardiometabolic diseases at Teladoc Health. She is board certified in internal medicine and endocrinology and is a practicing endocrinologist with special interests in diabetes care, diabetes technology, diabetes prevention, obesity, and weight management. Her interests include innovative chronic disease care models in primary care and virtual care settings with a focus on population health management and technology integration.
