Wendy Wiernik was sitting in her car, just after a doctor’s appointment when it hit her: She was not going to get diabetes. She started crying.
Wiernik, a 42-year-old mother with two jobs and a family history of depression and diabetes, weighed more than she should and had been flagged as “prediabetic” half a year before. That’s when her physician’s assistant made a surprising suggestion. Instead of writing her a prescription or offering her medical treatment, the PA suggested that Wiernik sign up for a diabetes-prevention class at the YMCA.
She was one of the first participants in a program that is now spreading around the country and upending traditional ideas about how to deliver medical care. Through a year of classes led by a trained lifestyle coach, the Y has been able to help about 60 percent of participants lose 5 percent of their body weight and dramatically reduce their chances of developing a dangerous (and expensive) chronic disease. “The biggest challenge we have is [that] doctors scratch their heads when you say you want them to send their patients to the Y,” says Jonathan Lever, the association’s vice president for health strategy and innovation, who helped launch the program. “We’re not a usual actor in that space.”
But it is a very effective one. A series of studies found the YMCA class outperformed any other treatment for people like Wiernik who are likely to develop the disease. In a clinical trial, the approach worked so much better than a diabetes-prevention drug that researchers stopped the trial midway because continuing to deny everyone access to the class would have been unethical. “This is the most evidence-based program for the prevention of Type 2 diabetes for those at high risk,” said Ann Albright, director of the division of diabetes at the Centers for Disease Control and Prevention.
All of the finalists National Journal honored in the category of innovative health care programs found smart ways to address problems in this field. But we chose the YMCA as the winner because it confronts a major medical challenge with a simple and cheap solution that offers long-term rewards. Some 26 million Americans are currently diagnosed as diabetic, a number that keeps growing, along with the cost. Altogether, diabetes cost our health care system about $245 billion last year in direct medical costs, according to the American Diabetes Association.
Even for individuals, the cost implications are huge. On average, the YMCA course costs about $400. But a person who develops diabetes can cost the health system $12,000 to $15,000 a year, says Timothy Koehler, president of the Diabetes Prevention and Control Alliance, a part of UnitedHealth Group. “The return’s really a no-brainer,” he says.
The classes aren’t complicated, and they work. Every week for 16 sessions and then monthly for the rest of a year, a group of eight to 15 people get together with a trained coach and talk about strategies for eating fewer calories and exercising more. They learn to keep track of what they eat and brainstorm ways to change their lifestyles. If you park at the far end of the parking lot, you can get in an extra three minutes of walking to the grocery store. If you have a bad day, just start again tomorrow. The “secret sauce,” Lever said, is the well-trained, upbeat coaches, and the advice and support class members offer one another.
People enrolled in the program lose the weight and reduce other diabetes risk factors. Even 10 years out, their risk of getting diabetes is reduced by more than a third. At Wiernik’s six-month appointment, she learned that through small diet changes and daily walks on the treadmill, she’d cut her blood glucose level in half and reduced her hemoglobin A1C level — a key diabetes indicator — by a full percentage point. “I just started crying, because it’s like, this can be prevented,” she says. She also lost 40 pounds over the year, bringing her down to 140.
Insurance companies have started to catch on. Now 37 different health plans include the YMCA program as a covered benefit, and more than 10,000 people have completed the class. CDC has developed standards to certify other community groups that want to offer the program.
It’s a model likely to be copied. Similar courses might be able to help at-risk people manage arthritis, reduce their risk of hypertension, or prevent falls. And in a country coping with a shortage of primary-care providers, there’s no shortage of YMCAs: 60 percent of Americans live within three miles of a Y, and the class is low-tech — it can happen in a classroom, a doctor’s office, or even a kitchen. It shows how prevention doesn’t have to be medical to make a big difference in people’s health.
See the finalists in each category: Digital Innovation | Expanding Exports | Workforce Training | Health Care | Financing Infrastructure | Disrupting Government | Regional Economic Strategies | Education | Energy