May 12, 2017
Area(s) of Interest: Patient Education Women's Health
Preventing type 2 diabetes requires self-management, motivation, and healthy lifestyle changes — but how do you encourage patients to improve their health while caring for the health of others?
This is a common question Catherine Gutfreund, M.D., a primary care physician at Kaiser Permanente, encounters while caring for busy moms and families in her practice.
Caring for Mom: A Unique Kind of Patient
As a family physician, Dr. Gutfreund has cared for mothers from diverse family settings—single mothers, full time working moms, women with several children and the "sandwich generation" mom, caring for children and elderly parents.
While each of her patients grapples with their own barriers and lifestyle factors, when caring for mothers, one prevailing trend usually emerges: "Mothers are under tremendous time pressure and have a tendency to prioritize everyone over themselves," Dr. Gutfreund said.
During appointments, she’d often see women who had delayed addressing their own medical issues to care for a child’s ailments, meet the demands of a career, lead busy households, and juggle countless other responsibilities. Moms swirling in a vortex of demands also present a unique challenge for physicians.
"Because they put caring for so many people above caring for themselves, often, we’d have to play catch up [with managing their own health]," Dr. Gutfreund said. "We’d have to catch up on controlling their blood pressure or catching their diabetes instead of preventing their diabetes. They often come in when things have gotten out of control."
Mothers, unlike their childless friends, are deeply connected to a network of daily stressors, which impact their health and the health of others around them. Finding the work/life/family balance can be difficult.
That’s why Dr. Gutfreund encourages physicians to build effective relationships with moms by strengthening partnerships with their children, spouses, families and communities.
How to Help Mothers Prevent Diabetes, Improve Health Outcomes
To help mothers avoid chronic disease and live a healthy lifestyle, she recommends physicians try these six clinical tips:
Ask the right questions about her family dynamic and support system. Before prescribing a care plan, Dr. Gutfreund always asks mothers about their entire family system to ensure any recommendation she makes aligns with her patient’s reality and is culturally competent – not a template prescription.
She routinely asks about intimate partner violence (one in four women are victims). Women’s chronic health conditions worsen if they are victims of violence – they can’t "thrive" if they’re just trying to survive.
"One of the great things about being a family physician is that I take care of more than just the mom," Dr. Gutfreund said. "I also care for kids, spouses, and sometimes extended family members. I have a family that I have cared for the past 17 years that covers five generations, I have had to learn the complex family dynamics to better support the matriarch, who is a brittle type one diabetic and to help guide her family to a healthier lifestyle choices."
In conversations with mothers, she recommends physicians consider key questions, such as:
- What’s her family support system like?
- What are her feelings of self-efficacy?
- What goals does she wish to achieve but feels too busy to accomplish?
- What small step could she start today?
- Are there any people in her life who may be effective allies?
"Think about the way you communicate," Dr. Gutfreund said. "So that instead of walking into a situation and being prescriptive, you’re having a conversation to understand your patient’s [health], what they’re dealing with, their barriers and abilities to manage their conditions. Social determinants of health are something to address. For example, not everyone has access to healthy foods or live in a safe neighborhood where they can easily just go for a walk to get exercise."
Remind mothers of their power and influence.
While it may be tempting to urge mothers to "put their health first," Dr. Gutfreund suggests a different approach.
"Many mothers take pride in their ability to take care of others," she said. "So it’s helpful to frame your advice or interactions with patients [by reminding them] that taking care of themselves empowers them to take care of their family members. I remind them: as they say on an airplane ‘put on your oxygen mask first before helping others.’ I also try to motivate her to be an example of health to the ones she loves."
Set small goals and give her a chance to suggest ways to accomplish.
In practice, Dr. Gutfreund found that her patients were often the best partners to consult when creating an effective care plan. Women can come up with effective solutions when given a chance.
To encourage lasting behavioral changes, she recommends physicians help moms identify concrete goals that align with people or things they find meaningful. Then, give them a chance to outline baby steps to accomplish these goals. Make for certain you follow up via email or at the next visit to celebrate even small successes.
"Usually when you sit back and listen to your patient, she will figure out a plan for herself," Dr. Gutfreund said. "As a physician, it is better to partner with them as this creates more engagement. When I give my patient a chance, she thinks of with creative ideas that will work best for her. I get her to state a small thing she is interested in doing like taking a short walk with the kids and choosing a healthier snack."
As you work with her to set goals, let her know that she doesn’t need to work alone to accomplish her health goals and that everything not need be accomplished all at one time. For example, if she has prediabetes you can refer her to a CDC-recognized lifestyle change program, which will offer education and group support as she seeks to make healthy changes to prevent the onset of type 2 diabetes.
Suggest turning "down time" into quality time with the kids.
This is especially helpful for patients who are single mothers because they routinely lament not having enough "quality time" with their children, Dr. Gutfreund said.
She encourages mothers to replace the passive downtime of scrolling phones and watching television, (by setting limits or better yet turning them off) —with healthy activities that support family-bonding.
For instance, "One of my most successful moms, in terms of losing weight and changing her lifestyle, started walking the track at school while her children had after school activities, rather than waiting in the car looking at social media. She also had her children help with meals where they connected and talked about their day while cooking healthier meals. She found that the kids would try new healthier foods if they assisted in preparing it."
Educate expecting mothers on gestational diabetes.
Many of the same women who are at-risk for developing type 2 diabetes are also at risk for developing diabetes during pregnancy.
"Pregnancy is a super interesting time [for patients] because women tend to be really engaged with making healthy choices," Dr. Gutfreund said. "It’s a great time to intervene and encourage behavioral changes."
Ideally, physicians who care for women of reproductive age should help mothers get closer to their ideal body weight and make healthy choices before they become pregnant; however, if a woman is pregnant, it’s important for physicians to dispel one common medical myth: ‘don’t start an exercise program while pregnant.’
Pregnancy is not the time to just ‘take it easy’ – it’s an ideal time to focus on health and wellness. In fact, women who are overweight and obese should engage in mild to moderate activity even while they’re pregnant, Dr. Gutfreund noted. Exercise is medicine and an active lifestyle and healthy weight are essential to preventing gestational diabetes.
Try games and apps.
Although every family isn’t tech-savvy, if your patient does embrace technology, use this interest so they can track their progress on apps like MyFitness Pal, Map My Run, or a myriad of others. I’ve had many patients that post their progress on Facebook, compete with others, and download their progress into their medical record.
Research has also shown that gamification can prompt patients to take steps toward a healthier lifestyle.
"Pokémon Go was hilarious, but it got so many people up and moving," said Dr. Gutfreund. "My sons love Geocaching, and this is another great way to involve the family and go out walking to search for hidden treasure. It is amazing how far people are willing to walk for something they enjoy."
Want more tips and tools to help mothers prevent diabetes?
Dr. Gutfreund practices Family Medicine for Kaiser Permanente in Santa Rosa. She’s the Chair of Physician Wellbeing and Integrative Medicine, as well as an AFM Regional Depression and Family Violence Prevention Champion. She serves on the CMA Board of Trustees.