Mental health is often viewed as its own category when thinking about patient care; however, mental health and physical health are intricately linked. And as a practicing endocrinologist, I see firsthand how the two are intertwined. I have had patients in the past with uncontrolled diabetes, for whom our ability to focus on diabetes management was impeded by underlying anxiety and other mental health concerns. Often, focusing on trust building and addressing those mental health concerns are prerequisite first steps before we can even talk more about diabetes management.
With an increased emphasis on whole-person health and more connected care delivery, multi-faceted chronic condition management programs must include a mental health component. I have spent a lot of time in my career focused on treating obesity – emphasizing mental heath – and helping people establish sustainable lifestyle changes to prevent some of the downstream implications, such as diabetes. Time and time again, my own experiences and industry data back up this more holistic approach to managing chronic conditions.
Why chronic care management is increasingly complex
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The prevalence of both chronic diseases and mental health conditions have increased, and for a number of reasons: it is harder and more expensive to eat healthful foods, our jobs today are more sedentary, and we are on screens more than ever which directly impacts our sleep, mental health and activity. Chronic disease epidemics are an overwhelming problem that need changes on many levels and will require empowering a broader group of individuals. And there are changes that are needed at a societal level. We can do more to equip individuals and their care teams in getting health guidance that is meaningful in this complex modern era.
Take how we manage a disease that is in many cases closely related to diabetes management – obesity. There are a lot of potentially serious complications and conditions that stem from having obesity. Driven by organizations like the American Medical Association and other patient advocacy groups, we’ve shifted in thinking about obesity as more of a chronic disease in recent decades as opposed to just a behavioral condition. This change reframes how we treat obesity instead of viewing it as something for vanity or a failure of willpower. Though we’ve seen advancement in our scientific and clinical understanding of obesity, there are multiple considerations for high quality obesity treatment and management, and managing expectations for all of those can be difficult. There are the lifestyle behaviors (nutrition, activity, sleep, stress) that are technically within one’s control, but are heavily influenced by social determinants of health. There are interactions with health care providers for appropriate screenings and treatments, but timely access to high quality providers can be limited. There are also issues related to coverage that heavily influence appropriate treatment for obesity. And, of course, there are issues related to stigma that can further exacerbate existing mental health challenges. Similar multi-faceted challenges exist for other chronic conditions like diabetes.
Comprehensive approach is required for long term chronic care management success
We’ve found that the most successful chronic care management programs focus on four key health behaviors that are the pillars for an individual’s healthy lifestyle change nutrition, physical activity, sleep, and stress. Self-monitoring (e.g., weighing in regularly, or logging one’s foods) to draw connections between behaviors and health outcomes is also critical.
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It is also important to give people access to the clinical support that they need and access to providers that have the most relevant clinical experience. Going back to our obesity case, this may include physicians with special training on removing bias in their treatment approach or are well educated on how to safely manage GLP-1s and the broader set of anti-obesity medications. Medication adherence support is also beneficial for many with chronic conditions, to help people understand when medications are relevant to them.
Everyone benefits from foundational health education on principles related to nutrition, physical activity, sleep, and stress, but then on top of that is the layering of flexible individualized care. It’s not just about calories and it’s not just diet and exercise. Part of the big shift is understanding that there are so many more behavioral components to weight loss and weight regulation. There is no one-size-fits-all approach to weight loss, and that’s true of many chronic health conditions in general like diabetes.
Chronic condition management is about the long term: building skills that are sustainable over a lifetime requires sustained engagement. With digital tools, the application of technology including machine learning and AI can help make the experience personalized by providing targeted reminders and increasing engagement.
Taking mental health support one step further
Through integrated mental health care, mental health concerns are addressed as a foundational element or in parallel alongside chronic care management. But what is most beneficial to the patient is to have mental health support tailored for the specific chronic care management challenges a patient is going through. For example, this could look like specific psychiatric support for diabetes distress, or cognitive behavioral therapy-based support for challenges related to weight management like body dysmorphia, ‘all or nothing’ mindset, or binge eating disorder.
Flexibility in the approach
There’s a mantra in nutrition that the best diet is one that you can stick to. Nutrition aside, when you think about lifestyle modification approaches in general, we all have different preferences, needs, and possibilities. Flexibility within the individual approach is essential to not just improving outcomes, but also making sure patients stick with their plan of care. When you’re thinking about combining cultural preferences, social drivers, physical and mental health considerations, no two patients are the same, requiring flexibility in the approach, tools, and support. Even within the same condition, two different people may have two entirely different focuses. The treatment for someone with obesity struggling with emotional eating looks very different from the treatment for someone with mobility impairments.
Virtual care and digital tools can help fill in a critical gap by providing daily support for behavior change that is usually harder to accomplish through episodic visits alone. Treating chronic disease is not just about the number on the scale, the blood glucose readings, or the BMI, it’s about taking a holistic approach to a patient’s mental health and overall health. Offering chronic care management and mental health support in parallel is crucial for successful health outcomes.
Employers and health plans should be looking for programs and solutions that have flexibility in terms of treatment options and address those four foundational pillars. Successful chronic condition management depends on an empowered individual, an accessible high quality health care team, and a strong foundation of healthful behaviors.
Photo: AlexandraFlorian, Getty Images
Dr. Tejaswi Kompala leads clinical strategy for cardiometabolic conditions at Teladoc Health. She is board-certified in Internal Medicine and Endocrinology and is a practicing endocrinologist with particular interest in diabetes care, diabetes technology, diabetes prevention, obesity and weight management. Her interests include innovative chronic condition care models in primary care and virtual care settings, with a focus on population health management and integration of technology.
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