In the fall of 2010, I had dinner with Rick Warren, the pastor of the 30,000-strong Saddleback Church in Southern California. Over a healthy dinner of beet and cabbage autumn soup and a salad, he described his extraordinarily successful experiment for sustained personal growth and change. Rick had encouraged his congregation to form 5,000 small groups that met every week to study, learn, and grow together in their community.
In that moment, I envisioned using those same small groups as a means of creating healthy lifestyle change. With the help of Drs. Mehmet Oz and Daniel Amen, we created The Daniel Plan, a 52-week curriculum for physical and spiritual health and renewal that would be delivered through the small groups. Rick named it “The Daniel Plan” after the book of Daniel, which tells the story of King Nebuchadnezzar and the Israelites he imprisoned.
In the first chapter of the book of Daniel (Daniel 1:3–16), Daniel and his three enslaved friends, Shadrach, Meshach, and Abednego, were commanded to eat from the king’s kitchen of rich foods and wine. Daniel and his friends were determined not to defile themselves by eating the food and drinking the wine. Daniel asked the chief of staff, Melzar, for permission to refuse the king’s command. But Melzar implored Daniel to do as he was told, so that he, Melzar, would not be beheaded for going against the king’s orders. He said that the king would know if Daniel and his friends hadn’t eaten his food because they would look malnourished.
Daniel then gave him this challenge:
Please test us for 10 days on a diet of vegetables and water. At the end of 10 days, see how we look compared to the other young men who are eating from the king’s food. Then make your decision in the light of what you see.
Melzar agreed to Daniel’s challenge and tested them for 10 days. At the end of 10 days, Daniel and his three friends looked healthier and better nourished than the young men who were eating the food assigned by the king.
So after that Melzar fed them only vegetables instead of the food and wine provided for the others. God gave these four men an unusual aptitude for understanding every aspect of literature and wisdom.
On January 15, 2011, the day we launched The Daniel Plan at Saddleback Church, more than 8,000 people signed up to participate in small groups, track their progress, and be part of a research study. Within two months, 15,000 people had signed up. The plan includes a weekly curriculum, learning objectives, videos, webinars, seminars, and online support. From a survey taken after the first six weeks, we found that the congregation had lost an estimated 160,000 pounds total (or about 8 percent of their body weight). After 10 months, the average weight loss for those who did the program was 18.6 pounds, and many lost 50 to 100 pounds. But those who did the program together lost twice as much weight as those who did it alone. Many experienced relief from chronic symptoms, including migraines, asthma, reflux, irritable bowel, autoimmune diseases, depression, insomnia, cravings, joint pain, gout, acne, skin problems, and more. The Daniel Plan changed the entire culture of the church almost overnight. Local supermarkets and restaurants were offering Daniel Plan–friendly options. It worked as a treatment for disease. Diseases went away as a side effect of creating health. And one of the most important ingredients of the treatment is the healing power of the group itself. I realized that the group is the medicine, the community is the cure.
The seed of this idea started in my mind when I went to Haiti with Paul Farmer after the earthquake in January 2010. His nonprofit organization, Partners in Health, has created a powerful and successful model for treating drug-resistant tuberculosis and AIDS in the most impoverished nations in the world. The brilliance of the vision wasn’t in coming up with a new drug regimen or building big medical centers, but in a very simple idea: The missing ingredient in curing these patients was making sure they had the medication they needed, and making sure they took it. They needed someone to “accompany” them back to health. By recruiting and training more than 11,000 community health workers across the world, Farmer proved that the sickest, poorest patients with the most difficult-to-treat diseases could be successfully treated. The community was the treatment.
The same vision can be applied to the diabesity epidemic. A community-based support system is an effective way to guide people toward sustainable behavior and lifestyle change.
Though the data from The Daniel Plan initiative is far from complete, we already know quite a bit about the impact community has on lifestyle change. The existing research proves that community and the use of small groups are more effective than any medication to treat obesity and diabetes. More studies are coming in every day showing that small groups of all kinds—led by trained laypeople, “peers,” community health workers, nurses, health coaches, and health professionals in community health centers, churches, schools, and even people’s homes—all work better than conventional care for diabesity and chronic disease.1
A landmark 2002 study based on the Diabetes Prevention Program2 and a 10-year follow-up study3 sponsored by the National Institutes of Health showed that group lifestyle intervention is much more powerful than any other treatment (including medication) to prevent diabetes in those with pre-diabetes. With regular lifestyle support and education, participants lost 5 percent of their body weight and reduced their risk of diabetes by 58 percent. This lifestyle-based group approach was also proven effective in a large Finnish Diabetes Prevention Study.4
I recently met one of the original participants in the Diabetes Prevention Program study. Her story astounded me. The lifestyle program was anemic and based on outdated nutrition advice. They met every few weeks in a group to share their progress and their difficulties. They had very basic nutrition counseling, which was mostly wrong (how to eat a low-fat diet for diabetes—the worst nutrition prescription we now know of for the illness). They had a journal to track their food intake, exercise, and weight, and they met for exercise only once a week. And still, this program worked better than any medication on the market. In fact, the study of the control group treated only with medication was stopped early. The ethics review board found it was unethical to continue to treat with medication and to withhold the lifestyle treatment.
The woman I met said the most powerful aspects of the program were the group sessions and tracking her progress in a journal. Once the program stopped and she no longer had to track her progress or had the social support, her health declined.
The Look AHEAD Study, a 13-year study of 5,000 people funded by the National Institutes of Health, compared an intensive group lifestyle change program for diabetes prevention to regular medical care with individual visits to the diabetic educator, nutritionist, and doctor. To date, the group lifestyle program has proven remarkably more effective in lowering weight, cholesterol, blood sugar, and blood pressure than conventional medical care.5 Once this study is completed, it will completely change our way of thinking about how to treat disease.
Group lifestyle intervention is not just effective with diabetes. Dr. Dean Ornish developed highly successful group treatment programs for heart disease and prostate cancer. These kinds of programs are more effective and will save more lives and money than medication and surgery for diseases caused by lifestyle and environmental factors.
Many of us don’t consider ourselves “joiners.” We find it difficult to get involved with a community of people. Ask yourself why you feel that way, and write about it. Remember that you can certainly start your own community, even if it’s a community of two. Write down a list of friends, co-workers, or family members and invite them to start a small group.
Let me reiterate that almost all of the programs that have been studied were based on outdated or less than optimal lifestyle interventions, yet they still worked better than any medication. That is the power of the social group, the power of the social cure, the power of the group as medicine. The right information delivered in a fun curriculum through a social group has the power to turn our obesity and diabetes epidemic around.
Imagine the power of a more intensive program based on weekly group meetings or experiences, current nutrition science, and better exercise recommendations, supported by an improved journal and tracking system and interactive expert education and coaching to help participants optimize and personalize their diet, supplement regimen, and treatment recommendations. That is what I have created for you in The Blood Sugar Solution and its companion website. Go to www.bloodsugarsolution.com now to learn more about our online course community, create a group, and start using the tools today.
Two Portland doctors approached me after a lecture I gave and told me about their program for poor undocumented Hispanic women with chronic symptoms, obesity, and diabetes. For very little money (about $15 per person per session), they successfully guided these women to health in a program they called Reclamado Su Salud (Reclaim Your Health). They used a program based on The Blood Sugar Solution (which I have taught at many medical conferences). Their group of 20 women met weekly for 5 classes, then every two weeks for a total of eight 3-hour classes. The weight loss ranged from 5 to 20 pounds, blood pressures dropped an average of 10–20 points, and depression and inflammation scores dropped significantly.
Much can be done with a little help from your friends.
These examples represent just the beginning of what is possible when we work together. We are social beings and thrive on connection. I met with human resource and benefits executives at Google to advise them on creating a healthy workforce. A survey of their “Googlers” discovered that most of them wanted more ways to connect with one another.
Social networks and groups are spontaneously sprouting up as support systems for lifestyle change. Not only can Facebook and Twitter help facilitate democratic revolution in countries such as Egypt, but they can link communities together in a common purpose to reclaim their health.
Smartphone applications including FitDay, DailyBurn, Gain Fitness, LoseIt, MyFitnessPal, and SocialWorkout all encourage tracking your progress and sharing it with your friends and community. These tools are early in development but speak to the need to build connection and community in support of health.
With the shift in health care policy prohibiting insurers from excluding sick patients or canceling insurance, and the mandate for universal coverage, insurers can no longer shift responsibility for prevention and health promotion. Large insurers such as UnitedHealthcare6 and CIGNA are scrambling to create innovative community-based programs to address the tsunami of disease and costs they can no longer avoid.
This community-based group approach solves many enormous obstacles faced by the health care system. Today conventional doctors are the primary method by which people with diabesity receive health care. Unfortunately, most of these doctors have no training in lifestyle medicine or behavior change; lack the time, resources, and support team to facilitate such change; and do not get paid for helping patients create a sustainable lifestyle. Currently physicians and health care organizations have nowhere to refer patients and no clear, well-documented, proven solution to provide their patients. Telling their patients to eat better and exercise more is just not enough.
We can be part of a larger movement to create a healthy nation—Take Back Our Health (learn how to join in Chapter 27)—but it starts at home, with our families, our friends, our social network, our communities, our schools, our workplaces, and our churches, temples, and mosques.
You need to build yourself a support system to succeed long term. You need a team working together toward the same goals. It might be just one person—a health coach, a wellness champion, a community health worker, or a health professional—or an online community that can support, encourage, and guide you.
Start by finding people who will do the program with you. Create a small group, even if it is just one friend, who can support you through the process. Ask your friends, family, coworkers, and spiritual community members to join you. Use the guided online course and support program to help you along each week at www.bloodsugarsolution.com and find others who can be your support group. You can still be successful following this program by yourself, but it will be more fun, effective, and sustainable when done with others in community.
Learn more about our online support community at www.bloodsugarsolution.com, where you will find both personalized individual support tools and a way to create a support group on your own. At the website I have also provided a way for community health workers, health professionals, workplaces, and faith-based organizations to start their own groups. Using these tools, you can create a self-guided support group with friends (or even just one friend), other members online, family members, coworkers, neighbors, or members of your faith-based community. Here is what is available to support your journey back to health:
Ask for support from friends, family, and coworkers who are not in your “group.”
Set clear boundaries with family, friends, and coworkers. Don’t let them sabotage your efforts to reclaim your health. Learn how to cope with “food pushers” in your life. These are the people who say, “Don’t worry about it. What can one little soda really do?” For some of us, that one little soda can set us on a downward spiral to overeating and all of the negative health consequences that come with it. Make a clear stand and explain to people why you are making these changes and why they are important to you. If they are true friends, they will see why it’s essential that you take back your health.
Use the online tools (www.takebackourhealth.org) and Chapter 27 in Part V to take action individually—at your workplace, your local schools, your faith-based communities, and your community centers—and to support the political changes needed to create health at home and in the world. Become part of the movement, become part of the conversation.