Practice Spotlight: Irene Willingham, MD, RD

 Life. Health. Performance.   

The above three words are more than the cornerstone of Dr. Irene Willingham's current work of Aeon Health. They are the heartbeat of all that she calls forth from herself, and the community.

 

A high school scholarship was the initiation into her future career. "I received a scholarship in any area of home economics I wanted, so I chose food and nutrition. That opportunity was key in leading me to graduate school and training in dietetics. I worked as a clinical dietitian at University Hospitals of Cleveland, a dialysis center as well as food and nutrition education in the public school and school lunch program."

 

After practicing hospital dietetics for a few years, Willingham wanted to be more involved in patient care. "At the time, I was working for two nephrologists who encouraged me to pursue medical school. During my training as a doctor, I enjoyed the physical work involved in surgery. Initially I was drawn to cardiac surgery but the microsurgery of neurosurgery was so engaging, so that is the specialty I chose."

 
Dietitian turned neurosurgeon is a major undertaking in itself. But that was not to be Willingham's final profession. "Over the years I became frustrated how our medical system fosters passivity on the part of the patient, and is invasive rather than empowering. I realized how important negotiation is, and by that I mean that the physician and patient negotiate, discuss, discern together the best path forward. Our medical system is set up for advice giving and prescribing, not listening and negotiating. In our current medical system it is easier to offer a patient an operation than guide them through successful sustained lifestyle health change."

"In my neurosurgical practice, especially in the non-surgery part of it, I began to realize patients needed Lifestyle Medicine intervention, not surgery. They came in thinking they needed, and therefore they wanted, surgery, when in fact the treatment they needed was weight loss and/or exercise, proper nutrition or other lifestyle change. Within the context of my practice, at that time, there were no resources for guiding patients through meaningful intervention. It was about three years ago that I started searching for words to describe this new way of practicing medicine. I found that many of the good words 'health', 'wellness' had been taken and were used to describe other things such as cosmetic procedure clinics. So I began talking about 'lifestyle health' and 'lifestyle health behaviors'."

 
In 2006, after twenty years as a neurosurgeon, Willingham retired and began engaging lifestyle medicine and her passion for nutrition and fitness. One year ago that pursuit materialized in the founding of a lifestyle health company, Aeon Health, which houses a lifestyle medicine practice, demonstration kitchen, and boutique fitness facility. "I partnered with a fitness professional to create Aeon in order to change the way health and fitness services are delivered. We both believe in a physician-directed approach to lifestyle health that addresses the three core areas of Life, Health and Performance."

Life appreciates that each individual lives in a unique, dynamic and demanding environment. Medical challenges and priorities, as well as stresses of daily life, are important aspects of that environment. The AEON team, led by the Aeon physician, uses scientifically sound practices to promote longevity and comprehensive wellness.

 

Health addresses how food fuels, protects, soothes, and heals the body, mind, and soul. Nutrition is more than just the food. It reflects a person's "food view" including the lifestyle habits of when, where, and why we choose certain foods. AEON uses its resources, such as the demonstration kitchen, "fueling station" and experienced dietitians, to ensure each client is equipped with accurate, evidence-based information for mindful nutrition choices.

Performance explores ways to realize individual potential through physical fitness. AEON measures the fitness of an individual within the context of overall well-being, as well as by function and appearance. Enhancing fitness, whether that means starting exercise anew or pushing an already extreme physical boundary, can improve performance in many aspects of life.

 

Willingham explained, "We bring together elite health and performance professionals for an integrated approach to health and fitness goals. Our Team includes physicians, physical therapists, exercise physiologists, registered dietitians, yoga and Pilates teachers, certified fitness trainers and wellness coaches. Our services are available to both members and non-members and may be combined to suit individual needs."

 

Aeon is designed to provide a more constructive fitness environment than traditional gyms. The 5000 square foot space is designed to be welcoming and functional for the learning and self-discovery that their lifestyle medicine patients need. 3200 square feet house the examination room, physical therapy treatment area, yoga classroom, staff office, demonstration area and relaxation venue. The health club component which is called The Studio occupies up to 1800 sq feet. They offer a limited number of memberships to the studio as well as a la carte services that allow members to create a customized wellness experience that best fits their needs while also allowing the Team to interact on a personal level with each client. The relaxation area, conference area, and wellness library with complimentary Wi-Fi all work together to make Aeon an environment for newfound connection with oneself and others, personally and professionally.

 

Willingham is clear about helping people change their personal environment to one that encourages stress management, exercise, nutrition. "It isn't all about willpower or lack thereof. It's about being proactive, so that decisions work for you, not against you. Simple things like not always parking near the store entry so that you intentionally walk further, and not waiting until you are starved to figure out what is best for you to eat. Clients will ask us, 'How long will I have to do this,' or 'how long will my program be?' Our reply is embedded in our greek name, aeon. However long you want to live a healthy life. This is a journey that goes on forever."

Comprehensive Options
Service options at Aeon include a physician supervised fitness assessment and wellness inventory, biofeedback training and stress management techniques, physical and medical assessment, nutrition counseling, yoga, Pilates, personal training, comprehensive fitness evaluation and plan, and more. Access to an on-site physician, dietitian, and fitness professional is foremost. Each team member is dedicated to helping clients reach health and fitness goals.

In asking if assessments are required or optional, Willingham explained, "The assessments and activities offered as part of the health club membership (AeonStudio) are optional. We realize that the client (patient) in the end decides what they will participate in. We do strongly urge that even our most casual users of the club undergo anthropometric measures and vital sign measurement. And we follow those over time." She continued, "We are launching a comprehensive lifestyle health program this year designed to address America's (indeed the world's) most challenging health conditions: diabetes, hypertension, and obesity. These programs include components of exercise, nutrition and emotional/cognitive resilience. The exact nature of the program is set in close consultation with the client. It is dynamic and will change as the needs of the client change and to keep engagement. All interventions are based on well-studied proven therapies."

 

"A staff member (that we call a 'health partner') monitors the patient's participation in the desired activity, such as keeping a food journal or attending an exercise class. We also record and track basic indicators like weight, waist to hip ratio, body composition(anthropometric), lipid profile, glucose levels, hemoglobin A1c levels (chemical) and changes on exercise testing using oxygen utilization measures."

 

Fitness and Performance
Fitness staff use proven techniques to create dynamic, functional and fun training sessions in a performance-oriented fitness facility, including cardiovascular equipment with personal entertainment monitors. Members have 24 hour access to the fitness facility and programs including:

• Personal and Group Training, Sport Specific Conditioning as well as Martial Arts
• Yoga, Stress Management and Meditation to invigorate, calm and restore our lives
• Pilates, an exercise system focused on flexibility, strength, and body awareness. Two key elements of Pilates are core muscle strength and spinal alignment
• Physical Therapy including manual therapy, electrical stimulation and therapeutic exercise. Licensed physical therapists offer a range of research-driven treatments for pain relief and promotion of maximum performance. Complimentary pain and injury assessments and comprehensive musculoskeletal evaluations are available.
• Healthy Back Program

Nutrition
A registered dietitian works closely with clients to optimize their health and performance through proper nutrition, offering:

• Nutritional Intake Assessment
• Caloric Needs Estimation
• Nutrition Counseling
• Weight Management
• Cardiac Risk Factor Reduction
• Sports Nutrition
• Eating Disorders
• Group and Community Nutrition Activities

"We have ongoing events to engage both our members and the community. The members are encouraged to stop by the kitchen and 'refuel' after their workout by choosing a healthy snack. This month we are offering to the community a lunchtime seminar with a local chef and our dietitian on the topic of nutritional needs of elementary age children and creative ideas for brown bag school lunches. Every Wednesday evening we host a Supper Club. We prepare and serve a meal with emphasis on creative (and great tasting) vegetables and have open discussion and fellowship."

 

Wellness Coaching
Health and productivity assessments, Leadership and Communication, and Strengths-based Executive Coaching are offered for clients who want to gain focus, control, mental strength and emotional intelligence to create optimal work-life balance.

Aeon for Communities
Willinghams' goal is to create a template for community lifestyle intervention so that other communities can create similar offerings that reflect the needs of their demographics. "My hope is to create a model for providing these kinds of services in any community. People need daily offerings such as this for on-going support. We have formed a non-profit entity called Aeon Project so that we can provide services to communities that may not be able to bear the cost of our services. We have not been awarded IRS 501C status yet."

Financial Viability
When asked about finances, Willingham noted that salaries were more of a struggle than anticipated. "I misguessed it at first, but now it is correcting itself. We have several creative avenues of collaboration I did not anticipate but that have been instrumental to our gaining financial stability:

1) We have connected with an excellent group of physical therapists who rent our space/equipment; 2) We have personal trainers who also utilize our space for their own work. Several have unique sets of additional skills that we are able to draw upon, such as web design and blogging. It thereby becomes a win-win financially. Working with professionals on a 'contractor' basis has been valuable. Everyone who works here makes referrals to the other, not only within Aeon but for their independent practices as well. It is very collaborative, non-competitive, which is in itself a high degree of success."

 

Demographics and the Documentation of Progress
"Aeon Studio is located in an affluent community within the Dallas metropolitan area. The school system is excellent, thus people with school age children are drawn to the area. The overall health status is higher than the average in Texas. Weight management, cardiac risk factors, hypertension and musculoskeletal issues are the most common issues we see - in addition to the complaints of poor sleep patterns and stress."

 

"Because we have only been open for one year, we have case-study type results at this point. An example: 38 year old man recently diagnosed and treated for colon cancer joined Aeon and has fully participated in several service lines - strength training, yoga and nutrition. He has been able to safely exercise in spite of the peripheral neuropathy associated with chemotherapy, his stress level is reduced and his flexibility increased through the yoga program and he has regained muscle mass through the strength training and nutrition services. We have documented his change in strength and body composition."

 

Reimbursement: A Moving Target

"Fully understanding reimbursement is an on-going challenge. Of course models exist for individual licensed partictioners to be reimbursed for their services. Though the rate of reimbursement, at least for dietitians, is inadequate and limited in scope to only a few diagnosis codes. I am interested in how physicians and licensed practitioners (dietitians, physical therapists, etc.) can interface with the non-licensed, certified professionals such as fitness trainers when it comes to reimbursement. People are obtaining information about lifestyle health from non-licensed individuals at the present time.  Thus we need to realize this and bring them into the system rather that seeing them as rivals. I am confident of discovering various ways to manage reimbursement. I am hopeful that the changes occurring in health care reform on the national level will continue to place increasing emphasis on lifestyle health issues. At present the majority of services are paid for by the member/client themselves."

Reaching Out
January 2010, Aeon is launching Lifestyle Health Offerings with the intent of reaching out to physicians offices and other organization about the flexible offerings that Aeon provides in the community. "I know there are physicians in our community," says Willingham, "who have patients in need of lifestyle health services. I want them to know Aeon as a source for authoritative, comprehensive, result driven services."

 

ACLM Disclaimer: Our Practice Spotlights are intended to provide examples of Lifestyle Medicine in practice. We recognize that Lifestyle Medicine practices vary widely, and inclusion in Practice Spotlight is not intended to imply official endorsement of individuals or practices.