Blood tests–specifically serum cholesterol, LDL-cholesterol, HDL-cholesterol, and triglycerides–remain the backbone of screening for cardiovascular disease. My father died at 44 from congestive heart failure. I have my levels tested regularly. I finally cleared time to get a fasting blood test.
BLOOD TEST RESULTS
Fasting tests are the biggest challenge. Mornings are a rush, getting my son off to school and both my husband and I off to work. I don’t want to fast until mid morning by the time I could get to the lab. I don’t feel good and am not nice when I get over hungry. I waited until my son’s spring break last week.
The results look better. Total cholesterol, LDL cholesterol and triglycerides dropped. HDL cholesterol stayed steady. But obviously not good enough for Kaiser. I received my annual counseling letter in the mail yesterday. They want me to sign up for a cholesterol class and I may need medication.
I already argued this issue with my physician last year. There is no good data suggesting medication for women without previous evidence of disease (not just a risk factor) is beneficial.
Out of curiosity my husband attended the cholesterol class last year. It was taught by a nurse who couldn’t answer his food questions. (Where are the dietitians?) He came back with a 113 page manual that was published in 2003. I reviewed the material and found it dated and inaccurate.
FOLLOW THE ENCLOSED DIET
I focus on the rest of the letter. The next line reads, “Please follow the enclosed cholesterol diet.” (I repeat, where are the dietitians?)
I almost choke on the words. I am admonished to eat more fruits and vegetables. Eat less red meat. Replace butter and margarine with oils. Limit foods high in cholesterol. Be physically active and lose weight.
The same message is sent out every year. Are the administrators and health professionals at Kaiser merely happy to check off the box or do they truly believe this is the path towards behavior change?
ONE SIZE DOES NOT FIT ALL
David Katz, MD is the founding director of Yale University’s Prevention Research Center. His 2011 Lenna Frances Cooper Memorial Lecture was published in the February, 2012 edition of the Journal of the Academy of Nutrition and Dietetics. He makes many valuable points, but this one sticks. “Messages that most effectively motivate behavior change are tailored messages; customized messages; individualized messages.” Five references follow this statement.
I already know what I am doing and why I am doing it. I don’t plan to change. But I cringe for other Kaiser members who would benefit from attentive and individualized nutrition consultation. Why do Kaiser patients get an anonymous and formulaic counseling letter from Kaiser each year?