After Three Years of Initial Success, TMA Looks to Expand Walk With a Doc Texas
Public Health Feature — November 2015
Tex Med. 2015;111(11):43-47.
By Joey Berlin
As straightforward as they might seem, Walk With a Doc Texas events can be a little unpredictable. And if you go to enough of them, something may happen that will stick with you. Walk With a Doc events entail physicians, their patients, and other locals coming together for regular walks to promote healthier living.
Take one particular walk in Georgetown, where Susan Pike, MD, began the first Walk With a Doc events in Texas three years ago. Traditionally, before a walk begins, one of the physicians attending will speak briefly on a health-related topic.
But at one Georgetown event, Dr. Pike recalls, one of the physicians scheduled to speak had gotten lost and didn't arrive at the walk. An overweight physician participant who'd undergone gastric sleeve surgery stepped up to fill the speaking void.
Without any sort of prepared speech, he grabbed the attention of his fellow participants. He talked about having the surgery and how it was only a tool, not a solution; to improve his health, he had to change his lifestyle and exercise regularly to maintain his new, healthier weight.
"It was very moving," Dr. Pike said. "It was truly somebody who was going through the process of becoming healthier. As a physician, it's hard to be healthy, and our lifestyle really challenges us to be healthy. I related to that. Honestly, people have still mentioned it from time to time — that he gave a really great talk, and it's because he shared something really personal that was to the benefit of a lot of people in the group."
Walk With a Doc Texas outings — increasing in numbers since the Texas Medical Association's pilot program brought the national initiative here in 2012 — are more than just a social stroll around a park, a track, or some other convenient stomping ground. There's the potential to see or hear something inspirational or something funny or something that will help people develop a better relationship with their physician.
"Once we start walking," said Cuero family physician Mike McLeod, MD, "you never know what topic's going to come up."
Fifteen Texas physicians lead 15 Walk With a Doc sites, and the walks will have attracted an estimated 7,500 participants in 2015 by the time the year concludes.
A More Comfortable Place
Columbus, Ohio, cardiologist David Sabgir, MD, founded the Walk With a Doc program in 2005. Today, doctors and participants are walking in about 40 states and some international sites, including Russia, Canada, Ireland, and Australia.
The TMA Foundation funds Walk With a Doc with an annual grant of more than $100,000, which includes generous support from the TMA Insurance Trust. The TMA Council on Health Promotion oversees the project. The foundation funded the pilot program, which started in 2012 with four sites. Just three years later, the financial backing is in place to potentially fund more than 25 sites.
The Texas program has four goals:
- Improve the health of all Texans;
- Increase the number of participants;
- Increase the number of physician leaders of Walk With a Doc; and
- Educate Texans about the prevalence of diseases associated with obesity by providing relevant talks to walk leaders.
The focus on obesity and greater physical activity is a particularly relevant one for Texas, where adult obesity is higher than the national average. Texas Behavioral Risk Factor Surveillance System data for 2013 showed 30.9 percent of surveyed adult Texans were obese, meaning they had a body mass index of 30 or more. In 2014, that number went up to 31.9 percent. The national obesity rate for 2013 was 28.3 percent.
Dr. Pike's first walk three years ago drew about 45 people. After some attendance fluctuations since then, she says her monthly Saturday walks now average around 40 participants.
"We have a very strong core group of people who are there almost every time. And then we have a lot of people who come in and out of the group, or they bring somebody new, and their reaction is always positive," she said.
"Wellness [is] a lot more than just height, weight, and blood pressure. It requires a sense of community, a sense of safety, and a willingness to get together and meet people with common needs and goals. All of those things are really met within this program."
Although most Walk With a Doc Texas sites feature monthly walks, some offer them weekly. Li-Yu Mitchell, MD, leads weekly Walk With a Doc events in Tyler, where she's a family physician. Dr. Mitchell is in her second year of Walk With a Doc participation, teaming up with the Smith County Medical Society for the events each Thursday.
Dr. Mitchell uses two sites for her walks: a four-mile city park trail and a junior college practice field with a one-third-mile track. Depending on the topic and the weather, she says, her walks average about 30 participants each, with as many as 80.
The pre-walk talks don't necessarily have to be about serious medical topics or life-threatening conditions. One local plastic surgeon, Dr. Mitchell says, spoke at a Tyler walk about new advances in breast augmentation and brought silicone implants to show the participants.
"It's been refreshing to the participants to be able to talk to the doctor," Dr. Mitchell said. "They're in their shorts and tennis shoes, and they're not intimidating. Participants can ask all the questions they might be too shy to ask in the exam room."
A frequent participant in the Tyler outings, Becky Bonilla, says not only do the participants feel more comfortable interacting with the doctor outside of a care setting, but also the physicians seem more at ease.
"You're not there sitting with them alone; you've got a whole group with you," Ms. Bonilla said. "There's more support, and they seem more relaxed to answer your questions because they're not having to worry about going to the next patient. So they take more time to answer your questions than if you have an appointment with them. If they have another patient, they can only give you so much time."
Dr. McLeod's Thursday walks in Cuero draw between 15 and 30 participants. He says with that less-structured time and no pressure to move on to the next patient, physicians have more time to hear about each patient's life on a personal level.
"Sometimes it's joys and things that have happened in their life; sometimes it's some struggles they've been having," he said. "And [doing it] while exercising generally helps the brain flow a little better."
Positive peer pressure is another way Walk With a Doc can encourage regular exercise, such as the case of a diabetic patient who regularly comes to the Lubbock walks internist Piyush Mittal, MD, leads on the second Saturday of each month.
"He's [walking] other days also, but certainly on [walk days] he feels that 'Everybody has been telling me to come out all the time, but with you as a role model, I am able to do it,'" Dr. Mittal said. "And now he has been showing up at each walk."
The first phase of TMA's 2015 survey to evaluate Walk With a Doc Texas found 48 percent of participants are meeting the U.S. Centers for Disease Control and Prevention's (CDC's) recommendations for physical activity by walking at least 150 minutes or running 75 minutes per week. Another 5 percent are within 10 minutes of reaching one of those benchmarks. The survey also showed Walk With a Doc participants are likely to be proactive about their own preventive care. (See "Polling Participants.")
For the first few years of Walk With a Doc's existence, when it consisted of just one regular walk event, Dr. Sabgir says he and his colleagues jokingly called their office "Walk With a Doc World Headquarters."
"Probably, people thought we were crazy, and we were doing it a little bit tongue-in-cheek," he said.
It's not a joke anymore, now that Walk With a Doc has expanded its reach worldwide.
It started in 2005 with a 101-person walk that Dr. Sabgir says was more of an event in itself, rather than the beginning of an ongoing movement. But Walk With a Doc hired an executive director, and the organization began developing relationships with local businesses.
"We had a response from a locally based international hamburger company here, of all things," he said. "They loved the idea before we even did our first walk. And we had a bunch of people tell us things like, 'Do you know what you have here? Do you know what this could be?'"
But recruiting physicians for the program proved to be extremely challenging, so the program stopped in 2006.
"I missed it," Dr. Sabgir said. "I think a lot of the participants missed it."
They started it again with one walk in 2007, and Dr. Sabgir and the rest of the organization decided to let Walk With a Doc grow organically. National press coverage led to requests for Walk With a Doc events around the country, and in 2009, Anthem became a sponsor.
The program has grown since then through what Dr. Sabgir calls "very classic, viral grassroots stuff, and the fire keeps getting bigger." In September, CNN featured Dr. Sabgir and his work on Walk With a Doc as part of a CNN Heroes segment.
Calling it "overwhelmingly rewarding" to see the program succeed in replication, Dr. Sabgir says Walk With a Doc's success stems from many physicians "having the same feeling that I do, that they want to do more."
"So many of these things that we see are ameliorated by regular physical activity, and we're just not seeing that," he said. "I would say, anecdotally, about 5 to 10 percent of our patients at most are getting [the right] amount of physical activity. So if we have an inroad to that, it's almost like a ticket to Oz. It feels like, 'Oh, my gosh, I think there's something we can do about this after years, if not decades, of banging our heads against the wall.'"
A national survey of Walk With a Doc participants for this year showed the following:
- 92.4 percent of participants feel they're more educated since beginning to participate;
- 79.4 percent say they've gotten more exercise;
- 78.8 percent feel more empowered in their interactions with health care practitioners, such as speaking up with regard to their own health; and
- 97.5 percent like the concept of bringing physicians and community members together outside a health care setting.
Dr. Sabgir says TMA has been a "phenomenal partner" in promoting Walk With a Doc and its message.
"We've talked to a lot of other state medical associations, and everyone holds the TMA in the highest regard. I mean, it's the pinnacle, and we see why," Dr. Sabgir said. "So we're really grateful that the TMA reached out … and they saw what we had when we were very small."
Reaching New Participants
In Texas and nationally, Walk With a Doc has plenty of places where it can continue to plant its footprints, both in terms of raw numbers and of reaching different demographic slices.
The 2015 Walk With a Doc Texas survey identified increasing the diversity of participants as one of its recommendations for improving the program. The survey showed 74 percent of participants are white, and 80 percent are female.
Dr. Pike, who sits on the TMA Foundation's Board of Trustees, says the foundation and Walk With a Doc leaders are working on bringing the program to a wider audience. One way to do that, she says, is through collaboration with community organizations like local school districts and health organizations, as well as nonprofits for the underserved, one target audience for the program's goals.
"The best initial way to build is simple word of mouth to other physicians that Walk With a Doc is in our community," the Georgetown plastic surgeon said, "because we all see people that are obese or have health problems that can benefit from exercise on a daily basis, whether it is hypertension, diabetes, obesity, or heart disease.
"I think the first thing is just reaching out to other physicians in our community and saying, 'Hey listen, this is a place for people to come and feel safe starting to learn more about ways to improve their health.'"
Nationally, Dr. Sabgir says Walk With a Doc shouldn't even be close to hitting a growth plateau.
"We've always had visions, and actually the visions are for this to grow much larger than it already is," Dr. Sabgir said.
For information about participating in Walk With a Doc, email Debra Heater or call her at (800) 880-1300, ext. 1390, or (512) 370-1390. To support the program with a tax-deductible donation to the TMA Foundation, contact the foundation at (800) 880-1300, ext. 1664, or (512) 370-1664, or visit the foundation webpage.
Joey Berlin can be reached by phone at (800) 880-1300, ext. 1393, or (512) 370-1393; by fax at (512) 370-1629; or by email.
TMA polled about 170 Walk With a Doc Texas participants and 12 physician program leaders in the first phase of its 2015 survey. TMA will send out the follow-up portion of the survey in December. The results from phase one showed:
- Forty-eight percent of participants and 58 percent of leaders are meeting the U.S. Centers for Disease Control and Prevention's recommendations for weekly physical activity by walking 150 minutes or running for 75 minutes.
- Ninety-four percent of participants said they were likely to contact their doctor before a problem worsened, with 53 percent saying they were "very likely" to do so.
- Twenty-five percent of participants said they attended the walks to maintain and improve their health; 18 percent said they did it to spend time outside; 16 percent did so because the walks were nearby and convenient; and 15 percent participated for community involvement.
- Eighty-four percent of leaders are likely to refer their patients to walk.
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