L -- Lose weight
E -- Exercise
S -- Stop
S -- Smoking

While no one would argue that each of these is valuable in the life or health of anyone, to our knowledge, there has never been a concentrated effort to confront an entire patient group with all three elements consistently every time they seek healthcare.
Here is how the LESS Initiative works. Every time a patient is seen in the clinic, no matter what the occasion for the visit is, they will be alerted to the health risk of:

• Their current weight , as measured by their body mass index (BMI) and their body fat content. They will be given a Weight Management Assessment which tells them their BMI, their disease risk associated with their current BMI and waist measurement, their percent of body fat and an explanation as to how a 5% change in their body fat will impact their health and future.
• The benefit which their heart and lungs are receiving from their current participation in exercise as indicated by the "aerobic points" which that exercise achieves for them and a recommend minimum exercise level which they need in order to achieve a "good" aerobic status for their age and sex. This exercise prescription will include information on how to increase the number of steps they take each day in order to have an "active" lifestyle which is defined by taking 10,000 or more steps a day. The average America takes fewer than 6,000.
• The imperative for stopping smoking . Even the tobacco companies' websites now state, "The only way to avoid the health hazards of tobacco smoke is to stop smoking completely." This is clever because with this warning, the tobacco companies which continue to encourage tobacco smoking have immunized themselves from future litigation because they have warned you that their product is harmful. Now, legally, the only one to blame for the harmful effects of smoking is the smoker. Also, the initiative includes the questioning of patients about exposure to "environmental tobacco smoke" either at home or at work.

Shared Responsibilities

The LESS Initiative is dependent upon the sharing of responsibility by the various members of SETMA's healthcare team:

1. The IT team (Information Technology) has to make it possible to easily and conveniently produce the documents and to audit the performance.
2. The Nursing and support staff have to collect the data - weight, height, waist size, abdominal girth, hip measurements, neck size, chest size, body fat, etc. - which allows the computation of the information used in determining the patient's health risk.
3. The Nursing Staff have to create, print and distribute the documents, as well as initiate the discussion with the patient of the information in each.
4. The Healthcare Providers - physicians and nurse practitioners - have to interact with the patient about the imperatives for change which are indicated by the information in the document, discussing what the health risks are of doing nothing and the health benefits of changing their lifestyles...
5. The Nurse Management Staff must audit the charts at the end of the day to make certain that this has been done. It has been established that a 95% effectiveness is the standard for determining success.

In addition:

6. Patients who decide to change their health and their future will be referred to SETMA's Education Department for dietary education, for weight management, diabetes, cholesterol, hypertension, the metabolic syndrome and other conditions where improvement is dependent upon patient dietary compliance.
7. Patients who are serious will be referred to SETMA's weight management clinic which has a proven record in helping patients... Utilizing the Adult Weight Management program published by the AMA, SETMA's electronic version of this excellent tool is used to assist patients in achieving their weight reduction goals.
8. Patients who are serious about cardiac and pulmonary conditioning can be referred to SETMA's cardiopulmonary rehabilitation program for assistance and guidance in that process.