A swell has been building up within and around the United States (US) healthcare system and the tide is about to change. I’m not talking about longer doctor consultations, transparent upfront healthcare pricing, more reasonable drug pricing, or even universal healthcare — although all four would add tremendous value to patients, providers, and the healthcare system. Rather I’m talking about lifestyle medicine, a relatively new clinical specialty that encompasses evidence-based lifestyle interventions for individuals and patients to prevent, treat, and/or reverse chronic diseases such as obesity, heart disease, diabetes, hypertension, osteoporosis, and certain cancers. Lifestyle medicine aims to treat the underlying causes of disease through the promotion of nutrition, exercise, stress and sleep management, and substance use avoidance. Such modalities may not be new yet the full use of them in clinical practice has been relatively rare, which is surprising given the fact that more than 8 out of 10 chronic diseases are attributed to lifestyle factors.
The conventional approach to healthcare has typically been:
- Diagnose an illness or disease.
- Match the diagnosis with a medical or surgical intervention.
- Follow-up with the patient and manage the disease if needed.
Such an approach works well in the acute care setting, for example, when you get a bacterial infection, a doctor can prescribe penicillin to attack the bacteria, or when you completely tear your ACL during a football game, a surgeon can mend the injury. This approach doesn’t work well though for chronic diseases that are attributed mostly due to the lifestyle we choose consciously and unconsciously. The reason is because such chronic, lifestyle-related diseases have numerous biological factors that one or even multiple drugs are unable to treat and reverse appropriately. Take for example, heart disease — we have a plethora of medical interventions that reduce the underlying risk factors, such as lowering blood pressure and slowing atherosclerotic plaque buildup, yet heart disease still remains the leading cause of death in the US. Comparatively, lifestyle medicine treats the underlying cause of the disease by emphasizing that the patient plays an active role in their health. Rather than focusing on medications that often have unwanted side effects, the treatment focus of lifestyle medicine has positive side effects as part of the outcome.
The lifestyle medicine approach to healthcare is to:
- Diagnose a chronic, lifestyle-related illness or disease.
- Listen to the patient’s values, beliefs, and attitudes and how they relate to their diagnosis.
- Have the patient play an active role in designing their individualized treatment plan that emphasizes lifestyle interventions over medication and surgery when appropriate.
- Engage with a cross-disciplinary healthcare team to ensure that the patient receives as much support as they need.
- Follow-up with the patient and continue to support the patient’s journey toward their wellness.
You can see that lifestyle medicine takes more time and effort compared with the conventional medicine route, and if you’ve been to a doctor’s office lately, she or he doesn’t have the luxury of time to counsel you for an hour to support and guide lifestyle interventions nor is she or he incentivized to do so. Doctors aren’t reimbursed for prescribing lifestyle changes for their patients, and doctors often aren’t knowledgeable, trained, and/or confident in their ability to provide lifestyle interventions. A survey of family physicians found that only about 5 out of 10 family doctors felt competent in prescribing a weight loss program for patients with obesity. This is an outstanding statistic given obesity and diabetes cost the US healthcare system more than $200 billion per year and these diseases are strong warning signs of eroding health and contribute to the development of heart disease and cancer (our two leading causes of death in the US). Lifestyle medicine has the potential to not only reduce these costs but to, as beautifully stated by Dr. David Katz, MD, MPH founder of the True Health Initiative, “add life to years and years to life”.
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