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This website mentioned in one of the pages that Lifestyle Medicine is the foundation of conventional medicine. When you think about it, it is true. Lifestyle Medicine is a new subspecialty although it has been practiced for thousands of years.
The current COVID-19 pandemic --- together with its consequential imposed safety protocols, quarantines, and community lockdowns --- has forced us to return to the basics and evaluate our current lifestyles. It has changed our approach to everything and that includes a heightened understanding of the importance of exercise, nutrition, stress management, sleep, social relationships, and avoiding toxic substances. Suddenly, the six main focus of Lifestyle Medicine became the center of public consciousness. This article will explain why and how it is so and will describe the basic structure of Lifestyle Medicine as a medical discipline.
Historical Perspective
To understand better the origins of Lifestyle Medicine, let us compare the causes of death between 1900 and 2019. The figure below shows a big difference.
During the 1900’s, acute and infectious diseases ranked high among the causes of death. You will see that all forms of pneumonia ranked first followed by all forms of tuberculosis.
At that time, the technology in medicine focused on the discoveries of cures. The identification of bacteria, the creation of antibiotics and vaccines, and the improvements in sanitation and hygiene that started in the late 19th century trickled down to the early 1900s in the race for eradicating these infectious diseases.
Yet, in 1918, the Spanish flu pandemic came and caused 20 million deaths worldwide in less than one year. This clearly illustrates how unpredictable the emergence of diseases could be. The appearance of AIDS, the re-emergence of multidrug-resistant TB strains during the 1980s and early 1990s provide additional evidence that as long as microbes can evolve, new diseases will appear. Who would have thought that COVID-19 could be this dangerous?
These infectious diseases underscore the importance of disease prevention through continual monitoring of underlying factors.
However, as time went on, the modern post-industrial era resulted in changes of living conditions and lifestyle behaviors. Scientific and technological advances played a major role and became the foundation for today's disease surveillance and control systems.
But despite the technological advances, by 2019, the leading causes of death became chronic in nature. You will see that heart diseases ranked first followed by all forms of cancer. It is even disturbing that suicide ranked tenth. Studies indicated that most chronic diseases are the result of lifestyles fueled by poor nutrition and physical inactivity. It just shows that there is a correlation between modernity and technologies that developed over time during the 20th and early 21st centuries and the changes in human lifestyles.
Chronic diseases are also responsible for most of our health care expenditures. Since 2010, nearly 18% of the US gross national product has been spent on health care, which exceeded $3.0 trillion in 2015. And with the current COVID-19 pandemic, our healthcare system might be on the verge of bankruptcy. If 1 in 10 individuals in the United States would adopt a healthy lifestyle, the amount of money saved could result in billions of dollars saved.
And that is what medical experts have been talking about the past decades until now. Lifestyle medicine first became a movement then later on it developed into a medical discipline.
Lifestyle Medicine vs. Conventional Medicine
Medical experts defined Lifestyle Medicine as the application of the principles on environment, behavior, and motivation, including self-care and self-management, in the management of chronic diseases which were lifestyle-related in a clinical setting. As mentioned in this website, Lifestyle Medicine is also an evidence-based approach. Below is a comparison between conventional medicine as we know it and Lifestyle Medicine as a discipline.
As you can see, the focus has shifted to the patient himself as it emphasizes self-care and self-management. The doctor acts only as the coordinator and motivator.
In order to prevent further complications of chronic diseases and chronic diseases itself, lifestyle medicine should become the primary approach to its management and prevention. It is time to change the destiny of our health by shifting our attitude toward a healthy lifestyle. That shift should also provide a positive impact which should be carried forward to our children as they mature. It is also our aim that the younger population should be exposed to this healthy lifestyle approach and should begin at a very young age.
The idea that many chronic diseases are simply the result of aging must be corrected. Hypertension, heart disease, diabetes, and osteoarthritis are not inevitable outcomes of aging, but are an end product of poor lifestyles.
There are four areas in conventional medicine where lifestyle medicine could be added: 1) the science (the epidemiology), 2) the art (the skills), 3) the materials (the tools) and 4) the procedures (the actions).
The Science
The dictionary defines “epidemiology” as a branch of medical science that deals with the incidence, distribution, and control of disease in a population. Simply put, it understands the causes of the disease and where the disease is, plus it includes its control and prevention. It was rather easy for infectious diseases to study its epidemiology because medical experts can pinpoint to a single biological cause and can also pinpoint the corresponding cure.
However, when it comes to chronic diseases, it is rather complex. Medical experts cannot pinpoint a single cause, but rather defines its epidemiology in collective terms like “determinants”, “markers”, or “risk factors”. Also, in a recent medical study, the term “anthropogens” surfaced. It is defined as “man-made environments, their by-products and/or lifestyles encouraged by those environments, some of which have biological effects which may be detrimental to human health”. The figure below shows how determinants or risk factors could become chronic diseases over time.
Therefore, a Lifestyle Medicine physician would study the interactions between these determinants of chronic diseases and conditions because all influences, and not just the obvious, need to be managed for optimal health. However, through the decades, leading proponents of lifestyle medicine have faced resistance or marginalization. Yet, studies show that more than 80% of chronic diseases could be avoided by recommending changes to a healthy lifestyle. Also, 80% of the population wants to live in a better state of health but do not know how to pursue it.
The Art
It was only during the last few decades that medicine was considered not just a science but also an art. The practice of Lifestyle Medicine requires huge amounts of motivation which includes both academic and professional skills in behavioral science and change. These skills are used in persuasion, motivation, education, and coaching.
Also, Lifestyle Medicine focuses on the risk factors rather than the disease itself although medical prescriptions are still an adjunct to therapy and medical intervention.
It also zeroes into the problem of poor lifestyle choices based on misinformation. Most patients typically gather their food and nutrition information from popular media rather than from clinicians, many of whom may have limited knowledge of lifestyle interventions. Another factor is the limited time provided in the traditional one-on-one medical consultation.
The Tools
Digital technologies has resulted in an array of lifestyle tools that help monitor and provide feedback to individuals. These self-operated digital gadgets are available to the public and most health-conscious individuals use these to monitor their blood pressure, blood sugar, heart rate, etc. This behavior has shifted the patients’ role from a minimally-informed recipient to an active collaborator. Thus, Lifestyle Medicine tools center on the concept of the “quantified self”. Patients now have the responsibility and control to measure what needs to be measured and monitored.
The Procedures
There are still several existing procedures in conventional medicine such as referrals, medication, and surgery (if needed) that are used in the practice of Lifestyle Medicine. I incorporate Lifestyle Medicine in my practice of Internal Medicine although there are new procedures that are unique to Lifestyle Medicine like shared medical appointments for the Group Starter Program and telephone triaging during the free medical consultation.
Integrating Lifestyle Medicine into clinical practice in the areas of food, nutrition, exercise, and stress reduction is now common. Creating change takes courage and a willingness to think creatively as we shift our medical system.
There are professional associations in Lifestyle Medicine in 18 countries around the world and still counting. The structure and pedagogy of Lifestyle Medicine as a medical discipline is still in its infancy. That is why sharing best practice models among peers will result in the most effective care of our patients.
Conclusion
Chronic diseases predominate the leading causes of death in the recent decade. But since there is no single cause for chronic diseases, medical experts describe its epidemiology collectively as risk factors. Studying these risk factors points out to lifestyle as the bottom line and over time, what first became a movement became a medical discipline called Lifestyle Medicine. Also, Lifestyle Medicine adds to the science, the art, the tools and the procedures of conventional medicine. Although Lifestyle Medicine is now recognized worldwide, it is still a medical discipline in progress.
Should you be interested in Lifestyle Medicine, feel free to schedule a consultation. Who knows? There is a health program that might suit your need. If you want to hear from me discuss more about Lifestyle Medicine, feel free to listen to my podcast. If you want to be updated with news and features from this website, subscribe to my newsletter or reach out using the contact form below.
Sources:
Birrell, Fraser. 2020. “Inaugural Lifestyle Medicine Editorial.” Wiley Lifestyle Medicine. May 15, 2020.
Bodai, Balazs, Therese Nakata, William Wong, Dawn Clark, and Steven Lawenda. 2017. “Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival.” The Permanente Journal. September 17, 2017.
Centers for Disease Control and Prevention. n.d. “Leading Causes of Death, 1900-1998.” Centers for Disease Control and Prevention. Accessed March 17, 2021.
---. “Leading Causes of Death.” National Center for Health Statistics, Centers for Disease Control and Prevention.
Egger, Garry. 2019. “Lifestyle Medicine: The ‘Why’, ‘What’ and ‘How’ of a Developing Discipline.” Australian Journal of General Practice. October 2019.
Merriam-Webster, Inc. n.d. “Epidemiology.” Merriam-Webster Dictionary. Accessed March 19, 2021.
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