| Teach Patients About
Lifestyle To Prevent Disease
To what extent does lifestyle cause or contribute to disease
and disability? And what exactly is a healthy lifestyle anyway?
There is much confusion about what type of diet or exercise is
best, not to mention how much sleep, stress or sex is ideal. Nor
is it clear how best to motivate people to change their habits.
This lack of clarity has inspired a growing movement to inform
health professionals and patients about the importance of lifestyle
in preventing and treating disease. Its aims are to disseminate
scientific research about what it means to live well and to encourage
doctors and other providers to incorporate this knowledge into
Two years ago, a group of doctors founded an organization with
the goal of making lifestyle medicine a credentialed clinical
specialty and a part of basic medical training. Symptomatically
treating disease without assessing patients' lifestyles or offering
them guidance on how to change is "irresponsible and bordering
on neglect," said Dr. John H. Kelly Jr., president of the fledgling
organization, the American College of Lifestyle Medicine.
A professor of preventive medicine at the Loma Linda University
School of Medicine in California, Dr. Kelly said the group was
formed because of people like his uncle.
Given a diagnosis of heart
disease, the uncle had a stent surgically implanted to open
a clogged artery but received no advice on how he might change
his lifestyle, even though research shows that diet, exercise
and stress management could greatly improve his condition.
Dr. Kelly says lifestyle medicine is essential in fighting the
national epidemics of obesity,
and cardiovascular disease. "We cannot solve the health problems
of society unless we change our focus from acute, episodic care
to health promotion and wellness - lifestyle medicine," he said.
The Centers for Disease Control and Prevention reports that 1.7
million Americans die and 25 million are disabled each year by
chronic diseases caused or made worse by unhealthy lifestyles.
And a 2005 study in The New England Journal of Medicine predicted
that average life expectancy in the United States would decline
in the next 20 years as a result of unhealthy lifestyles, reversing
a trend dating to the 1850s. The American College of Lifestyle
Medicine has 150 members in a wide array of specialties - nutritionists,
ophthalmologists, gastroenterologists and oncologists, among others.
Helping their cause is a new publication, The American Journal
of Lifestyle Medicine, which appears every other month with peer-reviewed
research on the way daily habits affect health.
"Bottom line is we want to promote the science, education and
practice of lifestyle medicine," Dr. Kelly said.
Lifestyle medicine proponents include researchers and clinicians
from the fields of medicine and public health. While they agree
on the importance of questioning patients about their lifestyles
and giving tailored advice on how to make improvements, there
remains disagreement about who should provide such counseling
and with what sort of training. Nor is there a widely accepted
prescriptive approach for encouraging patient compliance.
"We know lifestyle interventions can be very powerful," often
more effective than drugs or surgery, said Dr. JoAnn Manson, a
professor of epidemiology at Harvard's School of Public Health
and a member of the editorial board of the new journal. "But we
need to provide the scientific evidence on how to incorporate
that knowledge into practice."
Doctors may vaguely recommend that patients lose weight or get
more sleep, for example, but they do not necessarily know how
to help them do it.
Moreover, many physicians themselves have unhealthy habits that
may prevent them from offering advice.
Sleep-deprived doctors who scarf candy bars for lunch "tend to
feel inhibited in counseling others when they aren't exactly setting
an example," said Dr. Walter Willett, chairman of the department
of nutrition at the Harvard School of Public Health and a member
of the lifestyle medicine college's board of advisers.
"Primary caregivers at least should have extensive training
in lifestyle medicine," Dr. Willett said. "And it's reasonable
for there to be a medical specialty" so patients can consult a
trained practitioner who is certified as an expert in the field.
Others say lifestyle medicine should be incorporated into every
facet of health care.
"I don't think it's appropriate to segment it off," said Dr.
Thomas W. Rowland, chief of pediatric cardiology at Baystate Medical
Center in Springfield, Mass., who routinely counsels children
and parents on how to adopt healthy lifestyles. "It needs to be
a fundamental part of every doctor's practice" and therefore a
part of every medical school's core curriculum.
Still, he acknowledges that there are significant obstacles,
because lifestyle counseling is time-consuming and is seldom compensated
by Medicare or health insurers.
Reimbursement is a chief concern of the American College of Lifestyle
Medicine. The group plans to lobby Congress to that end. And it
wants Congress to require that patients be informed about the
relative effectiveness of lifestyle changes before receiving certain
medications - including blood
pressure, acid reflux and cholesterol
drugs - and before undergoing procedures like back surgery, bypass
surgery and stent placement.
But first, Dr. Kelly said, patients and insurers need to be assured
of the professionalism of lifestyle medicine providers.
Some doctors say the movement suffers from fringe elements that
advocate unproven strategies like strict vegan diets and daily
"Lifestyle medicine has to be scientifically based to distinguish
it from all the quackery out there," said David R. Brown, senior
behavioral scientist in the division of nutrition and physical
activity at the disease control center.
Dr. Kelly agreed. "We need to have a certification process in
place with rigorous, evidence-based standards," he said.
Proponents of lifestyle medicine are quick to distinguish it
from alternative medicine. "This is mainstream medicine supported
by mainstream medical research," said Dr. James M. Rippe, associate
professor of cardiology at Tufts University School of Medicine
and the editor of The American Journal of Lifestyle Medicine.
"The lifestyle medicine movement is not an anti-procedure, anti-medication
Rather, he said, it advocates that lifestyle interventions become
part of the doctor's arsenal in fighting disease: "For too long
we've ignored our most powerful weapon when it should be our first
line of defense."