Lifestyle Medicine, Revolution or Revelation?

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In the British Medical Journal on the 25th October 2018 an article was published exploring the development of a new diploma in ‘lifestyle medicine’, and asked if this is a new medical speciality? To many clinician’s ‘lifestyle’ is not simply a new speciality, but an unknown and misunderstood one. For many decades the significant role of changes in lifestyle in the prevention and recovery of non-communicable illness has been ignored or subjugated to a role of such insignificance that it has withered away from regular use in primary and secondary care.

But no longer; a combination of economic, social, political and patient driven needs is bringing the notion that investing in the development of a systemised approach to changing behaviour and the use of evidence-based lifestyle therapeutic approaches, such as a predominately whole food, plant-based diet, nutritional supplements, physical activity, sleep, stress management, tobacco cessation, alcohol management, and other nondrug modalities, to prevent, treat, and, oftentimes, reverse the lifestyle-related chronic disease that’s all too prevalent.

The term was apparently first used by an epidemiologist called Ernst Wynder in 1988 when discussing the effects of smoking on lung cancer risk and over the years it has become a frequently used, often poorly defined but fast-growing area of primary and allied health care. Functional medicine has taken the primary elements of lifestyle intervention and constructed a working frame work to allow for cross professional communication and associated strategy approaches to common mechanisms, rather than common diseases. Frameworks such as the ‘matrix’ are necessary to facilitate change in clinical management as clinicians entering this field after many years of work in the pharmacy and surgery dominated health care systems are accustomed to protocols and structured medication plans. Practitioners from the allied health care professions are often unfamiliar with the medicalised language and protocol structures, coming as they do from a patient centred and individualised approach.

To effectively implement lifestyle medicine programmes, the healthcare system and allied practitioners will need to support the provision of preventive care services and all involved clinicians will need to acquire a new skill set and develop allied partnerships. It is a rare person that can cover all of the required skills to deliver the approach, follow up and mentoring needed to progress someone from disability to health, and as such small teams of appropriately trained people will naturally form and evolve working systems.

Whilst nutrition is a foundational element of the process it only rarely operates on its own, other changes need to be incorporated to ensure that change is sustainable and viable, and to that end there are many other components of health delivery that need to be included in the process, each of which requires a high level of competence from the primary clinician, to recognise the role and opportunity, as well as applicability.

In a broader sense, the practice of lifestyle medicine requires acquiring the skills and competency in addressing multiple individual lifestyle practices, including diet, physical activity, behaviour change, body weight control, treatment plan adherence, stress and coping, spirituality, mind body techniques and tobacco and substance abuse.

We wish the British Society for Lifestyle Medicine all success in their development of the new diploma and trust that they will have a big network of allied health professionals in their sights as the job is too big for primary care providers on their own!

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