Lifestyle Medicine is no Trojan Horse: it is an Inclusive, Evidence-based & Patient-focused Movement

By BSLM

7th May, 2021

We welcome positive aspects of Nunan et al’s article and the opportunity to briefly discuss their analysis. However, likening Lifestyle Medicine to a Trojan Horse implies deception and malice; and is both unworthy and unjustified.

There are important positive messages conveyed: for example, articulating many of Lifestyle Medicine’s key drivers (Box 1), plus individual and public health level interventions (Box 2).

However, there are important fallacies too and we seek to correct these:

  1. Misrepresenting BLSM only as accrediting GPs. Although 885(~50%) members are GPs/GPSTs, membership includes all medicine disciplines, including internal medicine/surgery/nurses/allied health professionals/trainees. We also have patient members, encouraged to attend meetings through invitations via their clinicians (bslm.org.uk/events/bslm-2021-conference) and read our open access journal, Lifestyle Medicine (https://onlinelibrary.wiley.com/journal/26883740).
  2. Inaccurately linking alternative medicine practices/practitioners to lifestyle medicine; including bracketing BSLM with organisations like the (recently-rebranded) British Association for Nutrition and Lifestyle Medicine and (functional medicine-oriented) Prescribing Lifestyle Medicine
  3. Concern ‘lifestyle medicine practitioners’ may exploit commercial opportunities.
    The common fallacy here is blaming GMC/NMC/HCPC-registered practitioners for unregulated/commercial activities. This criticism (‘smearing by association’) is especially unworthy, especially as BSLM is standard-setting to mitigate these risks.
  4. The ‘Health Inequalities’ section is probably the most contentious.
    In brief, we recognise that environment and public health have key roles (see bslm.org.uk/lifestyle-medicine/what-is-lifestyle-medicine). However, we refuse to accept that: we are likely to widen inequalities ; medical practice cannot evolve; and personal/public health interventions don’t synergise. For a more detailed exposition, see <bslm.org.uk/lifestyle-medicine/what-is-lifestyle-medicine/evidence-based>. Criticising BSLM for not addressing upstream health determinants is simply incorrect: we do exactly that.

Lifestyle Medicine is inclusive, evidence-based, patient-focused and is not a movement needing to attack other health delivery approaches. We hope that scientific debate can be more dignified and constructive going forwards. We absolutely agree primary care and public health colleagues should work together and practise what we preach.

Given rapid BSLM growth, plus the success and popularity of progressive curricula like Imperial College’s ‘Lifestyle Medicine and Prevention’ undergraduate medicine modules, that are evidence-based and rooted in population health and inequalities, Lifestyle Medicine is becoming mainstream. We suspect future generations will term Lifestyle Medicine, as simply ‘Medicine’.

Author Affiliations

Fraser Birrell
Fraser.Birrell@bslm.org.uk
Occupation: Director of Science & Research, Consultant & Senior Lecturer in Rheumatology
Affiliation: British Society of Lifestyle Medicine
Competing interests: Director of Science & Research for the British Society of Lifestyle Medicine and Editor-in-Chief of Lifestyle Medicine, the official journal of the British Society of Lifestyle Medicine, Australasian Society of Lifestyle Medicine, the European Lifestyle Medicine Council and the Korean College of Lifestyle Medicine. Research grants for engagement through, plus spread and evaluation of group consultations (which create the time and space for effective delivery of Lifestyle Medicine) from Sir Jules Thorn Trust, National Institute for Health Research, Medical Research Council.

Richard J Pinder
richard.pinder@imperial.ac.uk
Consultant Public Health Physician
Imperial College London
Competing Interests: Director of Undergraduate Public Health Education and module lead for Imperial College London’s undergraduate medicine modules on Lifestyle Medicine and Prevention.
No direct or indirect other financial conflicts of interest to declare in relation to Lifestyle Medicine.

Rob Lawson
Rob.Lawson@bslm.org.uk
Lifestyle Medicine doctor & retired GP
British Society of Lifestyle Medicine
Competing interests: Chairman of British Society of Lifestyle, Medicine President of European Lifestyle Medicine Council, Chair of World Lifestyle Medicine Council (formerly known as the Lifestyle Medicine Global Alliance).

1) Nunan D, Blane DN, McCartney M. Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement. Br J Gen Pract. 2021 Apr 29;71(706):229-232. doi: 10.3399/bjgp21X715721. PMID: 33926883.

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