Blueprint for Health – BSLM Government Recommendations

Blueprint for Health

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A new approach to a national health crisis

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The British Society of Lifestyle Medicine is calling on government to adopt a new approach to tackling the health crisis facing the United Kingdom.

The British Society of Lifestyle Medicine, is an independent, scientific, evidence-informed Scottish Charitable Incorporated Organisation (SC046920), working across the UK and is dedicated to advocating the role of Lifestyle Medicine to transform people’s health and wellbeing. It was founded in 2016 by a group of leading medical professionals to transform health and wellbeing through Lifestyle Medicine. Lifestyle medicine uses comprehensive lifestyle changes to prevent, better manage and even reverse, the progression of chronic diseases, such as obesity and Type 2 diabetes. Importantly, it is a grass roots membership-based organisation with over 3000 members working within the NHS and in private practice who can be called upon to support our activities.

The scale and impact of chronic diseases in the UK is alarming. The four main chronic conditions affecting society today are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and Type-2 diabetes. They are rising at an unprecedented rate. Alongside this, we are seeing a stark rise in mental health conditions across many demographics in the population. This means that a new approach to healthcare is needed in addition to the important public health measures of prevention at population level. Lifestyle medicine is evidence-based clinical care that offers a significant, practicable and applicable solution to this. The BSLM educates a new breed of clinicians in the discipline of Lifestyle Medicine who are better equipped to improve health. We collaborated with and supported the development of the GP with Extended Roles in Lifestyle Medicine recently introduced by the Royal College of General Practitioners. The British Society of Lifestyle Medicine aims to inform the public about the influence of lifestyle factors on their health; we educate our healthcare professionals and leaders on this new approach to treatment; and we provide the highest quality, evidence-informed information across our healthcare systems. This must be done alongside strong public health and policy work to provide the means to live healthily – this is by far the most equitable, sustainable and effective way to improve health.

People of all ages, ethnicity, gender, and from any region or country are affected by, and are vulnerable to, potentially modifiable risk factors in the environment. These contribute to chronic disease and are issues that government can influence, one example being the provision of food through schools, other institutions and public services.

The British Society of Lifestyle Medicine teaches clinicians how to apply the basic evidence for lifestyle interventions alongside medicines or surgery. Support to change lifestyle can achieve better outcomes for long-term conditions – including not just prevention and treatment but in some cases, remission. This reduces the cost of care and importantly can also reduce the harm some patients experience from overprescribing and too much medical intervention.

The Lifestyle Medicine community is asking government to focus on:

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1. Prevention

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The British Society of Lifestyle Medicine strongly supports public health colleagues and backs their calls for:

Increasing access to green and blue spaces, walking and cycle paths, encouraging physical activity and movement by increasing access to affordable sport and recreation activities

Providing access to affordable healthy food and for policy restricting sales of ultra-processed food (UPF)

Supporting initiatives to minimise environmental pollutants and increase net zero campaigns

Providing affordable housing incentives and supporting affordable housing initiatives

Supporting asset-based community growth

Providing ring-fenced budgets to develop integrated neighbourhood asset-based community teams including the voluntary sector which support GP practices in their social prescribing endeavours

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2. Supporting Health and Social Care Professionals

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A commitment to continue to fund primary care with adequate GP provision, including GPs with Extended Roles, in addition to lifestyle medicine clinicians, nurses, dieticians, appropriately qualified nutritionists, health coaches, physical activity coaches, social prescribing link workers and mental health workers.

Training and policy levers that enable clinicians to offer patients options for support around lifestyle change in every routine clinical encounter, alongside medication or surgical options, to avoid the harms of polypharmacy and improve care

Lifestyle Medicine interventions and clinicians to be recognised and better described in major national clinical guidance across the four UK nations e.g. NICE guidance, SIGN guidelines

Group Consultations to be offered as a routine treatment option across the NHS to cost-effectively address waiting lists and improve: access, patient and clinician satisfaction and education

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3. Ageing Well

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Prioritising health throughout the lifespan, particularly children’s health and wellbeing

Introducing free school meals for all school age children

Providing support for healthy ageing, encouraging a whole food, plant-predominant diet, regular physical activity and social engagement

Tackling the wider social, economic and environmental determinants of health

The British Society of Lifestyle Medicine is asking government to:

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Embed Lifestyle Medicine throughout the current healthcare system, both primary and secondary, so people are supported at every opportunity during consultations. The tools available to Lifestyle Medicine practitioners include person-centred care, behaviour change interventions such as brief interventions (a technique used to screen and identify those at risk, for example, of excess alcohol or substance use and other unhealthy behaviours), health coaching, social prescribing and group consultations.

Return on Investment

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Medical costs associated with non-communicable diseases are huge, and increasing, with 11% of GDP spent on health delivery in the UK, which equates to just under £300 billion per annum (Office for National Statistics, 2024). Life expectancy has ceased to increase after sixty years of improvement, with more chronic conditions leading to an unhealthier old age. A growing body of evidence suggests that Lifestyle Medicine interventions, including group consultations, social prescribing, programmes for Type-2 diabetes ¹, obesity and heart disease, represent value for money alternatives to the prescription pad or surgeon’s table. Reported return on investment from Lifestyle Medicine interventions vary from 1.5 to 2.8 depending on the programme ². What is clear from these studies, however, is that not only can significant costs savings be achieved through activities such as group consultations and social prescribing, but that both patient and clinician satisfaction increases as people are “treated” in social settings, in their own communities. This in turn, makes it less likely for return visits to their GP surgery or hospital.

Lifestyle medicine (LM) is an evidence-based medical specialty that uses comprehensive lifestyle changes to prevent, better manage and even reverse the progression of chronic diseases, including cardiovascular disease, cancers, diabetes, respiratory and musculoskeletal disease, as well as mental health conditions. Lifestyle Medicine addresses the underlying causes of chronic diseases, which are a combination of genetic, physiological, environmental, and behavioural factors.

Lifestyle medicine seeks to address these issues to improve the health and wellbeing of individuals and societies. There are three key principles that guide Lifestyle Medicine, and these are:

• The up-stream determinants of health, including economy, environment and education
• The Science underpinning the pillars of Lifestyle Medicine. Lifestyle medicine is science and evidence informed
• The tools for behavioural change to implement lifestyle interventions.

On an individual level, LM principles focus on the following six pillars:

• Supporting being active
• Healthy eating
• Restful sleep
• Stress reduction and supporting mental health
• Avoidance of harmful substances, e.g. tobacco, drugs and alcohol, environmental pollution
• Supporting social connections

At a societal level, Lifestyle Medicine emphasises the importance of broader factors, including:

• Environment and ecological health
• Poverty and health inequality
• Social isolation
• Loss of culture and identity

Lifestyle Medicine is a multi-disciplinary approach to addressing chronic diseases. It supports and works in conjunction with conventional clinical medicine and our NHS care and public health systems.

Lifestyle Medicine has evolved from a grass-roots movement of patients, healthcare professionals, educators and researchers who want to address the underlying causes of ill health and prevent illness. It uses three key principles:

• The most up-to-date research to inform which lifestyle changes improve health and prevent illness
• Proven behavioural change techniques to support people to sustain a healthy lifestyle
• Wider community involvement in all aspects of health; including primary care, secondary care, social care and communities themselves

Lifestyle Medicine supports the use of knowledge of behavioural science to work with patients. It encourages working with people and their values to support problem solving and equip them with the skills they need to make changes to their health. Some of these techniques have been shown to be at least 80% more effective in supporting behaviour change than traditional advice giving ³ and include:

• Person-centred care
• Motivational interviewing
• Cognitive behavioural therapy techniques
• Health coaching
• Social prescribing
• Group consultations
• Use of Patient Activation Measures

BSLM aims to provide representation, education, training and support for doctors, nurses, allied health professionals and health/wellbeing practitioners including health/wellbeing coaches, public health professionals, researchers and educators in their practice of Lifestyle Medicine. As such, our key objectives are:

• Providing opportunities for learning and knowledge sharing among healthcare professionals around lifestyle medicine, through our world class Lifestyle Medicine education courses.
• Promoting greater adoption of Lifestyle Medicine in healthcare in the NHS, more widely in healthcare and in society.
• Raising awareness of the principles and practice of Lifestyle Medicine.
• Developing a solid evidence-base to support the use of lifestyle medicine in the treatment, management, and reversal of chronic disease.
• Ensuring access to this information for the wider interested public.

Making a sustainable change through Lifestyle Medicine

We know that the implementation of Lifestyle Medicine can drastically impact the prevention, treatment and even remission of chronic conditions, and there is growing evidence emerging to support this thinking. For example:

• In the prevention of chronic conditions, the EPIC trial, one of the largest studies of its kind involving 500,000 people, followed over 15 years, found that a Mediterranean diet is associated with reduced mortality and incidence of cardiovascular disease and cancer ⁴
• In the treatment of chronic conditions, Chronic Pain Rehabilitation, using exercise and techniques such as cognitive behavioural therapy has been shown to improve quality of life, to support people to live well despite the pain they are in, as well as actually reducing the pain itself. ⁵
• In the remission of chronic conditions the SMILES trial, demonstrated depression remission through a dietary intervention for moderate to severe depression and that this could be more effective than anti-depressant treatment.
• The implementation of lifestyle medicine techniques in adult social care and healthy ageing.
• The use of Lifestyle Medicine methods in Pre-habilitation and Re-habilitation programmes.

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For more information about BSLM and Lifestyle Medicine please contact Executive Director Fraser Quin at fraser.quin@bslm.org.uk

References:

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1: Unwin D, Delon C, Unwin J, Tobin S, Taylor R. What predicts drug-free type 2 diabetes remission? Insights from an 8-year general practice service evaluation of a lower carbohydrate diet with weight loss. BMJ Nutr Prev Health. 2023 Jan 2;6(1):46-55. doi: 10.1136/bmjnph-2022-000544. PMID: 37559961; PMCID: PMC10407412.

2: 2 Edington DW, Burton WN, Schultz AB. Health and Economics of Lifestyle Medicine Strategies. Am Journal of Lifestyle Med. 2020 Feb 22;14(3): 274-277.

3: Kelly MP, Barker M. Why is changing health-related behaviour so difficult? Public Health. 2016, 136, 109-116.

4: Trichopoulou A et al. Modified Mediterranean diet and survival: EPIC-elderly prospective cohort study. BMJ. (2005) 30;330, 7498, 991.

5: Hooten W et al, Treatment Outcomes after Multidisciplinary Pain Rehabilitation with Analgesic Medication Withdrawal for Patients with Fibromyalgia, Pain Medicine, (2007), 8, 1, 8–16.