BSLM2021 – flying the flag for lifestyle as medicine

Sometimes we just have to shake our heads and wonder what on earth has hit us in the last 18 months. A global infectious disease pandemic has killed millions and placed intense pressure on global healthcare systems.

This threat to population health from a communicable virus is sadly only part of the story. In fact, we have quickly learned that Covid-19 is one part of a syndemic: where non-communicable diseases – NCDs – interplay with communicable disease to cause maximum harm.

This summer has at least offered us some hope that we may be through the worst, and the development and rollout of vaccinations is a cause for celebration. And it was with some relief that we were able meet again in person as a lifestyle medicine community in Scotland this month for our annual conference.

It was wonderful to be in Edinburgh for the second time, flying the flag for Lifestyle as Medicine. Flying the flag for strong scientific evidence, and for the art of translating it into positive health outcomes – including a healthier lifespan.

I’d like to say a huge thank you to all our speakers who joined us either in person or virtually for the conference. Collectively, their experience and knowledge gave us plenty to reflect upon – and many practical ideas to implement. Together, we explored the true meaning of the science and art of a healthy lifespan.

Thank you also to our event sponsors, exhibitors, poster abstract writers and winners and crucially to the BSLM organising team and the EICC team.

BSLM2021 was our first hybrid lifestyle medicine conference – and came after last year’s successful online gathering.
The shadow of the syndemic formed the backdrop for much of our discussions. As conference was told, the reality is that every year 15 million people die as a result of non-communicable diseases. To date, Covid-19 has claimed the lives of four million.

BSLM2021 was an opportunity to explore the intrinsic link between the two pandemics – and how outcomes of communicable diseases such as Covid-19 are made worse by underlying chronic health conditions. And of course, our focus was on how lifestyle medicine can help to mitigate these outcomes – using the six pillars of Lifestyle Medicine and more.
So what are the lifestyle factors contributing to poor covid-19 outcomes? What did our speaker Professor Tim Spector tell us? That in many people Covid-19 has behaved like an autoimmune disease.

That in poorer areas, 30% of people have gained weight. That the common risk factors are obesity, Type 2 Diabetes, heart disease and deprivation. That poor diet is also a common factor. That nearly one quarter of Covid-19 cases could have been prevented if these differences in diet quality and wealth had not existed.

This conclusion is drawn from a huge dataset of 4.5 million people in the USA and the UK. We also know that lifestyle as medicine can impact very effectively on these risk factors.

And we can see that impact clearly in one of our abstract winner’s presentations which reported on the first 500 case studies from our diplomates. Hannah Findlater’s research has demonstrated real life impact – for example 95% of overweight subjects achieved substantial weight loss and 82% of sufferers of type 2 diabetes achieved lower HbA1c levels and some going into remission.

And just imagine our 600 qualified lifestyle medicine diplomates bringing their expertise to bear with these kind of outcomes – with thousands or even hundreds of thousands of our citizens. In fact, playing around with figures our diplomates could collectively have well over six million opportunities annually to start the ‘what matters to you’ conversation. The benefits for population health as a whole would look impressive to say the least.

But how do we ensure we achieve maximum impact? We don’t judge, we don’t tell people who already feel hopeless and not in control of their lives what to do. We ask them what they think they need to live better lives. As Sir Harry Burns said at our last conference – it’s about creating a wellbeing economy where people are more in control of their lives – and want to achieve better things. We could even call this health creation.

However, as a people-focussed discipline – which includes social prescribing – we don’t forget the upstream determinants of good or poor health.

So our conference programme covered a lot of ground – including planetary health, our lived-in built environment, nature, art and purpose in life.

Emerging from the pandemic

At last year’s conference I said we mustn’t walk out of this pandemic unchanged. So what solutions have been aired? Let’s start with the London School of Economics – Lancet Commission on the future of the NHS which was published in May 2021. It is titled: Re-laying the foundations – for an equitable and efficient health care service – after COVID-19.

What did it propose?

Firstly, working differently with patients to improve integration, shared decision making and achieve realistic expectations.

Secondly, addressing population health and inequalities. The burden of chronic disease has grown and demand will not lessen with growth in genomic and personalised care.

Thirdly, recognising changing health need: especially by acknowledging multimorbidity and mental health issues. Both of which are shockingly high.

Its recommendations included:

1. Increased investment in NHS, social care and importantly public health. By 4% per year for 10 years. BSLM supports this.
2. To develop a sustainable, skilled and inclusive health and care workforce to meet changing health and care needs. This requires workforce strategies to focus on optimal composition. It requires training of multi-disciplinary teams and developing new models of care that actively engage patients. This is what BSLM already promotes within our multidisciplinary membership – and through Group Consultations.
3. To strengthen the prevention of disease and disability – all UK administrations should have a strategy across government departments to promote health, wellbeing and equity in policies. We heartily agree.
4. To develop the culture, capacity and capability to become a learning health and care system. So there is a role here for electronic personal health record development and patient access.
5. Finally, to improve integration between health, social care and public health and across different providers including the third sector. That would mean single public sector entities responsible for managing budgets and care for geographically defined populations. We agree.

All of us at BSLM2021, and beyond, can help to make these recommendations happen – change can indeed come from the frontline and bottom up: #1change at a time.

Five years of BSLM

Which brings me to a few words about our Society. BSLM is now in its fifth year, achieving growth and reach beyond our expectations. So much so that our Trustees, at the turn of the year, took the decision to appoint a Senior Management Team led by Fraser Quin with the express aim of taking us into an ambitious development programme.

The creation of our Learning Academy is key to this – and it was wonderful to hear more about its creative educational output from Dr Ellen Fallows at the conference. This has resulted in greater membership engagement, more educational output and a bigger social media footprint. And of huge importance is the achievement of our lifestyle medicine Diplomates, from all healthcare disciplines.

Thanks also to all our volunteer directors from all around the UK who have put on local events and built up local lifestyle medicine communities – Cornwall being a stand-out example.

From an international perspective BSLM is contributing to the global spread of Lifestyle Medicine by holding the Presidency of the European Lifestyle Medicine Council and the Chair of the World Lifestyle Medicine Council – with an additional seat on its Governing Committee. We were lucky to have a conference session from both these international perspectives.

And let’s not forget a jewel in our scientific crown – the Lifestyle Medicine open access Journal, its Editor in Chief also being our Science and Research Director, Dr Fraser Birrell.

Call to action

So with all this going on – my call to action to you all is: get qualified, get involved and continue your good works. You are the future and in many areas you are already leading our nations into better health.
Given the strain you have all been under due to the SARS COV 2 pandemic I should like to conclude with a quote from Dame Clare Marx, head of the General Medical Council.

“There is so much to admire in the health service’s response to the last 18 months. But perhaps the greatest triumph is not what has been done, but how it has been done – through camaraderie, communication, and collaboration.
“Let’s hope this spirit carries through to the months and years ahead. So every doctor and every patient experiences the compassion that defines first-class care.”

Lifestyle Medicine is both the spirit and body of healthcare – it is both the present and the future of healthcare.
It can deliver healthier lives to millions here in the UK and around the world. By the end of BSLM2021 all of those present felt better placed to deliver it. And we certainly had some fun along the way!

Dr Rob Lawson, BSLM Chairman
September 2021