Lifestyle Medicine; a modern medical discipline full of optimism
By Dr Alex Maxwell (BSLM President), Dr Ellen Fallows (BSLM Vice-President), Dr Rob Lawson (BSLM Chair)
7th Oct, 2022
Lifestyle Medicine is a modern medical discipline providing solutions to the challenge of our declining health and over-stretched health-care systems.
The British Society of Lifestyle Medicine has just held its 6th annual conference this month in Tottenham, London. Over 1000 healthcare practitioners from all backgrounds; health coaches, nurses, physiotherapists, GPs and hospital consultants came together with patients and researchers to share the science behind this powerful new approach and how it is being used to transform healthcare in the NHS.
Lifestyle Medicine is a rapidly growing global discipline offering people more options to achieve health before and alongside medication or surgical options. It describes approaches that clinicians can use to support people to improve their sleep, mental wellbeing, relationships, reduce isolation, eat better quality food, increase activity levels, avoid overusing technology, and avoid harmful substances such as alcohol and smoking. These concepts are not new, with roots in ancient medical practice. However, discussion and support for lifestyle factors have been side-lined by an over-emphasis on technology and pharmaceuticals in modern medicine. Medications can do great good but repeated calls have been made to stem the risks from “over-prescribing” with the average number of repeat medications in England going from 10 per person to 20 in just 10 years. This is despite patient preference for research into non-medication options and for support with lifestyle change, particularly with long-term conditions. Doctors and their patients have been found to over-estimate the benefits and under-estimate the harms from many frequently prescribed medications.
This focus on pharmaceutical options is costly; it sends a disempowering message to people and risks over-whelming health care systems with record levels of practitioner burn-out. Finally, science is moving away from the determinism of genetics. In other words, away from the suggestion that our destiny is written exclusively in our DNA and is unmodifiable and only impacted by medications. Modern medical disciplines such as Lifestyle Medicine tell us that wider factors such as the environment, society and lifestyle have profound impacts on health outcomes. This is an optimistic message – your destiny is in your hands and with the right support, you can also modify your health without medications or surgery. This support is essential. Lifestyle Medicine isn’t about blaming or shaming but supporting and empowering; using behaviour change techniques, group clinics and linking into community groups through social prescribing. It provides person-centred and values-based care.
A key area of progress has been research into the bacteria in our bodies – our microbiome – that has been shown to play a significant role in supporting or eroding our health. As presented in our conference, evidence has shown that it is through these bacteria that our sleep, physical activity, stress and social connection impact our health. Studies into gene expression (epigenetics) have shown that genes can be turned off and on by these same factors. Most importantly, major clinical trials have now demonstrated that providing proper support for patients to improve lifestyle factors doesn’t just prevent but can treat, and put into remission some chronic diseases such as depression, Type-2 Diabetes, high blood pressure and heart disease.
A paradigm shift has happened in scientific research. Discoveries suggest that that the driving force behind much ill health from cancer, depression, to heart disease and even Covid-19 is “chronic inflammation”. Whereas a healthy immune response causes short-term activation in our immune system and is critical for survival, chronic inflammation describes when immune cells remain activated at a low level over many months to years and cause damage to our organs and blood vessels. This results in high blood pressure, the ‘wrong’ balance of blood fats, raised blood sugar and subsequently conditions such as Type-2 diabetes, depression, heart disease and even cancers. Research has also found that chronic inflammation is worsened by ultra-processed food (food that has had much of its fibre removed and substances added to it such as emulsifiers, sugar, salt and cheap fats), by lack of sleep, social isolation, stress, inactivity, mental ill health, alcohol and smoking. The British Society of Lifestyle Medicine is now turning this research into clinical practice through its network of thousands of clinicians.
Health training, policy and delivery is only just catching up with this major liberating shift from medication-based solutions to those that provide environments, societies and health care systems that support people to improve lifestyle factors. Critically, our environment continues to be degraded whilst inequality and deprivation worsen; these are the driving forces behind our lifestyles and behaviours. Despite these facts, the 2022 British Society of Lifestyle Medicine conference was buzzing with examples from coal-face clinicians and others presenting results demonstrating good practice which supported not just prevention, but reversal of long-term conditions, even in the most deprived areas of the UK. These clinicians were joined by influential policy makers and health care leaders such as Professor Sir Muir Gray, Dr Crystal Oldman CBE (Queens Nursing Institute), Professor Martin Marshall CBE (RCGP, Chair), Professor Dame Clare Gerada (RCGP President), Sir James Mackey (CEO NHS Trust), Dr John Dean (RCP, Clinical Vice Pres) all of whom recognise this is where the future of medicine lies; in the hands of patients, supported by their clinicians. We now call on policy makers and healthcare organisations to support this grass roots movement to deliver Lifestyle Medicine at scale.
As has been written by one of the founders of Lifestyle Medicine (Professor Garry Egger): “We need to legislate, regulate and advocate where we can; to educate, motivate and instigate where we can’t; medicate, operate and palliate if all else fails.”
There has to be a joined-up approach to bridge the gaps between clinical medicine and public health, between supply and demand, between equity and inequity of health.
Lifestyle Medicine is ‘Optimistic Medicine’ which delivers on the quintuple aims in whole system scaling. These are delivering excellent health outcomes, efficiency, patients’ and clinician satisfaction, and educational value.
Lifestyle Medicine can help lift the NHS off its knees.