Lifestyle medicine lessons from East Lothian

As the UK prepares for a winter under a blanket of restrictions and lockdowns to tackle the Covid-19 pandemic, how can we draw hope from the lifestyle medicine approach?

Almost 30 years ago, while still practising as a GP, I helped to found a charity in Scotland with a simple aim: to help people with a range of chronic conditions to live well, regardless of their condition.

By the time the pandemic struck earlier this year, the charity (now trading as Live Well East Lothian but registered as a Charity, ELCRG) had built up a membership totalling several hundred. On an average week we would welcome more than 150 people to classes offering gentle exercise and social connection. These classes were a vital lifeline for those with heart conditions, lung problems and diabetes, as well as those recovering from strokes. I’m immensely proud of the group and its achievements; it is the embodiment of the lifestyle medicine approach.

Earlier this year, the group’s work came to a grinding halt with the introduction of the first lockdown when the pandemic struck. And despite attempts to move some of our offering online, we have never quite recovered.

I wonder how many other similar groups across the UK have suffered a similar fate? How many patients with chronic conditions have been deprived of similar lifelines; denied similar opportunities to manage and cope with their illnesses?

This is perhaps the forgotten story of the pandemic, and our singular focus on suppressing the Covid-19 virus. This focus may on the surface seem laudable and understandable. But without a similar and sustained focus on the long-term health and wellbeing of people with chronic conditions then the situation may worsen.

This is because the focus on “controlling the spread of the pathogen” has ignored the “syndemic nature of the threat we face” – a point made powerfully in a recent article in the Lancet by Richard Horton.

“A syndemic is not merely a comorbidity”, writes Richard. “Syndemics are characterised by biological and social interactions between conditions and states, interactions that increase a person’s susceptibility to harm or worsen their health outcomes.”

His conclusion was that successful containment of the virus demanded an equal focus on attacking non-communicable disease – as it does on vaccine development and traditional infectious disease control.

This represents an opportunity for those of us who practice lifestyle medicine to demonstrate the contribution our discipline can make to pandemic containment and recovery. Communicable and non-communicable diseases are not mutually exclusive. They are closely intertwined.

Determinants of health

Covid-19 has shed a spotlight on the health of our populations and revealed the true scale of the determinants of that health. There are a range of complex bio, psycho, social factors at play and which demand our attention.

We must not emerge from this pandemic unchanged. We must learn its lessons and acknowledge the degradation of our individual and planetary health over which we have presided.

But identifying the problem is only the start – we must also develop practical and deliverable solutions to these challenges. A great example of this in 2020 has been the development of virtual group consultations.

Group consultations have long been an integral part of the lifestyle medicine approach. However, by shifting patient sessions online in response to covid we have been able to demonstrate their even greater potential to support patients. They are an innovative way to deliver continuity of care to patients, and are a true demonstration of the power of lifestyle medicine – to offer us hope that we can find a sustainable, long-term answer to the syndemic.

As the four corners of the United Kingdom face a looming winter under a blanket of lockdowns and restrictions, let’s try not to lose sight of that hope. If we have created an unhealthy environment it falls to us to uncreate it, and lifestyle medicine provides us with the knowledge and the tools to do so.

As lifestyle medicine pioneer Garry Egger recently argued, that requires we legislate and regulate where we can, and educate and motivate where we can’t. I certainly hope I will be doing some of the latter with my patients at Live Well East Lothian soon.

Rob Lawson, British Society of Lifestyle Medicine Chairman
November 2020

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