Covid-19 is not a lifestyle disease. It is a communicable disease and no one is immune from it. But, four months into the global pandemic, we are slowly realising that Covid-19 is not impacting on all of humanity equally.
Covid-19 does discriminate and we have recently begun to understand those factors which place some at greater risk than others. Certain groups in society seem to suffer disproportionately - whether it be those of a BAME background, older people, or those suffering socio-economic disadvantage. Men too appear to suffer higher death rates than women. Younger people, on the other hand, tend not to fare as badly if they catch the virus. It should go without saying, but these factors of course have nothing to do with “lifestyle”. We certainly have zero decision making capability when it comes to our age or ethnicity.
It is a fact that people with pre-existing, underlying health conditions are at greater risk of having worse outcomes from Covid-19. And supporting people with these conditions has become an even greater challenge due to the pandemic and the associated lockdowns. Engagement with primary care services, and access to face to face support networks being strained at present there is a greater risk their conditions will worsen. Prevention, treatment, management and even reversal of these chronic diseases has become ever more important.
Once again, this week, we have unfortunately seen a misrepresentation of lifestyle medicine and the role it can play in addressing some of these challenges. A clumsily titled conference run by the Royal College of General Practitioners erroneously suggested that Covid 19 was a “lifestyle disease”. The RCGP quickly realised its mistake in the titling of an otherwise excellent conference and apologised. This was the right decision but should not detract from the underlying principle of the conference, which was to support GPs to offer lifestyle advice to patients irrespective of background.
Criticism of the title of the conference does not appear to have been matched by criticism of its content - at least by the more than 770 GPs who attended. But in the world of social media, particularly where our arguments must be distilled to less than 280 characters, there is little room for nuanced discussion and debate. It’s far easier to get across outrage within such limitations.
So where does lifestyle medicine come in? What does it have to offer humanity - and is it even bad taste to mention it during a communicable disease pandemic?
The focus of lifestyle medicine is of course on non-communicable disease; on the chronic conditions which have been rising in prevalence, for roughly half a century, especially in relatively developed economies in the West, But there’s a misunderstanding that lifestyle medicine somehow offers a simplistic explanation of this trend - and puts forward simplistic solutions.
I would argue that lifestyle medicine, a term which has been kicking around for a couple of decades now, in fact offers an extremely thorough and science-based understanding of the problem of chronic illness - one which recognises the multi-faceted nature of human health in the 21st Century. In some respects, I understand why some people might have a problem with the term “lifestyle”. In fact I would go as far as to say the term lifestyle presents us with some challenges. Not least to better explain what we mean by it.
The central core of lifestyle medicine is about supported behaviour change at individual and community levels. How can we support individuals to make changes in the way they live which will leave them less prone to chronic illness? How can we help people to eat a healthier, more nutritious, diet, to reduce their consumption of processed foods, to exercise more, sleep better and reduce harmful substance misuse?
The answers to these questions are complex - and they don’t lie simply in people having individual lightbulb moments and making easy lifestyle “choices”. Lifestyle medicine as a discipline recognises that behaviour change isn’t easy and blaming someone for “poor” lifestyle “choices” doesn’t get you anywhere and is inappropriate. Our ability to change our behaviour is influenced by many complex factors. Some of these, no matter what our background, are potentially within our control. All of us have the capacity to make some small changes in how we live which could benefit our health and wellbeing. I have seen this happen, as a GP for 30 years, time and time again and in all walks of life.
But then there are the factors which are less within our control. We live our lives in a socio-economic and environmental context over which we have, often, fairly limited or no control. And lifestyle medicine doesn’t just acknowledge this - it proactively advocates for changes at these levels which will improve people’s health and wellbeing.
If you have any doubts about lifestyle medicine’s commitment to these broader social determinants of health I would strongly recommend listening to the recent conversation I had with Garry Egger, one of the founders of the lifestyle medicine movement. In a wide ranging conversation Garry touched on politics, history, economics, and climate change to weave a powerful argument explaining why non-infectious diseases began to overtake infectious diseases in certain parts of the world - roughly from the 1980s onwards.
“You legislate and regulate where you can,” Garry went on to explain … “but educate and motivate where you can’t.” This is a great summary of the lifestyle medicine approach. Garry certainly didn’t use the word ‘blame’ during any of our discussion because it is simply not part of our lifestyle medicine lexicon and never has been.
Garry is joining us this September for our fourth annual (virtual) conference. I hope you can join us too, not least because our list of topics and speakers demonstrates what a broad approach lifestyle medicine is.
The conference is an opportunity for those interested in lifestyle medicine to get the latest scientific evidence and thinking from a broad range of medical disciplines and schools of thought. I expect there will also be lots of nuanced discussion of lifestyle medicine in the context of the Covid-19 pandemic. Expect some thoughtful and considered contributions … which may well exceed 280 characters.
Dr Rob Lawson FRCGP Dip BSLM
Chair, British Society of Lifestyle Medicine