Everybody knows that diet, exercise and other aspects of lifestyle play a significant role in health. But the specifics are less well understood. To what extent does lifestyle cause or contribute to disease and disability?
And what exactly is a healthy lifestyle anyway? There is much confusion about what type of diet or exercise is best, not to mention how much sleep, stress or sex is ideal. Nor is it clear how best to motivate people to change their habits.
This lack of clarity has inspired a growing movement to inform health professionals and patients about the importance of lifestyle in preventing and treating disease. Its aims are to disseminate scientific research about what it means to live well and to encourage doctors and other providers to incorporate this knowledge into their practices.
Two years ago, a group of doctors founded an organisation with the goal of making lifestyle medicine a credentialed clinical specialty and a part of basic medical training. Symptomatically treating disease without assessing patients’ lifestyles or offering them guidance on how to change is “irresponsible and bordering on neglect,” said Dr John H Kelly Jr., president of the fledgling organisation, the American College of Lifestyle Medicine.
A professor of preventive medicine at the Loma Linda University School of Medicine in California, Kelly said the group was formed because of people like his uncle.
Given a diagnosis of heart disease, the uncle had a stent surgically implanted to open a clogged artery but received no advice on how he might change his lifestyle, even though research shows that diet, exercise and stress management could greatly improve his condition.
Kelly says lifestyle medicine is essential in fighting the national epidemics of obesity, diabetes and cardiovascular disease. “We cannot solve the health problems of society unless we change our focus from acute, episodic care to health promotion and wellness — lifestyle medicine,” he said.
The Centres for Disease Control and Prevention reports that 1.7 million Americans die and 25 million are disabled each year by chronic diseases caused or made worse by unhealthy lifestyles. And a 2005 study in The New England Journal of Medicine predicted that average life expectancy in the United States would decline in the next 20 years as a result of unhealthy lifestyles, reversing a trend dating to the 1850s.
The American College of Lifestyle Medicine has 150 members in a wide array of specialties — nutritionists, ophthalmologists, gastroenterologists and oncologists, among others. Helping their cause is a new publication, The American Journal of Lifestyle Medicine, which appears every other month with peer reviewed research on the way daily habits affect health.
“Bottom line is we want to promote the science, education and practice of lifestyle medicine,” Kelly said.
Lifestyle medicine proponents include researchers and clinicians from the fields of medicine and public health. While they agree on the importance of questioning patients about their lifestyles and giving tailored advice on how to make improvements, there remains disagreement about who should provide such counselling and with what sort of training.
Nor is there a widely accepted prescriptive approach for encouraging patient compliance.
“We know lifestyle interventions can be very powerful,” often more effective than drugs or surgery, said Dr JoAnn Manson, a professor of epidemiology at Harvard’s School of Public Health and a member of the editorial board of the new journal. “But we need to provide the scientific evidence on how to incorporate that knowledge into practice.”
Doctors may vaguely recommend that patients lose weight or get more sleep, for example, but they do not necessarily know how to help them do it. Moreover, many physicians themselves have unhealthy habits that may prevent them from offering advice.