by Dr Michelle Reiss
For many centuries medical treatment has been sought mostly for ‘acute’ problems – acute means an illness with trauma, pain, fever, or infection which requires an immediate diagnosis and treatment. Once correctly treated, usually with medication or surgery, most acute illnesses will resolve, with return to normal functioning in a short period of time.
Now, for the first time in history, the prevalence of chronic disease has overtaken acute disease as the main reason why modern patients see a doctor. Chronic diseases are mostly caused by lifestyle and environmental factors, and over the last 30-40 years have risen in prevalence to account for approximately 70% of all primary health care visits in developed countries.
Over the past four decades, with the rapid advancements in agriculture, manufacturing and processing, and now digital technology, mankind has seen significant changes in food types, dietary patterns, daily activity levels and general lifestyle behaviours. Unfortunately, these rapid changes in diet and activity levels have contributed to an emergence of chronic diseases of pandemic proportions. The list is long and includes conditions such as Type 2 Diabetes, overweight/ obesity, high blood pressure, pre-diabetes, high cholesterol, heart disease, chronic fatigue, emphysema, hip and knee joint pain, back pain, chronic stress and many forms of depression and anxiety.
The challenge is that they do not make a person feel ill until they have progressed to a point where organs or systems are under stress and already not functioning properly.
Diagnosis is therefore delayed unless appropriate screening is in place. Unfortunately, they also cannot usually be cured with medication alone because the cause of the illness remains, so they exist indefinitely which is why they are termed ‘chronic’ meaning ‘to persist for a long time or constantly recurring’.
The scary statistic is that these conditions now make up the top 5 causes of death in Australia for those in the over-45 age categories.
Today’s General Practitioners (GPs) are experts in managing both acute and the measurable parameters of chronic disease, such as blood pressure control or sugar control. Managing the CAUSE of chronic disease is different, and lies in addressing lifestyle choices and assisting with the modification of health behaviour.
In a standard GP practice setting, unfortunately, this remains problematic: patients usually want a quick fix (even better if in pill-form!). This high turnover, medication-focused approach severely limits the establishment of the deeper Doctor-Patient relationship that is required for meaningful change. Further, whilst GP’s are well-intended, they are usually time and resource-poor so are often unable to address the complexities of the underlying behavioural or environmental causes within the time space available.
What is Lifestyle Medicine (LM)?
Lifestyle Medicine is the newest field of sub-specialisation in modern medicine. The specialty first came to light in 1999 with the publication of the first Lifestyle Medicine textbook, and the field of practice has only gained worldwide momentum among GPs and Allied Health Professionals (such as nurses, psychologists, dietitians and exercise physiologists) in the last few years.
Lifestyle-related health problems are PREVENTABLE and in many cases, REVERSIBLE, so as the name suggests, Lifestyle Medicine addresses both the cause, and the cause-of-the-cause and can often reverse early to medium onset chronic disease by assisting patients through evidence-based lifestyle and behaviour modification.
Lifestyle Medicine is an evidence-based approach that bridges the gap between the old and new, between medical knowledge and common sense, and is the shining light at the end of a very dark chronic disease tunnel.
It is defined as “the application of environmental, behavioural, medical and motivational principles to the management (including self-care and self-management) of lifestyle-related health problems in a clinical and/or public health setting.”
To me, however, the most beautiful aspect of this clinical specialty is that “it is inexpensive and even cost-saving; free of all but good side effects; safe and appropriate for children and octogenarians alike. It is, quite simply, the best medicine we’ve got.”
As a Lifestyle Medicine physician I have learned over time, that for anyone to maintain the motivation to make sustainable change, their WHYs and their HOWs have to be clearly defined. To this point, with regard to LM, I hope that I have clearly explained:
• WHY YOU MAY WANT TO UNDERSTAND THE CONCEPT OF LIFESTYLE MEDICINE.
• WHY, ALTHOUGH BEING EVIDENCED-BASED CONVENTIONAL MEDICINE, IT DIFFERS IN ITS APPROACH TO CHRONIC DISEASE.
• WHY IT ADDRESSES THE UNDERLYING CAUSE AND THE CAUSE-OF THE-CAUSE OF CHRONIC DISEASE.
If you are a patient who would like to lose weight, change your lifestyle habits, prevent your chronic disease risk factors, or manage and potentially reverse your chronic disease, then it is also important that you establish your WHYs. This means setting your vision and your goals. By knowing WHY you have set these goals you can clearly define your pathway to that goal.
Only once you’ve set your goal and know your pathway, can you determine HOW best to follow that path.
How do you get Lifestyle Medicine from your GP or Allied Health Professional?
In reality you do not actually ‘get’ Lifestyle Medicine as you would get medication or surgical intervention.
In Lifestyle Medicine, your GP or AHP acts as a facilitator or coach, and provides you with the education and the tools (the Why’s and the How’s) to travel the pathway to achieving your goal. You become the driver.
A GP skilled in Lifestyle Medicine principles will:
1. EVALUATE YOUR PERSONAL LEVEL OF READINESS TO MAKE A LIFESTYLE CHANGE
2. GUIDE YOU TOWARDS FORMING AN ACTION PLAN
3. ASSESS YOUR KNOWLEDGE AND CONFIDENCE LEVELS IN APPLYING CHANGE
4. HELP YOU ADDRESS YOUR MOTIVATION AND ANY PHYSICAL OR PSYCHOLOGICAL BARRIERS TO CHANGE
5. PROVIDE YOU WITH THE LATEST IN EVIDENCE-BASED INFORMATION ON DIET, EXERCISE, STRESS, SLEEP, TOBACCO RISKS, AND ALCOHOL RISKS
6. CONSIDER A MULTI-DISCIPLINARY TEAM OF SUITABLY QUALIFIED LM ALLIED HEALTH PROFESSIONALS AS PART OF YOUR HEALTHCARE PATHWAY
7. OFFER YOU ONGOING NON-JUDGEMENTAL SUPPORT THROUGH ALL STAGES OF YOUR CHANGE PROCESS, THROUGH LAPSES AND RELAPSES AND ONGOING MAINTENANCE. SUPPORT COULD BE THROUGH A COMBINATION OF CONSULTATIONS, GROUP PROGRAMS, NURSE VISITS, TELEPHONE CONTACT, APPS OR SOCIAL MEDIA CONNECTEDNESS
In summary, you and your GP may like to apply the fundamentals of health by focusing on a holistic approach, namely the Bio-Psycho-Social model of care.
So, if your GP provides you with the tools, how could you ensure that you steer yourself along your health pathway? Consider the following:
1. ARE YOU REALLY READY TO MAKE LIFESTYLE CHANGES?
2. HAVE YOU SET A CLEAR GOAL AND KNOW YOUR WHY? IS YOUR PATHWAY TO YOUR GOAL DEFINED FOR YOURSELF? YOU CAN OF COURSE (AND SHOULD) SET SMALLER GOALS ALONG THE WAY
3. DO YOU UNDERSTAND THE DIFFERENCE BETWEEN ‘INTERNAL’ AND ‘EXTERNAL’ MOTIVATION AND HOW THIS IMPACTS YOUR CHANCES OF SUSTAINABLE CHANGE?
4. HAVE YOU RECEIVED ASSISTANCE IN EVALUATING YOUR OWN SELF-TALK AND HOW THIS MAY POSE BARRIERS ALONG YOUR PATHWAY TO YOUR ‘FOREVER CHANGE?’
5. DO YOU KNOW HOW AND WHERE TO GET SUPPORT, EITHER THROUGH YOUR HEALTH CARE PROFESSIONAL, FRIENDS, FAMILY, COMMUNITY GROUPS OR ONLINE?
As I explained in my introduction, Lifestyle Medicine is an emerging field and it may not be easy to find a GP or AHP that can apply all the principles of evidence-based information and couple that with support and behavioural change techniques. Rest assured, easier access is around the corner as the pandemic of chronic disease cries out for a different approach to medical care. And that approach is Lifestyle Medicine.
*This is an edited article. To read the full article please go to the website shown below and/or conduct your own further research.
