Lifestyle-related diseases are a growing threat to public health, but is enough being done to mitigate the risks? To discuss this, HEQ spoke with the Executive Director of the British Society of Lifestyle Medicine, Dr Fraser Quin.
Exercise, a healthy diet and not smoking are often cited as three key influencers in the prevention of chronic diseases. Yet, proven behavioural and social interventions to mitigate the risk of chronic lifestyle-related conditions are often not suitably recognised or implemented. In a bid to better address the root causes of ill health, and reduce the growing burden of non-communicable diseases, a burgeoning strand of evidence-based medicine is advocating a multidisciplinary, multi-system approach to care to be considered alongside conventional medical approaches. As well as focusing on the physical, emotional and environmental determinants of ill health, lifestyle medicine considers the socioeconomic factors and believes social prescribing and ultimately a more personalised approach to care should be better supported at community through to policy level.
One organisation committed to transforming population health is the British Society of Lifestyle Medicine (BSLM). Founded in 2016, BSLM promotes the wider uptake of lifestyle medicine principles among society, clinicians, and policymakers through the dissemination of educational resources, up-to-date research and knowledge sharing.
To discuss the key principles of lifestyle medicine and the challenges associated with its widespread adoption HEQ spoke to the Executive Director of the British Society of Lifestyle Medicine, Dr Fraser Quin.
How would you define lifestyle medicine and how does it differ from conventional medicine?
Lifestyle medicine is an established, evidence-based medical discipline. For at least two decades it has been used by clinicians around the world in the prevention, treatment, management, and reversal of chronic illnesses. Lifestyle medicine societies like BSLM want to see this approach become a mainstream part of conventional medicine. It should work in partnership with, and support, conventional medicine. And while lifestyle medicine seeks to reduce our reliance on surgery and medication, we of course believe there are instances where these are needed. Lifestyle medicine definitely is not alternative medicine, nor is it integrative medicine; it is scientific, evidence-based medicine.
In clinical practice, lifestyle medicine is all about supporting people to make healthy lifestyle changes. Our main focus is on what we call the ‘six pillars of lifestyle medicine’. These are healthy eating, physical activity, stress and mental health, sleep, avoiding harmful substances, such as alcohol or tobacco, and social connection. But that is not our only concern: lifestyle medicine is also committed to addressing the social determinants of health. Issues like poverty, inequality and deprivation, alongside environmental challenges like climate change, place huge barriers in the way of people’s health. Lifestyle medicine is all about breaking those barriers down to get to the root causes of what makes people ill.
What health conditions can lifestyle medicine support? Can you give some examples of lifestyle adjustments that might be prescribed?
There are many non-communicable diseases or conditions where lifestyle medicine can help. This includes diabetes, heart disease, some cancers, respiratory and musculoskeletal conditions, and mental health issues. Type 2 diabetes is a good example of where lifestyle interventions can make a difference. Medications are probably only ever going to keep people standing still when it comes to this condition – but dietary changes like carbohydrate reduction and avoiding processed foods have been proven to help many people achieve remission. The work of Dr David Unwin in Southport in this area has been game changing. Not only has he helped many of his patients to achieve remission – he has also massively reduced his practice’s drugs bill, which, can also have a big environmental impact! So, it is a win-win.
Depression and other mental health conditions are also worth mentioning. Here, physical activity, eating a healthier diet, getting enough sleep, cutting back on alcohol and nurturing good quality social connections can all help. In the UK, it was great to see these non-pharmacological interventions being recommended as ‘first priority’ treatments for mild depression – in new proposed guidelines issued by the National Institute for Health and Care Excellence.
Does this holistic approach to health represent the future of medicine?
Well for non-communicable illnesses I would certainly argue it does. These conditions remain the leading causes of death globally and even the COVID-19 pandemic has not changed that. In fact, COVID-19 has also served to highlight the much greater risks people with chronic underlying health conditions face.
Lifestyle medicine has the potential to help us prevent large numbers of premature deaths. Lifestyle is the cause and the cure of 80% of chronic diseases. It is really that powerful. In the UK we have 26 million people with self-reported long-term health conditions which account for over half of all GP appointments. Besides the obvious misery this causes people, it places a huge strain on our healthcare systems and taxpayers, with more than 40% of our health budget spent on trying to treat them.
Just think of the difference we could make to our society if we could change the way we do things for the better. Lifestyle medicine can be that change, in my view. It is evidence-based, low risk, compared to surgery and medication, and certainly more sustainable.
Where it works best, however, is where it is practised without blame or judgement. Lifestyle medicine will never work if we wag our fingers at patients and tell them to mend their ways. What we need to do is create the right conditions for people to enjoy a healthier lifespan – to make healthier living easier for people. We want to create equitable access to healthy living for all. That is the goal and it is ultimately what drives BSLM and our members.
What are the key challenges facing the wider adoption of lifestyle medicine by medical professionals? How can these challenges be overcome?
In terms of medical professionals, the key challenge probably relates to knowledge and skills – making sure clinicians know what to prescribe, how to get results and have the evidence, and confidence, to back it up. That is one of the key reasons we set BSLM up and why we have supported more than 600 members to complete a lifestyle medicine diploma, which gives them the solid grounding in lifestyle medicine to use it confidently in clinical practice. It is also the reason we have recently launched the BSLM Learning Academy which will be the UK’s leading provider of lifestyle medicine training and education.
Clinicians should not feel they have to know everything though – and effective referral and signposting is key to successful lifestyle medicine. GPs refer all the time to other specialists, in secondary care, for example. Lifestyle medicine is no different, but we are more likely to refer people to an exercise class or a smoking cessation group than the local hospital! This is where something like social prescribing fits nicely with lifestyle medicine. It is often about tapping into resources that exist in people’s local community and can help people make healthy lifestyle changes.
Finally, how can healthy living and good nutrition be made more accessible?
That is a crucial question and something BSLM is committed to addressing. It is important that lifestyle medicine does not become the exclusive preserve of the wealthy. Some of the most disadvantaged in our society have the most to gain from lifestyle medicine and we are determined they do not get left behind. Our clinicians will tell you that many of their patients often know what constitutes healthy living and good nutrition. But making those all-important lifestyle changes is the hard part, so behaviour change techniques are a critical focus and tool in lifestyle medicine.
Our #1change campaign is all about encouraging people to start with one small thing they can do to improve their health – like getting off the bus one stop earlier or reducing alcohol over time. By starting small we can begin to make big changes. But this has to be backed up by wider efforts to break down the barriers people face to living more healthily. And while there are things we can do as clinicians in the consulting room – action is also needed at the societal level. And for that, we need politicians and policymakers to also recognise the importance of creating the right conditions for healthier living.
Lifestyle medicine is not something we just do on our own as individuals. Lifestyle medicine is a blueprint for reframing healthcare and creating a healthier society. And for that to succeed, it has to involve everyone.
Dr Fraser Quin
British Society of Lifestyle Medicine