Promoting healthier lifestyles through lifestyle medicine training.
Many diseases, and in particular chronic diseases, are a result of poor lifestyle choices. These include behaviors and habits regarding diet and nutrition, physical activity, and substance use, among other things. Consequently, some of these choices have resulted in an increase in lifestyle-related illnesses at an alarming rate. Chronic disease has become such a burden globally, and such a major global health threat that it is the leading cause of death worldwide (71% of the world’s deaths), and the leading cause of disability (World Health Organization [WHO], 2021). Furthermore, chronic disease places immense strain on healthcare systems and resources everywhere. The strain is disproportionately greater in LMICs, where over three-quarters of the world’s chronic disease-related deaths occur (WHO 2021), and where the demand on the healthcare system is high but the resources to meet the demand are insufficient.
Poor lifestyle behaviors such as smoking, excessive alcohol consumption, unhealthy eating, and sedentary lifestyles (all of which are modifiable) increase the risk of developing chronic disease. It is estimated that every two seconds someone in the 30 to 70 age range dies prematurely from this, and there are projections that the global burden will be substantially greater by the next decade due to factors such as urbanization and globalization, among other things. The effects of this on global health and healthcare systems, global economic growth, the population, health equity, and poverty reduction will be devastating. Therefore, there is an urgent need for strategic efforts toward managing, reducing, and preventing chronic disease to improve global health outcomes.
To prioritize the management and reduction of chronic disease in a cost-effective, efficient and sustainable way, identifying and developing strategies and interventions that go beyond treatment is key. Strategies and interventions anchored in preventive measures such as promoting healthy lifestyles among populations, reducing exposure to associated risk factors, and increasing knowledge and awareness about the implications of exposure to risk factors are vital to these efforts. A useful strategy to this end is to employ lifestyle medicine counseling, interventions, as well as training to create positive lifestyle changes.
Lifestyle medicine is a branch of medicine that focuses on disease prevention by advancing and promoting healthy lifestyle habits and behaviors. Research has shown that amplifying and expanding lifestyle medicine efforts can result in positive health outcomes. Initiatives that place emphasis on building the capacity of healthcare professionals, increasing and enhancing health promotion clinical efforts, engaging communities through outreach, and engaging government and corporate stakeholders to effect policy and cultural changes are all considered efficient in advancing healthier lifestyles. These ideas have been advanced in numerous studies that demonstrate that lifestyle medicine is integral in promoting the adoption of healthy lifestyle choices and critical in preventing chronic disease.
A 2020 study conducted in Israel as part of our ATHP research advances that exposure to lifestyle medicine training can help residents and physicians to improve healthy habits among their patients. “Family medicine and other physicians can improve patients’ lifestyle behaviors, yet FM residency programs in Israel and other countries do not uniformly deliver lifestyle medicine (LM) training” (Malatskey et al., 2020, p. 1) The study further assessed the influence of lifestyle medicine training on residents’ personal health and counseling efforts showed that training not only improved residents’ health habits but also increased and enhanced their counseling. The research suggests that positive health outcomes are achievable “… by incorporating Lifestyle Medicine (LM) as part of routine clinical work and medical education programs” (Malatskey et al., 2020, p. 2). The notion is further supported by Tomlinson’s research that explores the successful use of LM through community engagement efforts. Tomlinson (2020) asserts that “Evidence-based research suggests that LM recommendations could extend the lives of disease risk individuals allowing them to live longer with fewer disabilities” (para. 5). This can yield positive health outcomes globally in the fight against chronic disease.
A major outcome of building capacity in lifestyle medicine among residents is that it helps to reshape their understanding of their role in health promotion. Family medicine residents in Israel, for instance, trained in lifestyle medicine, consider counseling patients about lifestyle habits as part of their work and that it is effective (Malatskey et al., 2020). Lifestyle medicine training also equips residents with the necessary knowledge and skills to counsel their patients about their health and lifestyle choices, and this, in turn, increases residents’ confidence levels. This approach in establishing lifestyle medicine counseling as a fundamental part of a physician’s daily practice can be transformative for the healthcare sector in several ways, including increased health promotion, greater awareness among people, the adoption of healthier lifestyles, and lower risks of exposure to the factors associated with chronic disease.
Interventions should also target healthcare professionals and aspiring healthcare professionals. Not only do they play a vital role in the fight against chronic disease and in providing pertinent information to patients about good lifestyle choices, but the research has shown that a correlation exists between their healthy habits and those of their patients. This expands on the Healthy Doc = Healthy Patient initiative previously developed. Participation in a wellness program for residents and enrollment in lifestyle medicine training has proven to be effective in influencing residents to adopt (or maintain) healthier behaviors. In a 2009 study that evaluated residents’ health patterns before and after participation in a wellness program, participants showed positive changes following the program. “Trends in exercise activity and perceived relevance of preventative counseling as well as frequency of counseling also improved following the wellness intervention” (Vormittag et al., 2009, para. 5). Lifestyle medicine training and health-related interventions used to influence positive behavior change and the adoption of healthier lifestyles among residents helped to enhance their health promotion efforts to patients and others requiring care. This suggests that interventions also have to be rooted in promoting healthy habits among residents, physicians, and other healthcare professionals to establish their support in health promotion, encourage them to transform their own habits, and help them to understand the impact this has on their patients’ lives. Healthier habits among residents also make them more credible to their patients (because they practice what they preach).
While the research has also shown that there has been success in the use of lifestyle medicine, there is evidence to suggest that greater efforts can be made towards integrating the training in health science programs across disciplines. The following excerpts from research papers almost a decade apart highlight this and indicate that there is room for improvements in expanding training efforts:
- Lifestyle medicine has shown to be a more cost-effective strategy than the approaches currently used in disease prevention and treatment, particularly chronic pathologies. Nevertheless, health professionals currently lack the training and resources to manage lifestyle interventions for their patients. (Ripoll, 2012, para. 10)
and
- For clinicians to enter the workforce with sufficient knowledge and skill to adequately serve patients with chronic disease, medical educators must incorporate LM into undergraduate medical education (UME), graduate medical education (GME), and fellowship curriculum as well as continuing medical education (CME) and maintenance of certification (MOC). However, a gaping void of adequate LM training exists across this entire medical education continuum. (Rea et al., 2021, para. 2).
Taking appropriate actions can facilitate major changes in global health and curb the advance of chronic disease. One such action is incorporating and expanding health promotion and preventive counseling as routine training in health science education, as this is critical to adopting healthier lifestyles and fighting against chronic disease. This approach should operate as part of the larger response to the issue of chronic disease, and the burden on healthcare resources this creates, and can contribute significantly to the implementation of the WHO best buys, and the actualization of the United Nations’ Sustainable Development Goal (SDG) 3. Lifestyle medicine training and participation in interventions for medical practitioners have been shown to instill positive behaviors and enhance counseling during clinical practice. Additionally, the use of lifestyle medicine training can help family medicine residents (and, by extension, other residents) to improve their patients’ lifestyle behaviors. “FM physicians can play a key role in the management of patients with chronic diseases […] Dedicated LM training and resident’s personal health promotion may improve critically important levels of LM counseling and patient outcomes, and this training should therefore become a higher priority” (Malatskey et al., 2020, p.8). This is also significant in solidifying the importance of all healthcare professionals in responding to the world’s lifestyle disease problem. Ripoll (2012) highlights that “[e]ffective application of lifestyle medicine should be considered a priority within the changes needed in current health systems and in public health policies” (para. 10).
In our next blog, we explore some discoveries and key takeaways from the research on Physicians and Addiction. Stay tuned!
References
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Aduke Williams
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