By Gretchen Welby, PharmD.
GUEST CONTRIBUTOR
“Lifestyle medicine” is not just a fad or buzzword that’s overused in health, fitness and wellness magazines, but is actually a medical specialty.
Lifestyle medicine is the practice of using diet and exercise, along with other lifestyle modifications, to prevent and manage disease. It focuses on six pillars: healthy eating, physical activity, restorative sleep, stress management, positive social connections and avoidance of risky substances.
The American College of Lifestyle Medicine was established in 2004. Since then, its membership and outreach have grown exponentially. Lifestyle medicine is now the fastest-growing specialty in medicine.
Lifestyle medicine’s primary aim is to use evidence-based, therapeutic lifestyle interventions to prevent/control chronic diseases such as cardiovascular disease, Type 2 diabetes and obesity. However, new data is emerging which expands that role into many other areas, including chronic low back pain, sleep, hormonal disorders, Alzheimer’s disease, chronic inflammatory conditions and mental health.
Lifestyle medicine differs from conventional medicine in that its approach is not disease specific. Conventional medicine targets and treats a specific disease process with medication or surgical intervention in a reactionary approach, while lifestyle medicine prevents or reverses the disease process through behavioral and dietary changes. In a perfect world, lifestyle medicine and conventional medicine can be combined to achieve the best results for some patients.
A JAMA study published in 1993 linked unhealthy lifestyles with premature death. Since that study was published, the rates of cardiovascular disease and Type 2 diabetes have continued to climb. Obesity rates are at an epidemic level: 70% of American adults and 22% of children fall into overweight/obese body mass index (BMI) categories.
According to the American Academy of Cardiology, only 6.8% of adult Americans meet the criteria for ideal cardio-metabolic health — a statistic the academy calls a “population level code blue.”
In 2020, the American Heart Association issued a presidential advisory for 2030 Impact Goals. The overall goal is to improve morbidity and mortality through preventive measures. Interventions should be targeted earlier in childhood and young adulthood, where healthy habits can be formed with greater success and maximum outcomes.
For example, physical activity is well established for its positive effects on cardiovascular health. Physical activity prevents clot and plaque buildup, is antiarrhythmic and provides hemodynamic stability — meaning vital signs, such as blood pressure, heart rate and oxygen levels, remain within normal, healthy ranges.
Physical activity has also been shown to have psychological, emotional and social benefits. The American Heart Association categorizes physical activity as a Level 1 (highest) intervention for primary prevention.
The efficacy of lifestyle medicine is supported in scientific literature. A study published in the New England Journal of Medicine in 2002 examined the prevention of the onset of Type 2 diabetes in prediabetic patients. Patients were divided into three groups: a placebo group, a metformin group (a Type 2 diabetes medication) and a lifestyle intervention group. The metformin group received daily metformin; the lifestyle intervention group received education and prescriptive interventions/instructions on diet, exercise and stress reduction. Patients were followed for three years. At the end of the study period, the metformin group saw a 31% incidence reduction of Type II diabetes, while the lifestyle intervention group saw a 58% incidence reduction — almost double that of the medication group.
There are other advantages of lifestyle medicine over conventional medicine:
• Medications come with side effects. Healthy eating habits do not lead to serious side effects.
• Medication costs are rising and are often not fully covered by insurance programs. Lifestyle interventions are within the patient’s control and may result in cost savings, potentially lowering food and medical bills.
• Current medications often are not completely effective for treating disease. For example, the Alzheimer’s Association International Conference emphasizes healthy lifestyle interventions. The organization stresses adopting four or five healthy lifestyle factors to reduce the risk of Alzheimer’s dementia by 60%.
Because lifestyle intervention involves behavioral changes, the process requires time and effort, as well as investment in education and reinforcement to sustain healthy patterns. Motivating clients to make necessary changes and stick with those changes can be the biggest challenge.
A lifestyle/wellness coach may be employed to start the client on their journey. The coach works with the client to make choices that are adaptable to the client while fitting within the six pillars. The role of the coach is to hold space and provide guidance for the client, but not to “fix,” “rescue” or “judge.” Coaching sessions last 30-60 minutes. Coaches and clients may meet 10 times over three months to a year to establish patterns.
If you, like so many others, have not achieved your health and wellness goals using traditional methods, it may be worth considering lifestyle medicine. Focus on healthy eating (minimizing processed foods and sugar intake), physical activity (minimum 300 minutes per week), restorative sleep (seven to nine hours per night), stress management (controlling anxiety and depression), positive social connections (consistent interactions with friends) and avoidance of risky substances (alcohol, tobacco/nicotine, illicit drugs).
Information about the six pillars of lifestyle medicine and specific intervention outcomes can be found at Balancedliving570 on Facebook and Instagram.
Gretchen Welby, PharmD., graduated from Philadelphia College of Pharmacy and Science, the University of Scranton, and Temple University with a Doctor of Pharmacy degree. She has been teaching for over 25 years at Rutgers University, Keystone College, Lackawanna College, the University of Scranton and Marywood University. She has certifications in Pilates, yoga and barre, and teaches all three locally. She has a wellness and lifestyle coaching certification from Harvard University. She lives in Scranton with her husband, Timothy Welby, M.D., and has three daughters, Casey, Kate and Caroline.
Paul J. Mackarey, P.T., D.H.Sc., is a doctor in health sciences specializing in orthopedic and sports physical therapy. He is in private practice in Scranton and Clarks Summit and is an associate professor of clinical medicine at Geisinger Commonwealth School of Medicine. Email: mackareypt@gmail.com.
