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Between high patient loads in the office, pharmaceutical reps pushing the latest and greatest drugs, and patients wanting a quick fix, lifestyle-as-medicine can sometimes be overlooked. The Nadolsky brothers have taken on a mission to change that. This monthly column will review studies in the field and offer tips on how to incorporate new knowledge into practice.
Apropos of a statement we made in our feature last month on why we are passionate about lifestyle-as-medicine, we thought it may be prudent to show that the medical consensus is to treat with lifestyle changes first.
Due to barriers in medical care from government, insurance, a corporate mindset, and other red tape, there is growing concern among the public that doctors do not think of lifestyle as an important component of healthcare delivery.
Our whole objective is to bring awareness to the contrary, and in this edition of Lifestyle Medicine, we will review some major medical society guidelines and recommendations that make lifestyle change the primary treatment.
Lifestyle treatments familiar to most physicians focus on obesity, diabetes, and cardiovascular disease. Despite that, perhaps we still need to get back to our roots, as there are plenty of Internet instigators proclaiming on social media platforms that doctors and nurses do not emphasize dietary and physical activity treatments for these intimately linked diseases.
The 2013 AHA/ACC/TOS certainly places emphasis on behavioral strategies for weight loss, focusing on dietary strategies plus physical activity, while even the recommends that "diet, exercise, and behavioral modification be included in all obesity management approaches" as its very first recommendation.
Treatment of type 2 diabetes and pre-diabetes has always centered on lifestyle therapy to treat the underlying obesity via weight loss and glycemic control through diet, but sometimes that gets overlooked. The and have continued to stress eating habits and physical activity for type 2 diabetes in addition to gestational diabetes, via .
The same can be said for the primary treatment of reducing cardiovascular risk due to dyslipidemia and hyperlipidemia. The is publicized as "statin guidelines," but makes very clear to reinforce lifestyle as the foundation for cardiovascular risk-reduction efforts.
Similarly, the National Lipid Association and accentuate medical nutrition therapy, physical activity, and smoking cessation as an integral part of treatment.
The from the Endocrine Society also recommends lifestyle therapy for the initial treatment of mild-to-moderate hypertriglyceridemia. Evidence supporting the reduction in cardiovascular risk due to hypertension via lifestyle intervention is well documented and has it front and center of its algorithm prior to the pharmacology it is intended to guide with a reminder to "continue throughout management."
For patients with known atherosclerotic cardiovascular disease, the prioritizes lifestyle modifications for management of lipids and blood pressure and dedicates a section to physical activity that details aerobic activity in addition to "complementary resistance training," which we fully support, of course.
For those who already suffer from heart failure, exercise training is recommended for improving functional status and touted as safe and effective by the .
It should be evident that lifestyle therapy is the foundation for cardiometabolic disease, but often unnoticed are a variety of other diseases that can be prevented or treated via a groundwork of lifestyle-as-medicine.
Osteoporosis and prevention of falls with subsequent fractures is a perfect example and an area that absolutely depends on lifestyle medicine. The , the , and the all put lifestyle first, focusing on diet (including calcium), vitamin D, weight-bearing exercise, and muscle strengthening, with the ultimate goal of fall prevention.
One of the most common complaints we get in the clinic is about joint pain stemming from osteoarthritis. The American College of Rheumatology puts an emphasis on various lifestyle changes to help mitigate the progression and pain including exercise and weight loss.
Even GERD gets lifestyle as first-line treatment, according to the American College of Gastroenterology -- despite most charges that physicians simply like to throw PPIs and H2 blockers at everyone.
It has unfortunately become common for both the physicians and patients to want to begin with a medicine for diseases that can be treated with lifestyle. As physicians, we should strive to do what we were taught in school and what is given as first-line treatment in these major evidence-based guidelines.
Many patients believe doctors are owned by big pharma and are professional drug dealers. We can change this with just a modicum of effort.
Some physicians believe we don't have enough time in the office setting to allow for the aforementioned lifestyle counseling listed in the guidelines. While time during a visit is certainly a barrier, we will be exploring ways to overcome this mindset in the coming months.
For now, we just wanted to offer a reminder that mainstream medicine is supposed to promote lifestyle as first-line treatment for many, if not the majority of chronic diseases before prescribing a drug.
, is an endocrinology fellow and is board-certified in internal and obesity medicine. , is a primary care physician board-certified in family and obesity medicine. Both have patient-facing blogs, at and .
Disclosures
Karl and Spencer Nadolsky disclosed no financial relationships with industry.