Lorna Rothery spoke to Alex Maxwell, President of the British Society of Lifestyle Medicine, to explore how this evidence-based discipline can enhance clinical care by promoting a more holistic approach to individual health
Lifestyle Medicine is an evidence-based clinical discipline that has three principles and six pillars. Its first principle is appreciating the importance of and acknowledging the need for action towards the socioeconomic determinants of health. Its second is skill with proven techniques to support people in making and sustaining lifestyle changes, and its third is knowledge of the six pillars, which are mental wellbeing, exposure to harmful substances, healthy relationships, healthy eating, sleep, and physical activity. There are Lifestyle Medicine societies, movements, and clinicians throughout the world – this is truly a global affair. Lorna Rothery spoke to Alex Maxwell, GP, School Doctor, and President of the British Society of Lifestyle Medicine (BSLM), to find out more.
How should Lifestyle Medicine be understood, and what are its key aims?
Lifestyle Medicine uses a strong understanding of behaviour science plus lifestyle approaches to treat and prevent illness in any setting. It can be utilised within the
community, general practice, hospitals, and even outside direct medical care. All healthcare professionals, as well as professionals in fields such as architecture and city planning, should be educated in Lifestyle Medicine to understand health principles and consider them in their work to improve people’s health. It’s important for everyone, including politicians, to consider these perspectives.
Lifestyle Medicine is a holistic approach that considers the individual as a whole. It’s not about replacing traditional medicine or eliminating the need for surgery and medications. Instead, it aims to serve the individual as effectively as possible. Lifestyle Medicine interventions are often effective and low risk – a potent combination that provides comprehensive care.
While ensuring a person’s lifestyle is considered is not a new concept it often plays second fiddle to pharmacological and surgical options. Healthcare workers’ training in Lifestyle Medicine is often inadequate. The BSLM’s focus is on formalising the discipline, advancing the evidence base, helping clinicians deliver support to patients to ensure they have all the options to improve health. Research shows that patients value this approach and appreciate the support they receive. It’s not just about following principles but understanding what is important to the individual. Instead of simply telling someone to eat healthily, it’s about understanding their specific challenges and environment. For example, if someone’s house is cold because they can’t afford proper heating, it can lead to mould and affect their health. Lifestyle Medicine teaches the importance of connecting them with the right resources and support, such as a social prescriber or assistance in contacting the council. We do not want to simply give superficial lifestyle advice, but help to address the real issues in patients’ lives. Patients often want more options and are keen to avoid medications or surgery when appropriate and possible.
Lifestyle Medicine is well established in 26 European countries as part of the European Lifestyle Medicine Council. Worldwide, 45 countries are members of the World Lifestyle Medicine Organisation. These organisations exist to support and develop countries’
healthcare professionals and advocate for policies relevant to their health systems and cultures.
What is the clinical, societal, and economic significance of Lifestyle Medicine?
The return on investment in prevention, early intervention, and community care is significant. When considering the economic and societal benefits, it’s clear that these aspects are closely intertwined. Healthy individuals are more likely to work, contribute to society, and experience overall happiness, leading to a positive impact on the community. As individuals become healthier and happier, they are more likely to engage in activities beyond work, and contribute to their community. This creates a significant virtuous cycle.
Principle one of Lifestyle Medicine involves knowledge and action to support the socioeconomic determinants of health, while principle two considers the evidence based psychology of health behaviour change and how to implement it effectively. Health inequality has grown significantly and is associated with negative outcomes in almost every way; if you’re able to influence the upstream determinants, you have a deeper appreciation using principle two of a person’s life and environment and work with them to help as best as you can in that context.
Substantial high-quality evidence shows that Lifestyle Medicine interventions can support physical activity and good nutrition, aid sleep, improve mental health, enhance social connections, and help reduce loneliness. Such improvements have then been shown to create medicine-free remission, or substantial improvement in long-term conditions such as obesity, type 2 diabetes, metabolic liver disease, hypertension, depression, mild cognitive impairment and many more. It’s important to empower clinicians to provide patients with all the available options rather than solely focusing on surgery and medications.
Many people are drawn to Lifestyle Medicine because they’re searching for their own solutions. It’s a common experience for healthcare professionals to become disillusioned and discover Lifestyle Medicine in their search for a way to best serve their patients. Lifestyle Medicine and Social Prescribing provide valuable options and tools to better meet the needs of each individual, which is particularly important in addressing burnout
in the healthcare industry. This approach can help healthcare professionals feel more positive, less burnt out, and better equipped to care for themselves and others.
How can Lifestyle Medicine help achieve the Quintuple Aim of healthcare?
The Quintuple Aim consists of improving population health, enhancing the patient experience, reducing healthcare costs, supporting clinician wellbeing, and advancing health equity.
Appreciating the importance of and promoting health equity is a key aspect of Lifestyle Medicine. So much so that our first principle is to appreciate and acknowledge how these impact the person in front of us. Lifestyle Medicine is distinct from public health, which primarily works on a population level. Instead, Lifestyle Medicine focuses on helping clinicians deliver lifestyle interventions on an individual and small group level, recognising that advice alone is unlikely to be effective. However, personalised, intensive and multi-component lifestyle interventions are effective. It serves as the clinical arm of public health, with leaders in the field advocating for equity and influencing policy in the broader context, thereby helping to reduce health inequities.
On average, people only see their GP around four times a year. They see hospital specialists even less often. They spend much more time in the community. Therefore, the narrative should be reframed to centre around the person, their families, friends, and their community. It’s challenging for healthcare professionals to significantly change someone’s life in the relatively short period of time they see them. A professional trained in Lifestyle Medicine appreciates one must engage with the resources available in the individual’s context. Lifestyle Medicine strongly advocates for community involvement, as people spend much of their time in their communities. As former health minister Lord Nigel Crisp states, ‘Health is made at home, hospitals are for repairs.’
Group consultations can provide an additional effective option for practices or groups, connecting people to their community and supporting behaviour change. These involve seeing eight to ten people with similar conditions at the same time; the clinician consults in the group setting with the support of a facilitator. They have been shown to meet the Quintuple Aim of healthcare in various contexts and conditions, and the BSLM supports their implementation throughout the NHS. While they’re not the ultimate solution, they can benefit both clinicians and patients.
It seems likely that Lifestyle Medicine can help improve population health. We need to build high-quality evidence to demonstrate this. From an individual clinician-to-patient perspective, it can make a difference. We have hundreds of great case studies and cohort studies showing how Lifestyle Medicine can enhance health, prevent illness, and support public health efforts.
How crucial is collaboration at different levels to the implementation of Lifestyle Medicine?
It’s everything. It’s important to always co-create and collaborate; lessons learned from local, regional, or national experiences and from other professional bodies are valuable and applicable elsewhere. Having a unified voice and sharing information is essential. This is a big part of what we’ve been working towards and making progress on. I’m proud of our incredible team, our advisory board, patient advocates, and the organisations we work with. They are an inspiring group of people and organisations that are advocating for the same things and working towards the same goals. We are determined to keep finding more like-minded people and organisations to make our collective voice louder – if you think you might be one of those, please get in touch.
Looking ahead, what is the BSLM working towards?
Our goals are to educate and support more clinicians, collaborate with more like-minded institutions, support all medical schools in integrating Lifestyle Medicine comprehensively into their curricula, have a greater impact on policy, and establish close ties with decision-makers. The BSLM has a five-year aim to increase the uptake of Lifestyle Medicine training for clinicians practising in areas of deprivation and high-risk prescribing in our bid to reduce health inequalities. We are confident that we are onto something important, and it is crucial that we are heard.
Our collection of up-to-date and evidence-based educational resources, including our Learning Academy’s Core Accreditation courses and webinars, are all available to our members, the learnings from which are then shared with their peers and patients. We have a broad reach, with millions of patients and tens of thousands of clinicians benefiting from our resources. For instance, we had 1200 attendees at a recent conference, and all the talks and resources, including PowerPoints and referenced research, are made available to them. We focus on creating practical and valuable content in addition to theoretical knowledge.
Furthermore, we are actively involved in conducting and supporting research and engaging with individuals who are making a positive impact in the community, sharing the lessons learnt with others, and supporting people in scaling their interventions. Our members and many other people are doing amazing things to support the health and wellbeing of our population, so we must learn from them to drive us all forward.
Although Lifestyle Medicine may not be the sole solution, it absolutely needs to be part of the conversation and will undoubtedly benefit our population. Ethically, we have a duty to know about effective, low-cost, low-risk interventions and support patients in achieving what they want. Patient-centred care is vital; we need to empower and activate patients towards better health, and Lifestyle Medicine can help us do this.
