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Is Lifestyle Medicine the Future of Chronic Disease Care?

Updated: Nov 8, 2020



The leading cause of death across the globe is chronic disease, responsible for around 60% of annual mortality (Grover & Joshi, 2014). These diseases such as cardiovascular disease, cancer, chronic respiratory disease, and diabetes are slow in progression and generally long lasting. Many chronic disease risk factors are caused by lifestyle and therefore preventable (Grover & Joshi, 2014). By implementing healthy lifestyle modifications such as diet and exercise can cause a reduction in chronic disease mortality (Australian Institute of Health and Welfare, 2016). As chronic disease increases, the need to address the cause has become an important challenge to every health system (Grover & Joshi, 2014). Where does Lifestyle Medicine play a role in chronic disease care? Using a SWOT analysis to identify its strengths to build on, weaknesses to minimise, opportunities to seize, and threats to counteract (Queensland Government, 2017) will identify the success that lifestyle medicine can play in the future of chronic disease care.

Strengths

Lifestyle medicine has emerged as a new discipline of medicine that is focused on the prevention and management of chronic disease whose causative risk factors are lifestyle. With the global rise in chronic disease showing little success in its prevention now warrants further investigations into its management. The economic burden of chronic disease impacts society with its high cost of health care and its loss of work productivity through death and illness. In the years 2008-2009 this figure reached around $27 billion and will continue to rise as this economic burden increases (Australian Institute of Health and Welfare, 2014). Lifestyle medicine is now able to use this economic burden to introduce an effective course of action in the delivery of evidence-based lifestyle interventions that will prove cost effective and beneficial in the care and prevention of chronic disease (Morton, Mitchell, Kent, Egger, & Hurlow, 2016).

Lifestyle medicine replaces unhealthy lifestyle habits with healthy lifestyle interventions in its treatment and prevention of chronic disease. Over the years this discipline has been strengthened by its success in evidence-based lifestyle programs such as the Complete Health Improvement Program (CHIP), the Ornish Program, the Pritikin Program, and the Diabetes Prevention Program (DPP) which have favourably confirmed that chronic disease can be managed and at times reversed with healthy lifestyle interventions (Bodai et al., 2017). To further build on this strength are several studies that have been conducted to support the positive outcome of the CHIP lifestyle program. These studies include the effectiveness of the CHIP in an Australasia feasibility study (Morton et al., 2013), the cohort study of the long-term effectiveness of the CHIP program in Hawera, New Zealand (Kent et al., 2013), and the cohort study of the short-term effectiveness of a lifestyle intervention program for reducing selected chronic disease risk factors in individuals living in rural Appalachia (Drozek et al., 2014).

Weakness

A weakness exists within primary health care with the general practitioner (GP) being limited by consultation times. A standard consultation does not allow the time required to deliver the broad topic of lifestyle interventions to patients who present with chronic disease (RACGP 2019). To implement lifestyle interventions requires the GP to collect relevant lifestyle information from the patient to identify lifestyle risk factors, and then find what will motivate the patient to implement the necessary lifestyle modifications (RACGP 2019). With limited consultation time may cause the GP to deliver broad advice that may not be necessarily tailored to the patient’s lifestyle needs (RACGP 2019). GPs may also lack the education required to deliver lifestyle medicine (Sagner et al., 2014, p. 1291), with many currently unaccepting of its positive role in the prevention and management of chronic disease.


A further weakness is the differing health disciplines not yet accepting that chronic disease can be cared for by lifestyle medicine. Though it is accepted that unhealthy lifestyle is a risk factor for chronic disease, few accept that a healthy lifestyle can reverse or cure such diseases. This is especially true for type 2 diabetes mellitus with Victorian State Government in consultation with Baker Heart and Diabetes Institute stating that research confirms there is no cure for this disease (Victorian State Government, 2015).

Opportunities

The impact of an unhealthy lifestyle gives rise to the opportunity of lifestyle medicine and its evidence-based ability to treat the cause of chronic disease. A decrease in physical activity due to sedentary lifestyles shows around 70% of the population not participating in acceptable levels of exercise (Sagner et al., 2014, p. 1289). An increase in unhealthy dietary choices and fast food takeaways have also been identified as major risk factors to chronic disease which can be prevented with health lifestyle interventions (Sagner et al., 2014, p. 1289). In 2015 nine out of every ten deaths in Australia can be attributed to chronic disease with each of those deaths having around three associated chronic illnesses (Australian Government Department of Health, 2017). The global economic burden of poor lifestyle choices and its risk factors for chronic disease is now unsustainable and requires action (Sagner et al., 2014, p. 1289). Preventative health programs are now recognised as an integral part of care and management of chronic disease with the focus being to reduce the risk factors through evidence-based healthy lifestyle interventions (Australian Government Department of Health, 2017). A warning was given by the World Health Organisation that chronic disease health challenges can no longer be ignored if dire consequences are to be addressed in the attempt to reduce these health outcomes (Parliament of Australia, 2010). Due to lifestyle related chronic disease being the leading cause of death and disability in Australia now opens the opportunity for lifestyle medicine to play a major role in chronic disease care.


Threats

Medications present as the accepted and preferred medical intervention for both the GP and the patient, creating a band-aid effect of masking the symptoms and not treating the underlying cause of disease (Sagner et al., 2014). With the removal of symptoms also removes the willpower on the behalf of the patient to implement any healthy lifestyle modifications. This accepted medical intervention has now caused chronic disease to become a global concern as numbers reach heights of economic unsustainability (The Australian Prevention Partnership Centre, n.d.).


Chronic disease gets its nourishment through the continual advertising of unhealthy food products. The Australian population are continually bombarded through social media, television, and radio advertisements enticing the purchase of products that are processed/refined, with high sugar and high fat content, all having the potential to cause food addictions (Gordon, Ariel-Donges, Bauman, & Merlo, 2018). This is also supported by unhealthy food products for sale at fast food take-aways, along with restaurants who fail to offer healthy options on their menu. With all this conflicting information pushed through the media has resulted in a confused population receiving conflicting information on what constitutes a healthy lifestyle (Sagner et al., 2014).

Society also poses a threat to lifestyle medicine by creating a health-destroying environment of liquor stores, tobacco shops, fast food take-aways, supermarkets that promote processed/refined high sugar and fat produce, entertainment venues such as movie theatres and recreational clubs catering unhealthy food and beverage options. Few resources have been utilised to promote a healthy lifestyle, with a lack of facilities that provide physical activity rendering it impractical to continue daily exercise during inclement weather. Exercise is now replaced with computer games, television, and social media with society (Bodai et al., 2017) successfully establishing an ongoing obesogenic environment.

In conclusion, the SWOT analysis presents strengths of successful lifestyle programs that are supported by research evidence. These strengths can no longer be ignored as the morbidity and mortality of chronic disease increases due to the present management of these non-communicable diseases. Though weaknesses do exist with the GP and their lack of consultation time, education, and acceptance of this new discipline. The opportunity is present to seize acceptance of this discipline due to the current high levels of chronic disease and the increasing economic statistics that are now unsustainable. Though threats do present in the areas of medication and society’s implementation of an obesogenic environment, these can be counteracted with advertising and education. With chronic disease being the leading cause of death across the globe, with its economic burden, and increasing prevalence clears the way for lifestyle medicine to be the future of chronic disease care.


References


Australian Government Department of Health. (2017, May 16). Chronic Conditions. Retrieved from https://www1.health.gov.au/internet/main/publishing.nsf/Content/chronic-disease

Australian Institute of Health and Welfare. (2014). Chronic disease - Australia's biggest health challenge (178). Retrieved from https://www.aihw.gov.au/getmedia/8f7bd3d6-9e69-40c1-b7a8-40dca09a13bf/4_2-chronic-disease.pdf.aspx

Australian Institute of Health and Welfare. (2016, April 19). Evidence for chronic disease risk factors. Retrieved from https://www.aihw.gov.au/reports/chronic-disease/evidence-for-chronic-disease-risk-factors/contents/behavioural-and-biomedical-risk-factors

The Australian Prevention Partnership Centre. (n.d.). Preventing our greatest health proble. Retrieved from https://preventioncentre.org.au/wp-content/uploads/2017/05/0417_FS_ChronicDisease_final-1.pdf


Bodai, B., Nakata, T. E., Wong, W. T., Clark, D. R., Lawenda, S., Tsou, C., … Liu, R. (2017). Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival. The Permanente Journal, 22, 17-25. doi:10.7812/tpp/17-025

Drozek, D., Diehl, H., Nakazawa, W., Kostohryz, T., Morton, D., & Shubrook, J. H. (2014). Short-term effectiveness of a lifestyle intervention program for reducing selected chronic disease risk factors in individuals living in rural Appalachia: A pilot cohort study. Advances in preventive medicine, 1-7. doi:10.1155/2014/798184

Gordon, E., Ariel-Donges, A., Bauman, V., & Merlo, L. (2018). What Is the Evidence for “Food Addiction?” A Systematic Review. Nutrients, 10(4), 477. doi:10.3390/nu10040477

Grover, A., & Joshi, A. (2014). An Overview of Chronic Disease Models: A Systematic Literature Review. Global Journal of Health Science, 7(2), 210-227. doi:10.5539/gjhs.v7n2p210

Kent, L., Morton, D., Hurlow, T., Rankin, P., Hanna, A., & Diehl, H. (2013). Long-term effectiveness of the community-based Complete Health Improvement Program (CHIP) lifestyle intervention: a cohort study. BMJ Open, 3(11), e003751. doi:10.1136/bmjopen-2013-003751

Morton, D., Mitchell, B., Kent, L., Egger, G., & Hurlow, T. (2016). Lifestyle as medicine – Past precepts for present problems. Australian Family Physician, 45(4), 248-249. Retrieved from https://www.racgp.org.au/download/Documents/AFP/2016/April/AFP-Viewpoint-Morton.pdf

Morton, D. P., Rankin, P., Morey, P., Kent, L., Hurlow, T., Chang, E., & Diehl, H. (2013). The effectiveness of the Complete Health Improvement Program (CHIP) in Australasia for reducing selected chronic disease risk factors: a feasibility study. The New Zealand Medical Journal, 126(1370), 43-54. Retrieved from https://www.nzma.org.nz/journal

Parliament of Australia. (2010, October 12). Improving the health of all Australians: the role of preventative health – Parliament of Australia. Retrieved from https://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/BriefingBook43p/preventativehealth

Queensland Government. (2017, July 18). SWOT analysis. Retrieved from https://www.business.qld.gov.au/starting-business/planning/market-customer-research/swot-analysis

RACGP. (2019). Views and attitudes towards physical activity and nutrition counselling in general practice. National survey report 2019. Retrieved from file:///E:/Education/UTS/Health%20Ed%20and%20Health%20Promotion/Assessments/Assess%202/Articles/Physical-activity-and-nutrition-counselling.pdf

Sagner, M., Katz, D., Egger, G., Lianov, L., Schulz, K., Braman, M., … Behbod, B. (2014). Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community. The International Journal of Clinical Practice, 68(11), 1289-1292. Retrieved from https://onlinelibrary.wiley.com/doi/full/10.1111/ijcp.12509

Victorian State Government. (2015, March). Diabetes. Retrieved from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/diabetes


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