When we founded the British Society of Lifestyle Medicine nearly five years ago the choice of the word “society” was deliberate. We had a real sense of people coming together with a shared passion for improving people’s health and wellbeing. We felt we could be greater than the sum of our parts. There really was “such a thing as society”.
And so it has proved to be, and Lifestyle Medicine week, which took place from May 24-30, was a wonderful example of this.
During the week, we saw lifestyle medicine organisations come together from across the world to shout about lifestyle medicine – and its growing relevance. We saw BSLM members collectively raise their voices, puncture some of the myths about lifestyle medicine and reveal to the world how multifaceted it is as an approach to effective health prevention, treatment, management and reversal.
One of the key messages which came through during lifestyle medicine week was the continuing need to focus on chronic disease as we fight the Covid-19 pandemic. Indeed in many respects we face two pandemics right now – a communicable one and a non-communicable one.
The chronic disease pandemic is in some respects like a dripping tap slowly filling up a bowl. Current approaches to healthcare involve much rushing round trying to mop up the spillages as the bowl overflows. Lifestyle medicine offers a solution which involves turning the tap off.
And why does it matter? Because healthy life expectancy is now stalling. If properly applied, lifestyle medicine can help us to reduce instances of early, avoidable death.
So preventing and reducing the long-term risk factors of ill health remains critical. Indeed coronavirus is taking a “disproportionate toll on those with underlying health conditions,” as our executive director Frances Elliot said during the week, “and the pandemic is also affecting the most vulnerable in society, particularly those living in poverty.”
Our members contributed a series of informative and entertaining videos during the week which highlighted different aspects of lifestyle medicine. We didn’t manage to cover everything but we certainly covered a lot. Below is a summary of some of the key points raised by our wonderful society trustees, directors and members – and thank you to everyone who contributed.
Covid-19 and lifestyle
The bad news: some of the worst outcomes and highest death rates for Covid-19 have been among people with chronic disease – those with high blood pressure, diabetes and obesity.
This is because if you have chronic disease, your body is inflamed and ”fighting” to bring itself back into healthy balance. So when the body that has been fighting for so long is infected with coronavirus, it is like having to climb a high mountain with no training – and after having run a marathon.
The good news: chronic diseases are reversible and we have the power to make the necessary changes to our lifestyles. Lifestyle medicine offers us the tools and techniques to do this.
Lifestyle starts with behaviour change. If this is to work, patients need to be fully involved and supported to achieve their goals. Behaviour change needs to be meaningful to the patient, and create strong motivation and buy in.
The SMART goals approach involves setting goals which are specific to the patient, and to the condition being treated. They must also be measurable in some way, so progress can be tracked, and achievable. Crucially, the patient must be involved in defining initial and ongoing steps. They must be realistic and relevant to the patient and there needs to be a willingness to adapt these to make them doable. Time-based goals are key and must be regularly reviewed to maintain momentum and there should be opportunities to celebrate as goals are achieved. When meaningful behaviour changes are made at a time of readiness, with the correct lifestyle medicine, amazing health benefits can occur.
Tackling health inequalities – which have been worsened by the pandemic – is also a critical element of lifestyle medicine. Deprivation is a key predictor of a worse outcome for coronavirus. Even before the lockdown a government policy paper was calling for targeted support, tailored lifestyle advice and personalised care to protect people and communities from ill health. The pandemic has only heightened the need for these measures. The 2010 Marmot Report stressed the role of ill health prevention in addressing health inequalities and that health promotion should be delivered at a level which is proportionate to the level of disadvantage.
Our approach must focus on establishing what support people want for which lifestyle changes and how this should be tailored to their individual needs. It starts with asking the right questions, such as “What matters to you right now about your health?” or “What are your health goals?” Then tools such as health coaching, social prescribing and virtual group consultations can be used to help patients achieve these goals. “Lifestyle medicine is not just about ill health prevention,” says Ellen. “We can put chronic disease into remission too, and by asking people what support they need we can ensure that everyone has a right to remission from long-term disease using a lifestyle medicine approach.”
Fighting for change at the national and international level
Lifestyle medicine practitioners and organisations around the world must come together and influence world leaders to make policy decisions which will support everyone to make healthy choices for themselves and their families. While we know what needs to be done to help prevent chronic disease we also need governments to help – for example to protect our environment. After the pandemic is over, we cannot go back to business as usual.
For further reading check out the joint letter which BSLM recently signed to G20 leaders calling for a healthy recovery to the pandemic.
The health of human civilisations and the natural systems on which they depend is another element of the lifestyle medicine approach. We call it planetary health. Fundamentally, issues such as climate change, pollution and deforestation are health issues – and addressing these issues is intertwined with improving our health and wellbeing. Looking after human health – using the tools and techniques of lifestyle medicine – also has “co-benefits” for our natural world. For example, healthy, sustainable diets aren’t just good for our health and reducing chronic disease – they are also good for the planet and its ecosystems.
Promoting physical activity and “active transport” – another key component of lifestyle medicine – can also help to reduce carbon emissions and pollution as we are less likely to travel by car.
Covid-19, lifestyle medicine and mental health
Studies have shown the impact on our psychological health of the lockdowns which have been put in place to slow the spread of coronavirus. Anxiety levels are understandably high for many people with concerns over the virus, social isolation and worries over money causing mental distress to many people.
People feel powerlessness which gives way to helplessness which can predispose people to depression. Lifestyle Medicine offers us many powerful tools which can improve our mental health – regular exercise, healthy eating, alcohol reduction and maintaining healthy relationships. But also lifestyle medicine invites us to take more control over our own health and wellbeing and this in turn reduces our sense of powerlessness.
Pandemic or no pandemic keeping physically active is critical to a healthy lifestyle. As Claire Nieland points out daily physical activity is brilliant for our mental and physical health, helping to reduce the risk factors for everything from depression and anxiety to Parkinson’s, dementia, type II diabetes and even cancer and cardiovascular disease.
But many of us need some help getting started with exercise. Dr Adaeze Ifezulike says wear appropriate footwear to avoid blisters, start off gently and build up gradually, take time to warm up first and stretch afterwards. And don’t forget hip and ice packs and pain killers in case you are feeling a bit sore afterwards. Also, don’t forget to give each muscle group a chance to rest. So one day you might focus on your arm muscles, the next on your legs. And if you need to have some rest days too – don’t feel like you have to exercise every single day.
“Get off your screen and out into the green,” says Devon-based GP Lucy Loveday. Combining physical activity with enjoying nature and the great outdoors can increase your vitamin D levels, boost your immune system, reduce stress levels and enhance your wellbeing. Green spaces – which we can often access at low or no cost – are the perfect facilitator for exercise.
If your sleep is low on quality and quantity you are at greater risk of developing Alzheimers, diabetes or have a heart attack or sports injury. It can also impact on your emotional wellbeing and put you at greater risk of an infection. Alka Patel says there are three things you can do right now to improve things: avoid caffeine after 2pm, try to spend at least 15 minutes outdoors to trigger your melatonin surge at night – and avoid staying in bed once you have woken up.
Community and social prescribing
Lifestyle Medicine is as much about community as it is about individual lifestyle choices. Feeling part of a community and reducing social isolation is key to the lifestyle medicine approach.
Social prescribing runs in parallel with this – where people are supported to improve their health and wellbeing through access to resources in their community. These varied resources include everything from post-natal mums’ activity groups, counselling, drawing classes, debt advice, and gardening groups. They are by the community for the community and depend on the hard work and dedication of link workers to act as patient advocates, directing people to where they would benefit most in the community.
This is crucial if we are to support people to take control of their own health and welfare. Social prescribing initiatives have also been key to ensuring people and communities are more resilient in the face of the Covid-19 pandemic. Lifestyle understands the power of social prescribing and being socially supported. It’s a two way street – people can benefit from contributing to and gaining support from their community.
Lifestyle medicine at work
What part can lifestyle medicine play in improving happiness in the workplace? How might this impact on our success or productivity? According to BSLM director and occupational doctor Nilesh Satguru if we are happy at work this can have a big impact on our performance and our productivity. In short if we are healthy and happier we are better at our jobs. We need a paradigm shift to boost our wellbeing at work, says Nilesh. And it can start with practising gratitude, forgiveness and kindness.
What we eat affects our health and wellbeing and it starts at home – somewhere we are all spending a lot of time at the moment. Covid-19 has shifted the way we eat – making us plan our meals more, using what’s in our store cupboard. Your kitchen can also be a medicine cabinet with ingredients which can not only improve your meals but improve your health and boost your immune system.
And finally our director of external affairs Neil Bindemann, offered this take on lifestyle medicine to round the week off. “Lifestyle medicine is akin to putting the general public in the driving seat of an eco friendly car… to travel on a road to health and wellness,” Neil explains. And with the guidance of support from health professionals they have the potential to become proficient drivers!
This blog was previously published by the British Society of Lifestyle Medicine.