Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement

Abstract

BACKGROUNDThe rise of non-communicable diseases, many of which share common risk factors of smoking, alcohol, poor diet, and physical inactivity, has resulted in calls to develop and expand lifestyle medicine, giving 'hope to those suffering from chronic illness' (https://bslm.org.uk/). It has been argued that lifestyle medicine should be recognised as a new medical specialty, 1 with primary care leading.There are numerous drivers for lifestyle medicine (Box 1). Our analysis does not aim to argue against the importance of these drivers as many of them are well informed. Instead we seek to balance existing discussions with aspects that, in our opinion, have been less well considered. With this in mind, we focus on the unintended consequences of uncritical endorsement and application of lifestyle medicine including the infiltration of pseudoscience, profiteering, and the potential for widening health inequalities by a continued focus on the 'individual'. We stress the need for greater attention to public health and community-level interventions and a more critical approach to current practice. WHAT IS 'LIFESTYLE MEDICINE'?Medical practice guidelines often advise on 'lifestyle factors'. These are usually in the form of individual behaviours that impact on health, framed as modifiable, often related to smoking, alcohol intake, physical activity, diet, and, to a lesser degree, sleep quality, stress, and social factors. However, translation of guidelines into achievable real-world benefits outside clinical trials is challenging.The British Society of Lifestyle Medicine (BSLM) describes lifestyle medicine as 'an established approach that focuses on improving the health and wellbeing of individuals and populations … It requires an understanding and acknowledgement of the physical, emotional, environmental and social determinants of disease.' (https:// bslm.org.uk/). Society membership is open to registered health professionals, who can take a diploma, and associate membership is available to others, such as reflexologists, homeopaths, herbalists, and naturopaths. Some have called for greater inclusion of lifestyle medicine education in professional training, including medical curricula, 2 based on evidence that knowledge of

The association between a lifestyle score, socioeconomic status, and COVID-19 outcomes within the UK Biobank cohort

“…We acknowledge that the word ‘lifestyle’ might over-emphasise the role of individual choice for unhealthy behaviours while ignoring the role of wider socioeconomic influences and result in victim blaming [ 20 , 21 ]. Furthermore, ‘lifestyle medicine’ might have strong but veiled links with alternative medicines that lack evidence [ 22 ]. While we recognise this linguistic problem, we use ‘lifestyle factors’ here due to the widespread understanding for their potential to predict adverse health outcomes and to be modified, leading to a reduction or delay in adverse health outcomes [ 23 ].…”

Is it time to embed Lifestyle Medicine in undergraduate and postgraduate curricula?

“…Population Health is a broader term including public health medicine and wider disciplines (including non‐medical interventions) that describes the amount of health and its distribution across a population 4 . At the same time, the term Lifestyle Medicine has itself been criticised for diminishing the role that structural inequalities play in determining health outcomes, not least for socioeconomically disadvantaged groups 5 . We argue the reverse is true.…”

“…Richard Pinder 1,2 Linda Bauld 3 Hannah Findlater 4 Abinav Mohanamurali 5 Ann Johnson 6 Fraser Birrell 7,8…”

“…4 At the same time, the term Lifestyle Medicine has itself been criticised for diminishing the role that structural inequalities play in determining health outcomes, not least for socioeconomically disadvantaged groups. 5 We argue the reverse is true. The teaching of Lifestyle Medicine (as a clinical approach) in the context of the wider determinants of health and associated inequalities (at populationlevel) is an avenue that can engender empathy and contextual understanding of patients' decision-making and agency within clinical practice.…”

Lifestyle medicine is no Trojan horse: it is an inclusive, evidence-based, and patient-focused movement

“…However, likening lifestyle medicine to a Trojan horse implies deception and malice; and is both unworthy and unjustified.There are important positive messages conveyed, for example, articulating many of lifestyle medicine's key drivers (Box 1), plus individual and public health-level interventions (Box 2). 1 However, there are important fallacies too and we seek to correct these:…”