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British Journal of General Practice

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Analysis

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

David Nunan, David N Blane and Margaret McCartney
British Journal of General Practice 2021; 71 (706): 229-232. DOI: https://doi.org/10.3399/bjgp21X715721
David Nunan
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford.
Roles: Senior Research Fellow
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David N Blane
Institute of Health and Wellbeing, University of Glasgow, Glasgow.
Roles: Clinical Research Fellow in General Practice and Primary Care
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Margaret McCartney
CSO Fellow, University of St Andrews, St Andrews, Fife, Scotland.
Roles: Honorary Senior Lecturer
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  • Is evidence based medicine the real Trojan horse?
    Peter A Churn
    Published on: 27 May 2021
  • Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
    Jonathan Dinmore
    Published on: 14 May 2021
  • Behavioural determinants of health: individual versus societal responsibility
    Samuel P. Trethewey, Ella K M Reynolds and Christopher S Trethewey
    Published on: 10 May 2021
  • Distinguishing ‘lifestyle medicine’ from pseudoscience
    Samuel P. Trethewey, Ella K M Reynolds and Christopher S Trethewey
    Published on: 10 May 2021
  • Lifestyle medicine is no Trojan Horse: it is an inclusive, evidence-based and patient-focused movement
    Fraser N. Birrell, Richard J. Pinder and Rob J. Lawson
    Published on: 09 May 2021
  • BANT welcomes the BJGP article on lifestyle medicine and opens the door to discussions.
    Satu Jackson
    Published on: 06 May 2021
  • Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
    Michael E. Ash
    Published on: 04 May 2021
  • Published on: (27 May 2021)
    Page navigation anchor for Is evidence based medicine the real Trojan horse?
    Is evidence based medicine the real Trojan horse?
    • Peter A Churn, GP partner, Educational Supervisor, Harbours Medical Practice
    I enjoyed reading your thoughtful analysis of lifestyle medicine1 but worry that it is evidence-based medicine itself that is the ‘Trojan Horse’ that has smuggled in numerous harmful, unnecessary pharmaceutical interventions. Applying the same crude methodology to ‘lifestyle medicine’ misses the common sense that the majority of these interventions are extremely likely to help, whether evidenced or not, but also likely not to cause harm. Relying on validation from EBM before applying our objective common sense is precisely what has eroded the trust of our patients and opened us to justifiable claims of professional arrogance in dismissing alternative approaches to healthcare. Nobody is arguing that these are not more effective when applied at a population health level, but this should not preclude GPs from applying our professional common sense in tailoring sensible and safe lifestyle interventions for our patients.
     
    Reference
    1. Nunan D, Blane D, McCartney M. Exemplary medical care or Trojan horse? Br J Gen Pract 2021; 71 (707): 229-232.
     
    Competing Interests: None declared.
  • Published on: (14 May 2021)
    Page navigation anchor for Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
    Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
    • Jonathan Dinmore, GP trainee, none

    Thank you for an interesting article which rightly highlights the many vested interests across the colourful and evolving landscape of health services for chronic disease.

    That said, the general premise of the article seems to be to suggest a dichotomy, which in reality I am sure is a false dichotomy - individualised v public health centred care. There is room for both!

    I agree that the umbrella term 'lifestyle medicine' can be surreptitiously and dishonestly secured to poorly evidenced practices, by practitioners with a keen eye for profit. However, it seems rather 'lumpish' to associate the BSLM with these kinds of behaviours.

    I think the 'bang-for-buck' commentary is fair, in recognising that public health policy can be a very powerful tool. However, entities like the BSLM, alongside honest individual lifestyle medicine practitioners, aim to influence public health policy, using latest peer-reviewed evidence. We should also be mindful that the individual approach may serve more than the individual patient, since improved health is often a subject for discussion with friends and family, and the improved health behaviours of a parent for example, are likely to cascade positively to children.

    I would fully expect that BLSM and the Centre for Evidence Based Medicine both are firmly committed to an evidence-based approach to healthcare.

    Competing Interests: None declared.
  • Published on: (10 May 2021)
    Page navigation anchor for Behavioural determinants of health: individual versus societal responsibility
    Behavioural determinants of health: individual versus societal responsibility
    • Samuel P. Trethewey, Clinical Research Physician, Oak Tree Surgery and Pensilva Health Centre, Liskeard, Cornwall, UK
    • Other Contributors:
      • Ella K M Reynolds, Paediatric Nurse; Health Professions and Nursing Lecturer, Royal Cornwall Hospitals NHS Foundation Trust, Truro, Cornwall, UK
      • Christopher S Trethewey, Translational Scientist; Scientific Associate, University of Leicester, Leicester Cancer Research Centre, Leicester, UK

    Nunan et al draw our attention to the emphasis of so-called ‘lifestyle medicine’ on behavioural determinants of health and the responsibility of individuals for behaviour modification.¹ Whilst it is important to address the leading behavioural determinants of premature mortality in England, namely tobacco use/unhealthy diet/alcohol and drug use/physical inactivity,² the authors rightly highlight the importance of considering the wider determinants of health.

    An important point being made here is that overemphasis on health behaviours and individual-focussed interventions (intentional or unintentional) may actually increase health inequalities and draw attention away from the main drivers of poor health, namely the wider socioeconomic and environmental determinants of health. As the Marmot reviews have shown us, differences in socioeconomic status are associated with dramatic differences in rates of premature mortality and disability; the 2020 review reported a 12 year difference in healthy life expectancy at birth between the most and least deprived regions of England.³ Moreover, a recent cross-sectional study of 2.5 million premature deaths in England found that 1/3 of these deaths were attributable to socioeconomic inequality.⁴

    Clearly, a balance must be struck between individual responsibility and wider societal/governmental responsibility. It is important not to minimise individual responsibility for one’s...

    Show More

    Nunan et al draw our attention to the emphasis of so-called ‘lifestyle medicine’ on behavioural determinants of health and the responsibility of individuals for behaviour modification.¹ Whilst it is important to address the leading behavioural determinants of premature mortality in England, namely tobacco use/unhealthy diet/alcohol and drug use/physical inactivity,² the authors rightly highlight the importance of considering the wider determinants of health.

    An important point being made here is that overemphasis on health behaviours and individual-focussed interventions (intentional or unintentional) may actually increase health inequalities and draw attention away from the main drivers of poor health, namely the wider socioeconomic and environmental determinants of health. As the Marmot reviews have shown us, differences in socioeconomic status are associated with dramatic differences in rates of premature mortality and disability; the 2020 review reported a 12 year difference in healthy life expectancy at birth between the most and least deprived regions of England.³ Moreover, a recent cross-sectional study of 2.5 million premature deaths in England found that 1/3 of these deaths were attributable to socioeconomic inequality.⁴

    Clearly, a balance must be struck between individual responsibility and wider societal/governmental responsibility. It is important not to minimise individual responsibility for one’s own health or create a false dichotomy between individual responsibility and societal responsibility; both are important and should be advocated for simultaneously. Nunan et al provide a useful framework regarding ways to integrate ‘Individual-level interventions’ with ‘Public health interventions’ to address key modifiable risk factors. In doing so, the authors remind us of the importance of national policy in improving the nation’s health and reducing health inequalities, by placing some of the responsibility at the feet of governments and national public health organisations.

    References
    1. Nunan D, Blane DN, McCartney M. Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement. Br J Gen Pract 2021; 71 (706): 229-232. https://doi.org/10.3399/bjgp21X715721.
    2. Steel N, Ford JA, Newton JN, et al. Changes in health in the countries of the UK and 150 English local authority areas 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet 2018; 392:1647-61. https://doi.org/10.1016/s0140-6736(18)32207-4.
    3. Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J (2020) Health Equity in England: The Marmot Review ten years on. London: Institute of Health Equity. www.health.org.uk/publications/reports/the-marmot-review-10-years-on. 
    4. Lewer D, Jayatunga W, Aldridge RW, et al. Premature mortality attributable to socioeconomic inequality in England between 2003 and 2018: an observational study. Lancet Public Health 2020; 5(1):e33-e41. https://doi.org/10.1016/S2468-2667(19)30219-1.

    Show Less
    Competing Interests: None declared.
  • Published on: (10 May 2021)
    Page navigation anchor for Distinguishing ‘lifestyle medicine’ from pseudoscience
    Distinguishing ‘lifestyle medicine’ from pseudoscience
    • Samuel P. Trethewey, Clinical Research Physician, Oak Tree Surgery and Pensilva Health Centre, Liskeard, Cornwall, UK
    • Other Contributors:
      • Ella K M Reynolds, Paediatric Nurse; Health Professions and Nursing Lecturer, Royal Cornwall Hospitals NHS Foundation Trust, Truro, Cornwall, UK
      • Christopher S Trethewey, Translational Scientist; Scientific Associate, University of Leicester, Leicester Cancer Research Centre, Leicester, UK

    Nunan and colleagues caution against uncritical adoption of so-called ‘lifestyle medicine’.¹ We agree that as healthcare professionals we need to be careful to avoid unwittingly implementing or condoning non-evidence-based practices. The authors raise an important point regarding a central tenet of ‘integrative medicine’, in that it seeks to integrate so-called complementary and alternative medicine (CAM) with ‘conventional medicine’. Credulously welcoming CAM with open arms as part of integrative medicine may give undeserved credibility and legitimise practices with weak/no evidence of efficacy or worse, evidence of harm. We previously argued the case for abandoning the umbrella term CAM,² due to its ambiguous definition which groups a “highly heterogeneous group of health-related practices with significantly different evidence bases” and therefore risks conflating evidence-based treatments with pseudoscientific practices. Put simply, any healthcare intervention championed as part of lifestyle medicine should be evaluated and subjected to the same level of scientific rigor as all other healthcare practices.

    We suspect that we may inadvertently enable non-evidence-based practices to pervade healthcare as a result of a fundamental desire to practice holistic medicine and support patients’ self-management, combined with a perception that many ‘alternative’ interventions are low ris...

    Show More

    Nunan and colleagues caution against uncritical adoption of so-called ‘lifestyle medicine’.¹ We agree that as healthcare professionals we need to be careful to avoid unwittingly implementing or condoning non-evidence-based practices. The authors raise an important point regarding a central tenet of ‘integrative medicine’, in that it seeks to integrate so-called complementary and alternative medicine (CAM) with ‘conventional medicine’. Credulously welcoming CAM with open arms as part of integrative medicine may give undeserved credibility and legitimise practices with weak/no evidence of efficacy or worse, evidence of harm. We previously argued the case for abandoning the umbrella term CAM,² due to its ambiguous definition which groups a “highly heterogeneous group of health-related practices with significantly different evidence bases” and therefore risks conflating evidence-based treatments with pseudoscientific practices. Put simply, any healthcare intervention championed as part of lifestyle medicine should be evaluated and subjected to the same level of scientific rigor as all other healthcare practices.

    We suspect that we may inadvertently enable non-evidence-based practices to pervade healthcare as a result of a fundamental desire to practice holistic medicine and support patients’ self-management, combined with a perception that many ‘alternative’ interventions are low risk. However, the hidden hand of vested interests pervades the wellness ecosystem and one of the major risks to patients is that of financial forfeiture.³ Other potential risks include adverse events resulting in emergency department visits and hospitalisations,⁴ drug interactions⁵ ⁶ and opportunity costs where patients suffer because of a delay in seeking evidence-based treatment.⁷

    Sadly, it is unsurprising that the lifestyle medicine movement might be hijacked in some cases by individuals predominantly motivated by financial conflicts of interest. Whilst encouraging patients to practice self-help and seek additional lifestyle-focussed support in the community may be empowering, it is also important to caution patients against the deluge of pseudoscientific practices espoused by charlatans and ‘snake oil salesmen’. By encouraging scepticism and signposting to evidence-based information, we may help to prevent patients from being taken advantage of by the private sector. We must not permit pseudoscience to infiltrate our practice in the name of holistic medicine.

    References
    1. Nunan D, Blane DN, McCartney M. Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement. Br J Gen Pract 2021; 71(706): 229- 232. https://doi.org/10.3399/bjgp21X715721.
    2. Trethewey SP, Morlet J, Trethewey CS, Reynolds EKM. Defining ‘complementary and alternative medicine’. The British Student Doctor Journal 2019; 3(1): 42–7. http://doi.org/10.18573/bsdj.74.
    3. MacFarlane D, Hurlstone MJ, Ecker UKH. Protecting consumers from fraudulent health claims: A taxonomy of psychological drivers, interventions, barriers, and treatments. Soc Sci Med 2020; 259:112790. https://doi.org/10.1016/j.socscimed.2020.112790.
    4. Geller AI, Shehab N, Weidle NJ, et al. Emergency Department Visits for Adverse Events Related to Dietary Supplements. N Engl J Med 2015; 15;373(16):1531-40. https://doi.org/10.1056/nejmsa1504267.
    5. Werneke U, Earl J, Seydel C, Horn O, Crichton P, Fannon D. Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer 2004; 90(2):408-13. https://doi.org/10.1038/sj.bjc.6601560.
    6. Tucker J, Fischer T, Upjohn L, et al. Unapproved Pharmaceutical Ingredients Included in Dietary Supplements Associated With US Food and Drug Administration Warnings. JAMA Netw Open 2018; 1(6):e183337. https://doi.org/10.1001/jamanetworkopen.2018.3337.
    7. Johnson SB, Park HS, Gross CP, Yu JB. Use of Alternative Medicine for Cancer and Its Impact on Survival. J Natl Cancer Inst 2018; 110(1). https://doi.org/10.1093/jnci/djx145.

    Show Less
    Competing Interests: None declared.
  • Published on: (9 May 2021)
    Page navigation anchor for Lifestyle medicine is no Trojan Horse: it is an inclusive, evidence-based and patient-focused movement
    Lifestyle medicine is no Trojan Horse: it is an inclusive, evidence-based and patient-focused movement
    • Fraser N. Birrell, Director of Science & Research, Consultant and Senior Lecturer in Rheumatology, British Society of Lifestyle Medicine, on behalf of the Trustees of the British Society of Lifestyle Medicine
    • Other Contributors:
      • Richard J. Pinder, Consultant Public Health Physician, Imperial College London
      • Rob J. Lawson, Lifestyle Medicine doctor and retired GP British Society of Lifestyle Medicine

    We welcome positive aspects of Nunan et al’s article and the opportunity to briefly discuss their analysis. 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).

    However, there are important fallacies too and we seek to correct these:

    1. Misrepresenting BLSM only as accrediting GPs. Although 885(~50%) members are GPs/GPSTs, membership includes all medicine disciplines, including internal medicine/surgery/nurses/allied health professionals/trainees. We also have patient members, encouraged to attend meetings through invitations via their clinicians (https://bslm.org.uk/events/bslm-2021-conference/) and read our open access journal, lifestyle medicine (https://onlinelibrary.wiley.com/journal/26883740).
    2. Inaccurately linking alternative medicine practices/practitioners to lifestyle medicine; including bracketing BSLM with organisations like the (recently-rebranded) British Association for Nutrition and Lifestyle Medicine and (functional medicine-oriented) Prescribing Lifestyle Medicine
    3. Concern ‘lifestyle medicine practitioners...

    Show More

    We welcome positive aspects of Nunan et al’s article and the opportunity to briefly discuss their analysis. 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).

    However, there are important fallacies too and we seek to correct these:

    1. Misrepresenting BLSM only as accrediting GPs. Although 885(~50%) members are GPs/GPSTs, membership includes all medicine disciplines, including internal medicine/surgery/nurses/allied health professionals/trainees. We also have patient members, encouraged to attend meetings through invitations via their clinicians (https://bslm.org.uk/events/bslm-2021-conference/) and read our open access journal, lifestyle medicine (https://onlinelibrary.wiley.com/journal/26883740).
    2. Inaccurately linking alternative medicine practices/practitioners to lifestyle medicine; including bracketing BSLM with organisations like the (recently-rebranded) British Association for Nutrition and Lifestyle Medicine and (functional medicine-oriented) Prescribing Lifestyle Medicine
    3. Concern ‘lifestyle medicine practitioners’ may exploit commercial opportunities.
    The common fallacy here is blaming GMC/NMC/HCPC-registered practitioners for unregulated/commercial activities. This criticism (‘smearing by association’) is especially unworthy, especially as BSLM is standard-setting to mitigate these risks.
    4. The ‘Health Inequalities’ section is probably the most contentious.
    In brief, we recognise that environment and public health have key roles (see https://bslm.org.uk/lifestyle-medicine/what-is-lifestyle-medicine/). However, we refuse to accept that: we are likely to widen inequalities; medical practice cannot evolve; and personal/public health interventions don’t synergise. For a more detailed exposition, see
    https://bslm.org.uk/critical-and-evidence-based-adoption-of-lifestyle-me....Criticising BSLM for not addressing upstream health determinants is simply incorrect: we do exactly that.

    Lifestyle medicine is inclusive, evidence-based, patient-focused and is not a movement needing to attack other health delivery approaches. We hope that scientific debate can be more dignified and constructive going forwards. We absolutely agree primary care and public health colleagues should work together and practise what we preach.

    Given rapid BSLM growth, plus the success and popularity of progressive curricula like Imperial College’s ‘Lifestyle medicine and prevention’ undergraduate medicine modules, that are evidence-based and rooted in population health and inequalities, lifestyle medicine is becoming mainstream. We suspect future generations will term lifestyle medicine, as simply ‘medicine’.

    Show Less
    Competing Interests: FNB is Director of Science & Research for the British Society of Lifestyle Medicine and Editor-in-Chief of Lifestyle Medicine, the official journal of the British Society of Lifestyle Medicine, Australasian Society of Lifestyle Medicine, the European Lifestyle Medicine Council and the Korean College of Lifestyle Medicine. Research grants for engagement through, plus spread and evaluation of group consultations (which create the time and space for effective delivery of Lifestyle Medicine) from Sir Jules Thorn Trust, National Institute for Health Research, Medical Research Council. RJP is Director of Undergraduate Public Health Education and module lead for Imperial College London’s undergraduate medicine modules on Lifestyle Medicine and Prevention. RJL is Chair of British Society of Lifestyle, Medicine President of European Lifestyle Medicine Council, Chair of World Lifestyle Medicine Council (formerly known as the Lifestyle Medicine Global Alliance). No other direct or indirect other financial conflicts of interest to declare in relation to Lifestyle Medicine.
  • Published on: (6 May 2021)
    Page navigation anchor for BANT welcomes the BJGP article on lifestyle medicine and opens the door to discussions.
    BANT welcomes the BJGP article on lifestyle medicine and opens the door to discussions.
    • Satu Jackson, Registered Nutritional Therapy Practitioner (RNTP), British Association for Nutrition and Lifestyle Medicine

    BANT is encouraged by the BJGP acknowledgement of well-informed drivers validating lifestyle medicine.1 Since its foundation in 1997, BANT has been at the forefront of nutritional therapy (NT) and personalised nutrition in support of its 3,500 members. This individualised approach is founded on principals of lifestyle medicine, where diet and lifestyle are recognised as modifiable factors for therapeutic consideration. A ground-breaking 2021 pilot study by Harris and Benbow highlights the effectiveness of NT in delivering satisfying outcomes.2

    Lifestyle medicine is part of a wider paradigm change that has been evolving partly in response to the rise of non-communicable diseases, but most notably in recognition of the individual factors that determine how these diseases express themselves. It has been fuelled by the public response to public health measures, aimed at the general population and unable to serve at an individual level. The result, chronically ill individuals seeking personalised support.

    Lifestyle medicine is purposefully patient-centred and provides individualised protocols offering optimum, rather than generic, support. The American Nutrition Association highlight this most eloquently in their 2020 paper ‘Toward the Definition of Personalized Nutrition’3 in which they argue that “a disease-centered, acute care approach is ill suited to chronic conditions that develop over time and h...

    Show More

    BANT is encouraged by the BJGP acknowledgement of well-informed drivers validating lifestyle medicine.1 Since its foundation in 1997, BANT has been at the forefront of nutritional therapy (NT) and personalised nutrition in support of its 3,500 members. This individualised approach is founded on principals of lifestyle medicine, where diet and lifestyle are recognised as modifiable factors for therapeutic consideration. A ground-breaking 2021 pilot study by Harris and Benbow highlights the effectiveness of NT in delivering satisfying outcomes.2

    Lifestyle medicine is part of a wider paradigm change that has been evolving partly in response to the rise of non-communicable diseases, but most notably in recognition of the individual factors that determine how these diseases express themselves. It has been fuelled by the public response to public health measures, aimed at the general population and unable to serve at an individual level. The result, chronically ill individuals seeking personalised support.

    Lifestyle medicine is purposefully patient-centred and provides individualised protocols offering optimum, rather than generic, support. The American Nutrition Association highlight this most eloquently in their 2020 paper ‘Toward the Definition of Personalized Nutrition’3 in which they argue that “a disease-centered, acute care approach is ill suited to chronic conditions that develop over time and have multiple causes”. Non-communicable diseases differ by person, impact multiple biological systems and do not subscribe to a one-size-fits-all solution.

    The BJGP raise valid considerations regarding standards and evidence-based practice of lifestyle medicine. BANT is especially happy to address this and share its own mission statement,4 criteria for membership,5 and standards of practice6 in conjunction with CNHC Code of Conduct, Ethics and Performance.

    BANT supports all efforts to reduce the health inequalities highlighted by the BJGM and has launched two strategic projects in 2021; a Food for your Health campaign,5 providing open access to nutrition resources, and a dedicated diversity panel.

    BANT is fully invested in achieving the shared objectives of making nutrition and lifestyle medicine part of an integrated healthcare system and is open to further discussions.

    References
    1. Nunan D, Blane DN, McCartney M. Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement. Br J Gen Pract 2021; 71 (706): 229-232. DOI: 10.3399/bjgp21X715721
    2. Harris MD, Benbow A. Evaluating the Effectiveness of Nutritional Therapy in the McClelland Teaching Clinic at the University of Worcester. On J Complement & Alt Med 2021; 6(3): OJCAM.MS.ID.000637. DOI: 10.33552/OJCAM.2021.06.000637
    3. Bush CL, Blumberg JB, El-Sohemy A et al. Toward the Definition of Personalized Nutrition: A Proposal by The American Nutrition Association.  J Am Coll Nutr 2020;  39(1):5-15. doi: 10.1080/07315724.2019.1685332.
    4. BANT Mission https://bant.org.uk/our-story/
    5. BANT Membership Criteria https://bant.org.uk/membership-types-and-fees/
    6. BANT Standards of Practice https://bant.org.uk/our-standards/

    Show Less
    Competing Interests: CEO & Director, British Association of Nutrition and Lifestyle Medicine, Lecturer at Centre for Nutrition Education & Lifestyle Management (CNELM)
  • Published on: (4 May 2021)
    Page navigation anchor for Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
    Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
    • Michael E. Ash, Lifestyle Medicine, Clinical Education

    Thank you for this article, however you disingenuously imply that the ‘benefits’ of lifestyle medicine are subjugated on the application of inadequate critique, the inclusion of pseudoscience and ‘alternative medicine’, profiteering and an absence of focus on social and political reduction of poverty and other societal drivers of health inequality by the related beneficial behavioural changes being individualised in their application.

    We live in a socio-economic and environmental context over which we have, often, limited or no control. Lifestyle medicine does not just acknowledge this, it proactively advocates for changes at these levels which will improve people’s health and wellbeing.

    Examples of good quality lifestyle-based evidence include The Direct Trial for Type-2 Diabetes remission,1 The SMILES Trial2 for depression remission and The Lifestyle Heart Trial3 and related follow ups4,5 for coronary arterial disease reversal.

    Further qualified work in this area is presented by the Preventative Medicine Research Institute. The central core of lifestyle medicine is about supported behaviour change at individual and community levels. Until clinicians operate at the level of policy and legislation, their primary focus is on meeting the needs of their patients and community within their scope of capability.

    Prescribing lifestyle medicine (supplied by...

    Show More

    Thank you for this article, however you disingenuously imply that the ‘benefits’ of lifestyle medicine are subjugated on the application of inadequate critique, the inclusion of pseudoscience and ‘alternative medicine’, profiteering and an absence of focus on social and political reduction of poverty and other societal drivers of health inequality by the related beneficial behavioural changes being individualised in their application.

    We live in a socio-economic and environmental context over which we have, often, limited or no control. Lifestyle medicine does not just acknowledge this, it proactively advocates for changes at these levels which will improve people’s health and wellbeing.

    Examples of good quality lifestyle-based evidence include The Direct Trial for Type-2 Diabetes remission,1 The SMILES Trial2 for depression remission and The Lifestyle Heart Trial3 and related follow ups4,5 for coronary arterial disease reversal.

    Further qualified work in this area is presented by the Preventative Medicine Research Institute. The central core of lifestyle medicine is about supported behaviour change at individual and community levels. Until clinicians operate at the level of policy and legislation, their primary focus is on meeting the needs of their patients and community within their scope of capability.

    Prescribing lifestyle medicine (supplied by Clinical Education) provides a format that allows clinicians to empower and motivate individuals to generate their own solutions to their problems. i.e the journey and responsibility become shared individually and in community.

    References
    1. Lean M et al, Primary care-lead weight management for remission of type-2 diabetes (DiRECT): an open-label, cluster-randomised trial. The Lancet 2018; 391:10120, 541.
    2. Jacka et al, A randomised controlled trial of dietary improvement for adults with major depression (the SMILES trial). BMC Medicine 2017; 15:23.
    3. Ornish D, et al, Intensive lifestyle changes for reversal of coronary heart disease. JAMA 1998; 16;280(23):2001-7.
    4.  Pischke CR, Scherwitz L, Weidner G, Ornish D. Long-term effects of lifestyle changes on well-being and cardiac variables among coronary heart disease patients. Health Psychol 2008; 27(5):584-92.
    5. Razavi M, Fournier S, Shepard DS, Ritter G, Strickler GK, Stason WB. Effects of lifestyle modification programs on cardiac risk factors. PLoS One 2014; 9(12):e114772.
     
    Show Less
    Competing Interests: Managing Director of Nutri-Link, Co Founder of Precribing Lifetyle Medicine, Managing Director of Nutri-Link Co Founder of Prescribing Lifestyle Medicine Founder of Clinical Education a NFP organisation, vegetarian, non-coeliac gluten sensitive, teetotal non smoker and exercise enthusiast.
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British Journal of General Practice: 71 (706)
British Journal of General Practice
Vol. 71, Issue 706
May 2021
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Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
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Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
David Nunan, David N Blane, Margaret McCartney
British Journal of General Practice 2021; 71 (706): 229-232. DOI: 10.3399/bjgp21X715721

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Exemplary medical care or Trojan horse? An analysis of the ‘lifestyle medicine’ movement
David Nunan, David N Blane, Margaret McCartney
British Journal of General Practice 2021; 71 (706): 229-232. DOI: 10.3399/bjgp21X715721
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  • Top
  • Article
    • BACKGROUND
    • WHAT IS ‘LIFESTYLE MEDICINE’?
    • TROJAN HORSE AND CONFLICTS OF INTEREST
    • LIFESTYLE ‘CHOICES’ AND HEALTH INEQUALITIES
    • INTEGRATING PERSONAL HEALTH AND PUBLIC HEALTH
    • CONCLUSION
    • Acknowledgments
    • Notes
    • REFERENCES
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More in this TOC Section

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Print ISSN: 0960-1643
Online ISSN: 1478-5242