Teaching Doctors to Teach Patients About Lifestyle

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Teaching Doctors to Teach Patients About Lifestyle

http://www.nytimes.com/2007/04/17/health/17life.html?_r=1 & oref=slogin

By KATE MURPHY

Everybody knows that diet, exercise and other aspects of lifestyle

play a significant role in health. But the specifics are less well

understood.

To what extent does lifestyle cause or contribute to disease and

disability? And what exactly is a healthy lifestyle anyway? There is

much confusion about what type of diet or exercise is best, not to

mention how much sleep, stress or sex is ideal. Nor is it clear how

best to motivate people to change their habits.

This lack of clarity has inspired a growing movement to inform

health professionals and patients about the importance of lifestyle

in preventing and treating disease. Its aims are to disseminate

scientific research about what it means to live well and to

encourage doctors and other providers to incorporate this knowledge

into their practices.

Two years ago, a group of doctors founded an organization with the

goal of making lifestyle medicine a credentialed clinical specialty

and a part of basic medical training. Symptomatically treating

disease without assessing patients' lifestyles or offering them

guidance on how to change is " irresponsible and bordering on

neglect, " said Dr. H. Jr., president of the fledgling

organization, the American College of Lifestyle Medicine.

A professor of preventive medicine at the Loma University

School of Medicine in California, Dr. said the group was

formed because of people like his uncle.

Given a diagnosis of heart disease, the uncle had a stent surgically

implanted to open a clogged artery but received no advice on how he

might change his lifestyle, even though research shows that diet,

exercise and stress management could greatly improve his condition.

Dr. says lifestyle medicine is essential in fighting the

national epidemics of obesity, diabetes and cardiovascular

disease. " We cannot solve the health problems of society unless we

change our focus from acute, episodic care to health promotion and

wellness — lifestyle medicine, " he said.

The Centers for Disease Control and Prevention reports that 1.7

million Americans die and 25 million are disabled each year by

chronic diseases caused or made worse by unhealthy lifestyles. And a

2005 study in The New England Journal of Medicine predicted that

average life expectancy in the United States would decline in the

next 20 years as a result of unhealthy lifestyles, reversing a trend

dating to the 1850s. The American College of Lifestyle Medicine has

150 members in a wide array of specialties — nutritionists,

ophthalmologists, gastroenterologists and oncologists, among others.

Helping their cause is a new publication, The American Journal of

Lifestyle Medicine, which appears every other month with peer-

reviewed research on the way daily habits affect health.

" Bottom line is we want to promote the science, education and

practice of lifestyle medicine, " Dr. said.

Lifestyle medicine proponents include researchers and clinicians

from the fields of medicine and public health. While they agree on

the importance of questioning patients about their lifestyles and

giving tailored advice on how to make improvements, there remains

disagreement about who should provide such counseling and with what

sort of training. Nor is there a widely accepted prescriptive

approach for encouraging patient compliance.

" We know lifestyle interventions can be very powerful, " often more

effective than drugs or surgery, said Dr. JoAnn Manson, a professor

of epidemiology at Harvard's School of Public Health and a member of

the editorial board of the new journal. " But we need to provide the

scientific evidence on how to incorporate that knowledge into

practice. "

Doctors may vaguely recommend that patients lose weight or get more

sleep, for example, but they do not necessarily know how to help

them do it.

Moreover, many physicians themselves have unhealthy habits that may

prevent them from offering advice.

Sleep-deprived doctors who scarf candy bars for lunch " tend to feel

inhibited in counseling others when they aren't exactly setting an

example, " said Dr. Walter Willett, chairman of the department of

nutrition at the Harvard School of Public Health and a member of the

lifestyle medicine college's board of advisers.

" Primary caregivers at least should have extensive training in

lifestyle medicine, " Dr. Willett said. " And it's reasonable for

there to be a medical specialty " so patients can consult a trained

practitioner who is certified as an expert in the field.

Others say lifestyle medicine should be incorporated into every

facet of health care.

" I don't think it's appropriate to segment it off, " said Dr.

W. Rowland, chief of pediatric cardiology at Baystate Medical Center

in Springfield, Mass., who routinely counsels children and parents

on how to adopt healthy lifestyles. " It needs to be a fundamental

part of every doctor's practice " and therefore a part of every

medical school's core curriculum.

Still, he acknowledges that there are significant obstacles, because

lifestyle counseling is time-consuming and is seldom compensated by

Medicare or health insurers.

Reimbursement is a chief concern of the American College of

Lifestyle Medicine. The group plans to lobby Congress to that end.

And it wants Congress to require that patients be informed about the

relative effectiveness of lifestyle changes before receiving certain

medications — including blood pressure, acid reflux and cholesterol

drugs — and before undergoing procedures like back surgery, bypass

surgery and stent placement.

But first, Dr. said, patients and insurers need to be assured

of the professionalism of lifestyle medicine providers.

Some doctors say the movement suffers from fringe elements that

advocate unproven strategies like strict vegan diets and daily

saunas.

" Lifestyle medicine has to be scientifically based to distinguish it

from all the quackery out there, " said R. Brown, senior

behavioral scientist in the division of nutrition and physical

activity at the disease control center.

Dr. agreed. " We need to have a certification process in place

with rigorous, evidence-based standards, " he said.

Proponents of lifestyle medicine are quick to distinguish it from

alternative medicine. " This is mainstream medicine supported by

mainstream medical research, " said Dr. M. Rippe, associate

professor of cardiology at Tufts University School of Medicine and

the editor of The American Journal of Lifestyle Medicine. " The

lifestyle medicine movement is not an anti-procedure, anti-

medication movement. "

Rather, he said, it advocates that lifestyle interventions become

part of the doctor's arsenal in fighting disease: " For too long

we've ignored our most powerful weapon when it should be our first

line of defense. "