Tackle lifestyle before drugs and surgery – Diabetes Diet



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BMJ 20 May 2023 Adapted from Letter of the Week by Ellen Fallows, British Society of Lifestyle Medicine

Changing the mindset in medicine

Clinicians are often overwhelmed when they see patients with many complex conditions who have brought both physical and social problems to a long awaited but short consultation.

When medical guidelines are viewed in totality, it is clear that we can’t see the wood for the trees, have forgotten the person behind the disease, and are failing to tackle the root cause of their symptoms.

Basic science now describes a common underlying pathology to long term conditions: immune dysregulation resulting in chronic systemic inflammation. Key drivers include environmental and lifestyle factors influencing gene expression and our microbiome.

Our current medical model is however based on a reductionist and deterministic view of health that stems from the era of gene discoveries. This has led to a belief that diseases exist in isolation and we are powerless without medicine and drugs. This is not the case. If we step back from the relentless assessment, quantification, and labelling of disease and spend more time tackling its root causes, we can support people to reverse- or at least improve or delay-these conditions.

Fewer guidelines and assessments are needed, as well as more public health measures and more lifestyle medicine. Lifestyle medicine is a discipline that considers the socioeconomic drivers of behaviour, acknowledges the difficulties people face, and uses person centred techniques to support lifestyle changes to tackle nutrition, physical activity, social isolation, sleep, mental wellbeing, and consumption of harmful substances such as tobacco and alcohol.

This approach isn’t new or controversial- it is the first step in all major long term condition guidelines. But it is neglected, with funds for creating good quality education and an evidence base sorely lacking and requiring a policy shift.

The hardest behaviour to change however, is not that of patients but that within medicine itself.

My comment: I am so much in agreement with this letter. It was impressive that the BMJ published it so prominently.


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