The British Society of Lifestyle Medicine (BSLM) applauds the BJGP article titled ‘Exemplary medical treatment is a Trojan horse? A review of the “lifestyle medicine movements’ (1) focuses on the significance of the causes of non-communicable diseases caused by lifestyle factors like drinking, smoking, poor diet, and physical exercise. The BSLM will also look at sleep, social interaction with nature, and relaxation to be less examined but equally important factors in the health of certain people.
The report supports several goals of the British Society of Lifestyle Medicine. It also says that “translating guidelines into achievable real-world benefits outside clinical trials is challenging.” BSLM is trying to bring research and guidelines on lifestyle changes into the hands of healthcare professionals. It is currently offering instruction in the practice of group consultations. It is soon to provide education in the application of tools to assist with the change in lifestyles, including health coaching, person-centered care, and motivational interviewing. It also teaches social prescribing and shared decision-making. The BSLM degree and its curriculum do not provide any information about “reflexology, homeopathy, herbalism or naturopathy,” nor is it affiliated with any pharmaceutical, nutraceutical, or cosmetic organizations.
The BSLM is not associated with the British Association for Nutrition and Lifestyle Medicine (BANT), functional medicine, nor integrated medicine and does not support any alternative medical practice. The BSLM aims to empower the most people possible, regardless of whether they are professionals, patients, or professionals from whatever background, with research-based knowledge of the effects of lifestyle choices on health. It will provide education in the tools needed to assist those looking to make the principles of lifestyle change in conjunction with conventional surgical and pharmaceutical interventions for better health, regardless of the challenges sufferers face.
The principal concerns revolve in the context of three key issues that warrant further consideration:
- A lack of evidence-based evidence (uncritical endorsement or the infiltration of pseudoscience).The possibility of profit-making.
- The possibility of increasing health disparities by focusing on the individual.
Specific issues related to the first two points apply to medical practice generally. Medical professionals from any discipline can practice medicine privately and benefit from their knowledge and abilities. The main issue with profiteering and evidence-based practice is the regulations regarding the use of the term”lifestyle medicine,” as it can be utilized by professionals that are not licensed. The BSLM was created to address these issues regarding the quality of evidence and its base. Its goal is to free this “lifestyle arena” from quacks and gurus. It is growing into an organization that sets standards, awards practices, and offers quality, evidence-based training.
The BSLM acknowledges it is necessary to establish guidelines for the practice of lifestyle medicine and will continue to examine regulations with the GMC; however, until lifestyle medicine becomes an approved medical specialty, The BSLM will educate and promote evidence-based practices through its publications and qualifications.
The question then becomes: why should we refer to this practice as anything other than medicine in its current controlled form? The authors outline the currently based on evidence-based “individual-level” interventions that treatment is designed to promote, including “advice and support, exercise prescription, referral to weight management.” But, evidence suggests that in the clinical setting, there aren’t enough training opportunities for medical professionals to talk about and utilize these kinds of interventions, especially in the area of diet and nutrition (2) and that the provision of such information and support for patients is not a widespread practice (3 4). If it is offered at all, “reasons behind the lifestyle and dietary advice had not been adequately explained,” and “dietary advice was vague” (5).
In addition to highlighting the need to promote and name this strategy is the apparent difference in research funding for nutrition and lifestyle interventions, with the latter being a great illustration (6). In particular, the majority of research funding is devoted to pharmaceutical treatments (7 8) which is despite evidence that patients would like more research that focuses on the evaluation of lifestyle changes, according to some of the most critical research areas for the majority of chronic conditions according to James Lind Foundation (9). James Lind Foundation (9). Similar to the study, given the decision between taking a preventive drug or changes in lifestyle, 90 percent of patients indicated a preference for lifestyle changes (10).
By giving the term “lifestyle medicine” a name and increasing its visibility and visibility, the BSLM can tackle these issues and encourage the implementation of higher-quality and more effective individual-level interventions. By doing this, the BSLM hopes to decrease the adverse effects on the health of “too much medicine” and the dangers of over-medicating issues triggered by lifestyle and social issues (11).
The article also suggests that healthcare professionals should refrain from employing”individual-level interventions “individual-level interventions” that are promoted by the lifestyle medicine community because they could increase the gap in health. The global community of lifestyle medicine is also aware of this problem (12). It has reviewed the evidence that those who face socioeconomic disadvantage have more difficulty altering their lifestyle. The BJGP article highlights, that, for instance, nutrition education and other dietary counseling interventions are less likely to change the diets of those in the most deprived populations (13). The same connection is observed in preventive medical actions (14) and the adherence to prescriptions for various long-term illnesses, without a call for doctors to stop promoting the prevention of or prescribing for these ailments (15, 16, 16). In addition, social and economic inequality affects access to medical care overall (17). These problems, which are now exacerbated due to an epidemic of Covid pandemic, pose an issue for everyone in healthcare. There will be a need for interventions at the individual level (lifestyle as well as surgical and pharmaceutical interventions) and public health policies, which are sometimes mutually distinct. The proportion of resources allocated for both types of interventions must be continuously re-examined. The BSLM will agree that there is a lot of focus on providing healthcare. There needs to be more effort to create healthy living environments, provide equal access to nutritious food, let people get adequate sleep, establish significant relationships, etc. But, if we offer healthcare, and if these problems are solvable, we should pay attention to these issues in the consulting room.
Instead of clinicians refusing to assist patients in front of them by recommending lifestyle and behavior changes in the fear that those with more wealth will be healthier instead, we should focus on implementing, delivering, and evaluating better treatments and more intensive care to those who need the most. Prof. Sir Michael Marmot concluded in his study ‘Fair Society; Healthy Lives’ that health inequalities can be reduced by “strengthening the role and impact of ill-health prevention” and recommended providing treatment “with a scale and intensity that is proportionate to the level of disadvantage” (18). This applies to all medical practices, whether it’s methods to change behaviors and lifestyles as well as medications or surgical procedures.
For us to be able to do this service as health professionals (rather than as policymakers), We must find patients who are the most deficient and more effectively take them on a journey of person-centered healthcare. Alongside deprivation scores, more extensive assessments of needs, like those based on the Active Patient Measure (PAM), can be utilized by healthcare professionals to accomplish these goals (19). Studies have shown that interventions to increase activation may increase health outcomes, even with social and economic inequalities (20 21, 22, 22).
Clinicians who support individuals with changes in their lifestyle are not a prerequisite for the BSLM working in public health (many of them are part of society). The article is correct to draw attention to the widely-recognized hazards associated with “lifestyle drift” in policymaking (23) and how this could allow industry and politicians to blame the person that “chooses” a particular lifestyle when those choices aren’t freely made. But, by defining the distinct requirements of policymaking and the clinical setting and the clinical encounter, the BSLM is convinced that if the evidence-based evidence for lifestyle changes is placed on the same with surgical and pharmaceutical strategies (in terms of the funding process, medical training, and the importance of the consultation) and these conflicts can be more easily recognized.
The authors recommend that lifestyle medicine requires a “clear consensus on what constitutes evidence-based practice with organizational standards and leadership commitment to the removal of bad science and financial and ideological conflicts.” The BSLM recognizes this and is the only lifestyle medicine group in the UK to distinguish itself from alternative medicine that is free of any sponsorship from pharmaceuticals or nutraceuticals and is currently establishing an academy of learning to offer the BSLM’s certificate, maintaining of certification program with fellowships as well as CPD possibilities to make sure that we can provide medical education that is evidence-based and that is accessible to everyone.
It also works with academic partners and NHS healthcare providers to ensure that the work it undertakes is well-thought-out and is utilized to tackle health disparities. Practical approaches to assisting struggling people undergoing lifestyle change are often overlooked by medical professionals. They shouldn’t be left in the control of social media influencers or “lifestyle gurus,” nor should they only be available to the wealthy. The BSLM helps develop the expertise and understanding necessary to address the problems that the authors have raised. We want to welcome those who want to help us work on these issues by joining our organization.
The BSLM can work with a broad spectrum of partners with many different opinions as a group. In doing so, we work to ensure transparency and that the foundations of lifestyle medicine and changes for all are at the center of what we do.
