Lifestyle Medicine in Disease Prevention and Management

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Definition

Lifestyle medicine is the integration of lifestyle practices into every day clinical practice in order to prevent or reduce the risk of occurrence of a disease and where the disease has occurred to serve as adjunct to its treatment.

Domains of Optimum Health

Lifestyle medicine goal is to keep people in optimum health by making available information, strategies, and tools that individuals could employ in their choice and behavioral practices in relation to daily life activities.
Optimum health requires that positive healthy actions are exhibited in the following seven domains of health or wellness:

Physical
Occupational
Intellectual
Social
Spiritual
Emotional
Environmental

(POISE)

Common Daily Life Activities

Walking
Handling health-related information
Sleep
Eating
Dressing
Cleaning/bathing
Sexuality
Working
Feelings/emotions
Prayer/worship
Rest/leisure time activities
Digital behavior
Relating with people

Screening for Readiness for Lifestyle Modification

The Prochaska-DiClemente Stage of Change
The 6 stages of change:

Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Adoption/Termination

I smoke cigarette and I do not intend to change in the foreseeable future
I currently smoke cigarette but I am considering dropping this habit in the next 6 months
My current alcohol intake is high but I have plans to reduce it to two drinks daily by next month
I have been exercising regularly but I have done so only in the last six months
I currently take four servings of vegetable daily and I have done that for more than six months now
I currently meditate daily and I have done so for over five years now

PS. Note the stages of change

At the end of both history and assessment:

Patients already on Lifestyle Medicine (LM) and do not require additional intervention
Patients that require counseling for healthy living and the level of intervention
Patients in need of therapeutic Lifestyle modification

What is Counseling

Counseling is the process of assisting clients in making an informed decision regarding how to change their behavior.
One-on-one counseling is one of the most effective methods of assisting clients to change unhealthy behaviors.

Nutrition
Physical activity
Stress management
Sleep management
Smoking cessation
Personal hygiene and a variety of other non-drug modalities

Lifestyle Medicine Practices

Exercise/Physical activity
Weight management
Diet and nutrition
Personal safety practices
Stress management
Health Literacy
Emotional management
Cleanliness
Digital behavior
Sexuality
Spirituality
Relationship management
Humour and music
Substance abuse
Sleep

Weight Management

What is Weight?

Degree to which an individual is drawn towards the earth by gravity.
It is also 'how heavy an individual is.'
It is usually measured by weighing scales and expressed in kg or lbs.

Weight management is the maintenance of body weight at a healthy level BMI 18.5 to 24.9 (WHO).

Designing Individualized Weight Loss Program

Estimating caloric intake
Daily caloric requirement computation
Monitoring diet using daily food logs
Exercise for weight loss
Behavioral modification and adherence to lifetime weight control program

BMI and Health Risks
Classification	BMI (kg/m²)	Disease Risk to BMI
Underweight	<18.5	Increased
Normal Range	18.5-24.9	Very Low
Pre-obese (Overweight)	25-29.9	Increased
Obese Class 1	30.0-34.9	High
Obese Class 2	35.0-39.9	Very High
Obese Class 3	>40.0	Extremely High

Obesity Complications

Diabetes Mellitus
CHD (Coronary Heart Disease)
Hypertension
Osteoarthritis
Increase morbidity and mortality
Complication of Pregnancy
Short life expectancy
High BP (Blood Pressure)
Gout
Gall bladder disease
Mood disorder
Respiratory problems
Poor reproductive health
Cancer
Stroke

How to maintain a healthy weight

Weight management

Weight Loss Strategies

Counseling
Motivational Interview

Eating habits
Commercially modified Meals
Exercise
Behavioural approaches
Medications
Surgery (Bariatric)

Eating habits
- Choice of food items
- Timing of eating
- Frequency of eating
- Style of eating
- Portion sizes
- Eating environment
- Use of water
Commercially modified Meals
- Low caloric meals
Exercise
- Type of exercise
- Duration
- Intensity
- Regularity
Behavioural approaches
- Perception of food
- Contingency planning
- Visualization
Medications
- Types
Surgery
- Type
- Indication

African Diet: Increase intake of these

Beans and bean cakes:
- This contains high amount of protein and are good building blocks for muscle.
- They are also one of the fat burning foods.
Fish: Fish is very high in protein content.
Fruits: Watermelons, apples, oranges, bananas, etc.
Vegetables: With very little oil in it.
Chicken and turkey: Try peeling off the skin before taking these!

Ideal Weight

Bone size

Women wrist circumference:
- Large Frame > 15 cm
- Small frame ≤ 15 cm
Men Wrist circumference:
- Large Frame > 18 cm
- Small frame ≤ 18 cm

In Men:

45 kg for 150 cm of height and add 1 kg for each additional 1 cm of height (e.g., 168 cm tall man would have 45 + 18 = 63 kg)

In Women:

47 kg for 150 cm of height and add 0.85 kg for each additional 1 cm (e.g., 160 cm tall woman would have 47 + 8.5 = 55.5 kg or 56 kg)

Ideal Weight and Caloric Requirement

Adjust weight to body frame:
- Large frame - increase weight by 5%
- Small frame - reduce weight by 5%
Example:
- 168 cm (63 kg) man with a wrist circumference of 19 cm = 66 kg
- 160 cm (56 kg) woman with a wrist circumference of 14 cm = 53 kg
Calories Requirement:
- Basal Metabolic Rate (BMR) - the energy required for body function while at rest such as being in bed.
- BMR = ideal weight x 22 calories as energy required in 24 hours (e.g., 66 kg x 22 = 1452 calories) (note that 1 calorie = 4.184 kilojoules); 6075.17 kJ or 3.84 kJ/kg/hr

Losing Weight Tips

A mix of methods is required to lose weight
Good weight loss is a slow process
Aim to lose 10% in 6 months
Consider:

Eating habits
Exercise
Behavioural therapy at the same time if client is not resistant to change

Make use of water to improve weight loss
Try lifestyle modification for at least 6/12 before considering pharmacotherapy
Meal replacement can be used to initiate weight loss and to serve as motivation
Do not try both meal replacement and drug use at the same time
Monitor patient closely for side effects when using drugs
Educate patient to monitor progress using SMART goals for both eating habits and exercise

Physical Activity

Level of Activity

Number of daily footsteps

< 5000: Sedentary
5000 – 7499: Low active
7500 - 9999: Somewhat active
10000 – 12499: Active
> 12500: Highly active

Daily time spent on physical activity or exercise

Footsteps:

Physical activity or exercise

30 minutes of daily physical activity or moderate-intensity exercise at least five times weekly (walking, gardening, dancing, etc.)
Or 20 minutes of high-intensity exercise thrice weekly (running, jogging, cycling, dancing, etc.)

Exercise

Rule out contraindications (CVDs, family history, etc.)
Warm-up; work out; cool down
FITT principles

Nutrition

What is a "Healthy Diet"?

Emphasizes fruits, vegetables, whole grains, and fat-free or low-fat milk and milk products
Includes lean meats, poultry, fish, beans, eggs, and nuts
Low in saturated fats, trans fats, cholesterol, salt (sodium), and added sugars

Food:

Food is any substance taken into and assimilated by a plant or animal to keep it alive and enable it to grow and repair tissue.

Diet:

Diet is the customary amount and kind of food and drink taken by a person from day to day.

Meal:

The food served at any of the times, especially the customary times of eating such as breakfast, lunch, or dinner.

Food Group Classification

Macronutrients: Nutrients that are needed in large amounts and provide calories (energy).
Micronutrients: Nutrients that our bodies need in smaller amounts.

Categories of Macronutrients:

Carbohydrates: 1g of carbohydrate provides approximately 4 calories.
Proteins: 1g of protein provides approximately 4 calories.
Fats: 1g of fat provides 9 calories.
Alcohol: 1g of alcohol provides 7 calories. Alcohol, however, is not a macronutrient because we do not need it for survival.

Micronutrients:

Micronutrients (Vitamins and Minerals) are nutrients that our bodies need in smaller amounts.

Water: Adult men need about 3.7 litres of water per day, and adult women need about 2.7 litres of water per day.

Keys to Healthy Eating

Regular Meals

Eat regular meals, if possible at regular intervals.
Start off the day with a breakfast.

Carbohydrates

Throw refined sugar out as much as possible. Some advocate a low carbohydrate diet.

Meat and Fish

Eat less red meat. White meat, fish, and poultry are good alternatives.
Always remove the skin from your chicken.
Fry less. Instead of frying, grill or even boil.
Use less oily food or use trans-free vegetable oil.
Remove as much fat from your meat or fish before cooking it.

Fruit and Vegetables

Eat five portions of fruit and vegetables in a day. You can do this by eating vegetables or fruits with your three meals, as well as in between meals as snacks.
A portion of vegetable is one apple, or one banana, or one orange.
A glass of orange juice is also counted as a portion.
A mango or any other fruit is also considered as a portion.
However, for small fruits like grapes or cherries, a handful will be required to count as a portion, and a dessert bowl full of salad is a portion.

Reduce Salt

Reduce the amount of salt you consume.
Do not add salt to the food once it is cooked and served.

Eat Variety

Add spice to your life. Eat a variety of foods. They will provide you with a wide range of nutrients.

Drink a lot of water

Drink at least 3L of water or other liquid drink (nonalcoholic) per day.

Weight loss diet

Food pyramid showing the types and amount of food groups in a healthy diet

Hand as a Serving Tool

A fist or cupped hand = 1 cup

1 serving = 1/2 cup cereal, cooked pasta or rice or 1 cup of raw, leafy green vegetables or 1/2 cup of cooked or raw, chopped vegetables or fruit.

Palm = 3 oz. of meat

Two servings, or 6 oz. of lean meat (poultry, fish, shellfish, beef) should be a part of a daily diet. Measure the right amount with your palm. One palm-size portion equals 3 oz. or one serving.

1 tennis ball = 1 serving of fruit

Healthy diets include 2-4 servings of fruit a day.

Thumb tip = 1 teaspoon

Keep high-fat foods, such as peanut butter and mayonnaise, at a minimum by measuring the serving with your thumb. One teaspoon is equal to the end of your thumb, from the knuckle up. Three teaspoons equal 1 tablespoon.

Handful = 1-2 oz. of snack food

Snacking can add up. Remember, 1 handful equals 1 oz. of nuts and small candies. For chips and pretzels, 2 handfuls equal 1 oz.

WHO 12 Steps to Healthy Eating

Eat a nutritious diet based on a variety of foods originating mainly from plants, rather than animals.
Eat grains, bread, pasta, rice, or potatoes several times per day.
Eat a variety of vegetables and fruits, preferably fresh and local, several times per day (at least 400g/day).
Maintain body weight between the recommended limits (a BMI of 18.5–24.9) by taking moderate levels of physical activity, preferably daily.
Replace fatty meat and meat products with beans, legumes, fish, poultry, or lean meat.
Use milk and dairy products that are low in both fat and salt.
Select foods that are low in sugar and eat refined sugar sparingly, limiting the frequency of sugary drinks and sweets.
Choose a low-salt diet.

Total salt intake should not be more than one teaspoon (5g) per day, including the salt in bread and processed and preserved foods.

If alcohol is consumed, limit intake to no more.
Prepare food in a safe and hygienic way.
Steam, bake, boil, or microwave to help reduce the amount of added fat.
Practice exclusive breastfeeding for at least 6 months and promote breastfeeding for the first.

Stress Management

Measures to reduce stress:

Coping with stress
Time management
Relaxation techniques

Physical activity
Meditation
Progressive muscle relaxation
Breathing techniques

Dealing with Stressful Situations: The Four A’s

Change the situation:

Avoid the stressor.
Alter the stressor.

Change your reaction:

Adapt to the stressor.
Accept the stressor.

Stress Management Strategy: Avoid Unnecessary Stress

Not all stress can be avoided, and it’s not healthy to avoid a situation that needs to be addressed. You may be surprised, however, by the number of stressors in your life that you can eliminate.

Take control of your environment: If the evening news makes you anxious, turn the TV off. If traffic’s got you tense, take a longer but less-traveled route.
Avoid hot-button topics: If you get upset over religion or politics, cross them off your conversation list. If you repeatedly argue about the same subject with the same people, stop bringing it up or excuse yourself when it’s the topic of discussion.
Pen down your to-do list: Analyze your schedule, responsibilities, and daily tasks. If you’ve got too much on your plate, distinguish between the “shoulds” and the “musts.” Drop tasks that aren’t truly necessary to the bottom of the list or eliminate them entirely.

Stress Management Strategy: Alter the Situation

If you can’t avoid a stressful situation, try to alter it. Figure out what you can do to change things so the problem doesn’t present itself in the future. Often, this involves changing the way you communicate and operate in your daily life.

Express your feelings instead of bottling them up: If something or someone is bothering you, communicate your concerns in an open and respectful way. If you don’t voice your feelings, resentment will build, and the situation will likely remain the same.
Be willing to compromise: When you ask someone to change their behavior, be willing to do the same. If you both are willing to bend at least a little, you’ll have a good chance of finding a happy middle ground.
Be more assertive: Don’t take a backseat in your own life. Deal with problems head-on, doing your best to anticipate and prevent them. If you’ve got an exam to study for and your chatty roommate just got home, say upfront that you only have five minutes to talk.
Manage your time better: Poor time management can cause a lot of stress. When you’re stretched too thin and running behind, it’s hard to stay calm and focused. But if you plan ahead and make sure you don’t overextend yourself, you can alter the amount of stress you’re under.

Stress Management Strategy: Adapt to the Stressor

If you can’t change the stressor, change yourself. You can adapt to stressful situations and regain your sense of control by changing your expectations and attitude.

Reframe problems: Try to view stressful situations from a more positive perspective. Rather than fuming about a traffic jam, look at it as an opportunity to pause and regroup, listen to your favorite radio station, or enjoy some alone time.
Look at the big picture: Take perspective of the stressful situation. Ask yourself how important it will be in the long run. Will it matter in a month? A year? Is it really worth getting upset over? If the answer is no, focus your time and energy elsewhere.
Adjust your standards: Perfectionism is a major source of avoidable stress. Stop setting yourself up for failure by demanding perfection. Set reasonable standards for yourself and others, and learn to be okay with “good enough.”
Focus on the positive: When stress is getting you down, take a moment to reflect on all the things you appreciate in your life, including your own positive qualities and gifts. This simple strategy can help you keep things in perspective.

Stress Management Strategy: Accept the Things You Can’t Change

Some sources of stress are unavoidable. You can’t prevent or change stressors such as the death of a loved one or a serious illness. In such cases, the best way to cope with stress is to accept things as they are. Acceptance may be difficult, but in the long run, it’s easier than railing against a situation you can’t change.

Don’t try to control the uncontrollable: Many things in life are beyond our control—particularly the behavior of other people. Rather than stressing out over them, focus on the things you can control such as the way you choose to react to problems.
Look for the upside: As the saying goes, “What doesn’t kill us makes us stronger.” When facing major challenges, try to look at them as opportunities for personal growth. If your own poor choices contributed to a stressful situation, reflect on them and learn from your mistakes.
Share your feelings: Talk to a trusted friend or make an appointment with a therapist. Expressing what you’re going through can be very cathartic, even if there’s nothing you can do to alter the stressful situation.
Learn to forgive: Accept the fact that we live in an imperfect world and that people make mistakes. Let go of anger and resentments. Free yourself from negative energy by forgiving and moving on.

Stress Management Strategy: Make Time for Fun and Relaxation

Beyond a take-charge approach and a positive attitude, you can reduce stress in your life by nurturing yourself. If you regularly make time for fun and relaxation, you’ll be in a better place to handle life’s stressors when they inevitably come.

Personal Wellness Plan

Practice mindfulness and reframing as ways of coping with stress
Ensure a minimum of 7-8 hours of sleep every day
Accord top priority to the use of personal safety measures such as immunization, use of bed nets, seat belts, and other preventive services.

Risk reduction counseling
Counseling for healthy living
Detoxification of the human body
Digital lifestyle and health
Nutritional supplement and healthy living
Music in health and disease
Humour therapy

Lifestyle medicine is the medicine for the present and the future, and it remains for now the only medicine that the physician can test before administering it to a client or patient.
Lifestyle-related diseases have assumed epidemic status in developed countries and are posing serious epidemic threats in developing nations.
There is incontrovertible evidence that lifestyle changes hold the keys to the prevention and control of lifestyle-related diseases.
Lifestyle medicine is the preferred choice of treatment in both mild and moderate forms of the most common non-communicable conditions like hypertension, diabetes, CHD, overweight, etc.

Practice Questions

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