'Lifestyle as medicine', where lifestyle modification is offered as medical therapy, can bring about many health benefits. But who will pay for it? Is it the responsibility of the government, the healthcare system, the business community or the individual citizen? No single actor can accomplish such a transformation on their own. We must go towards a new ecosystem that emphasizes lifestyle medicine and has a role for every party. Together we are responsible for a healthy society.
Health care as we know it doesn't always make sense. We only take action once disease is present, instead of preventing it. That is odd, when you compare it with dentistry. From a young age we go to the dentist twice a year to prevent dental problems. But we do not practice this sort of prevention for our most important asset – our health. Why not have a routine check every so often? In this way we can strive towards a transformation from the current system, which is centred on 'treating disease', to a system that really delivers 'health' care. In such 'health' care, as a society we focus on proactively maintaining good health and preventing 'diseases of prosperity'.
Lifestyle as medicine
We have a long way to go. Let us start by zooming in on curative care, which is after all what lifestyle as medicine is addressing. Lifestyle factors such as unhealthy eating habits, stress, and little exercise and sleep can contribute to the development of conditions like type-2 diabetes, cardiovascular disease, obesity and osteoporosis. We now tend to treat symptoms like high glucose levels with medication, yet this does not tackle the underlying cause or, more importantly, the disease progression.
“We now tend to treat symptoms with medication, yet this does not tackle the underlying cause or, more importantly, the disease progression”
But there are other options. It is fascinating to see that lifestyle modification can largely halt disease progression and even normalize symptoms – what is known as remission. This should be taken advantage of as much as possible. Take type-2 diabetes, for example. Longitudinal research into the possibility of normalizing type-2 diabetes is scarce so far, yet quite promising. In a recent study with a large group of type-2 diabetics (n=306) that applied tested and standardized lifestyle recommendations, 46% of the intervention group went into remission after one year as against 4% of the control group (Lean et al., Lancet 2017). The results of the Dutch initiative 'Keer Diabetes2 Om' ('Turn Diabetes2 around') are also very promising. Nearly 90% of the participants is completely or partially off medication, and/or has healthier blood sugar levels. Nearly 40% is still off medications after one year.
What's the catch?
These numbers look great, but everyone knows that for many people a total lifestyle turnaround is very difficult to keep up. Besides, lifestyle changes will not result in remission for every single patient. The lifestyle intervention did not work on all the patients with type-2 diabetes in the mentioned study of Lean et al. The cause of the disease also influences whether certain lifestyle interventions are more successful towards achieving remission than others (Blanco-Rojo R et al., Diabetologia 2015). In short, to successfully implement lifestyle as medicine an extensive diagnosis with a suitable lifestyle intervention is needed that works more efficiently for you as an individual patient. Ideally it should also take your food tastes and preferences into account.
“If 40% of type-2 diabetes patients with lifestyle as medicine went into remission, that would already save 2.7 billion euros in medical costs in only five years”
Lifestyle as a practical tool
If 40% of type-2 diabetes patients with lifestyle as medicine went into remission, that would already save 2.7 billion euros in medical costs in only five years. And this percentage is feasible in a scenario of extensive diagnosis, customized lifestyle interventions and intensive coaching. Reduced sickness absenteeism and increased productivity are additional factors that can lead to cost savings. It goes without saying that in addition to economic benefits, lifestyle as medicine also has a positive impact on patients' quality of life.
If we agree that lifestyle medicine works, why is it hardly ever applied in practice? For many parties, lifestyle medicine is not interesting. It cannot be patented, and that makes it difficult to finance. Furthermore, many parties are involved that would have to work together to implement it. Against this there are the health gains for the patient, and in the long term also the gains for care providers, health insurers and society in general.
“Without business models that place value and profits with the parties that invest, little will happen in the field of lifestyle medicine”
Without business models that place value and profits with the parties that invest, little will happen in the field of lifestyle medicine. Creating innovative models and giving visibility to the added value for all the interested parties is essential. We have to find out how to best shape initiatives of this kind. Who is investing, and what does the business model look like?
Fortunately there already are all sorts of initiatives – Keer Diabetes2 Om, the Bas van de Goor Foundation, GezondDorp – that are bringing lifestyle as medicine into practice and seem to be having success in achieving lifestyle modification. In this process it is important for initiatives to be evidence-based, and to this end more implementation-oriented research is crucial. The Nederlands Innovatiecentrum voor Leefstijlgeneeskunde (Dutch innovation centre for lifestyle medicine) wants to be the platform where all relevant parties meet and collaborate to make this type of research possible and implement lifestyle as medicine. The good news is that the government is paying more attention to lifestyle medicine, and by now employers are also recognizing the need for a healthy lifestyle in order to reduce sickness absenteeism.
It is important to take action now, while developing an ecosystem that revolves around lifestyle medicine and gives a role to all the stakeholders involved. Only then will we have a healthier society and real 'health' care.
This TNO project supports the following Sustainable Development Goal
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Do you have any questions about lifestyle as medicine? Please contact Suzan Wopereis.