Doctors must help patients change lifestyles to beat disease
It saddens me that many Americans appear to be comfortable with the notion that chronic disease is a rite of passage through middle age and beyond.
At present, most people over age 45 suffer from one or more of high blood pressure, high blood cholesterol, diabetes, arthritis, heart attack, angina, heart failure, stroke, atrial fibrillation, cancer, kidney insufficiency, lung insufficiency or dementia. Diseases such as these impart a heavy burden, but also are a harbinger of a more sinister problem — an accelerated path to frailty, defined by a declining to enjoy the things that make life worth living.
While those of us who survive long enough will eventually become frail, there is nothing innate to our biology that would predict it before the 10th decade of life. Yet frailty is typically observed at much earlier ages, and modern medicine allows most people in frail condition to live on for years.
It is increasingly clear that our “lifestyle” — behaviors regarding food, physical activity, sleep and peace of mind — exerts a powerful influence on the likelihood of chronic disease and the rate of progression to frailty.
Food is paramount, and today's eating and drinking habits are driving an epidemic of overweight, which facilitates chronic disease. In my opinion, present evidence points to a whole food, plant-based diet comprised of unadulterated fruits, vegetables, tubers, legumes, whole grains, nuts and seeds as most effective in warding off chronic disease while promoting a healthy body weight. Also crucial is a personal culture of physical activity, to include regular exercise as well as standing in lieu of sitting and walking in lieu of riding. Adequate and restful sleep is essential for health, given its role in bodily repair and replenishment. Peace of mind may be the greatest lifestyle challenge, given its multi-faceted nature which is unique to each person, and ways to achieve it may include addressing problems at work or with relationships, pursuing causes, or experimenting with faith, hobbies, behavioral counseling, medications, meditation and yoga, among others.
Despite a compelling body of evidence which correlates optimal lifestyle with disease — resistant aging and delayed frailty, it is rarely practiced by people who have yet to be diagnosed with a chronic disease. This is regrettable, as preventing disease is far easier than reversing it. Shockingly though, the situation is similar among people who do have one or more chronic diseases, even though lifestyle optimization can do as much or more to ameliorate disease as medicines or surgery.
In my experience, few physicians adequately inform their affected patients of the imperative for lifestyle optimization as the bedrock of any chronic disease management strategy. Most have never received training in lifestyle medicine, and remain unaware or unconvinced as to its feasibility, efficacy or sustainability. Even among believers, time, resources and incentives are inadequate in current practice settings to teach these skills to patients, and to facilitate long-term
adherence. The infrastructure required to do this well is substantial, and largely unsupported by payors. Neither are patients at present adequately incentivized to defend themselves, an onerous fact in our current culture which strongly promotes chronic diseases.
Nonetheless, we physicians must endeavor to integrate lifestyle optimization into chronic disease care. We must empower patients by emphasizing that their choices will strongly influence how they will fare, and is essential to minimizing and optimizing responses to medicines or surgeries which we might recommend. We must agitate for care delivery models that effectively teach and incentivize lifestyle optimization. We must walk the talk by adopting the lifestyles we are espousing, and communicate that fact to our patients. We must make it clear that we anticipate their compliance in the spirit of partnership, and keep it front and center in our conversations. We must take every opportunity to define and promote a culture of optimal lifestyle in our communities.
Although the present era is witnessing an erosion of trust in authority figures, physicians still occupy a bully pulpit. If we do not utilize this privilege, we are risking our stewardship of the health of our communities.
Dr. David Schwartzman is a cardiologist and professor of medicine at the University of Pittsburgh. He specializes in the evaluation and management of disorders of heart rhythm. Among the diseases he treats is atrial fibrillation, which is potentially dangerous. The occurrence of atrial fibrillation is often caused by poor lifestyle choices, and for maximal benefit, its treatment must include lifestyle optimization.