Viewpoint: How lifestyle medicine can help GPs tackle health inequalities

Dr Ellen Fallows explains the evidence to support lifestyle medicine, how it can help those from all backgrounds to improve their health and what the British Society of Lifestyle Medicine is doing to enable more clinicians make use of it in practice.

Dr Ellen Fallows

Lifestyle medicine is a rapidly growing discipline offering patients more options than medications and surgery alone. Most importantly, lifestyle medicine trains clinicians to support people at an individual level, to make and sustain lifestyle changes despite the challenges they face.

It has grown from the early work of the father of modern medicine Dr William Osler, who warned about the harms of too much medicine and used nutrition, physical activity and avoidance of smoking and alcohol over medications.

The term was first used in the 1980s by Ernst Wynder, the epidemiologist who discovered the link between smoking and lung cancer. It has now grown into a global medical movement and a board-certified medical speciality in America with a diploma here in the UK from the British Society of Lifestyle Medicine.

There is good evidence for lifestyle medicine

Research around lifestyle interventions has been historically slow and beset by funding challenges but we now have good evidence for their effectiveness to not just prevent but to treat and reverse some chronic diseases.

Good examples include the DiRECT trial where remission from type-2 diabetes was achievable for around 40% of participants after one year of a low-calorie meal replacement intervention with behaviour change support and the SMILES trial where an intervention to improve food quality resulted in improvements to mood equivalent to that seen with anti-depressants.

Talking General Practice podcast
Listen to an interview with Dr Ellen Fallows discussing lifestyle medicine in our podcast here

Lifestyle medicine, with its individual and group level interventions, faces the same challenges as public health’s population level interventions; some patients will need more support than others and blanket approaches risk worsening health inequalities.

Repeated studies find that those facing disadvantage are less able to make the lifestyle changes needed to live healthy lives. This health inequality has been highlighted during the pandemic when those in overcrowded homes without access to green spaces or living in 'food deserts' for example, were more likely to have poorer outcomes from COVID-19.

The importance of a personalised approach

This is why lifestyle medicine uses personalised approaches – asking what matters right now to people about their health alongside social prescribing and proven behaviour change techniques such as group consultations, motivational interviewing and health coaching.

Practically, for clinicians in the consulting room, this approach means we need to rethink the priority we give to some of our current interventions.

Dispensing simple advice or medications risks distracting us from the root causes of people’s presentations. We need to research and teach about the impact of writing letters to a patient’s landlord to raise concerns about the health impact of poor housing, to offer food vouchers or signpost to local community and voluntary groups.

We need to tap into our patient’s own skills and values as well as their communities and build on their ability to manage their health. We need better tools to identify those in our care who need more help due to deprivation or vulnerability and we need to avoid only offering support for healthy living to those more well-off.

Outside the consulting room we can use our position of influence as clinicians to raise the importance of action at a social and economic level to support healthy living. We can champion these critical issues in a PCN meeting with other practices, with the local council, with the wider hospital trust, with CCGs or as a voting citizen at the ballot box.

Three core principles

I have worked with the British Society of Lifestyle Medicine (BSLM) since 2019 to champion three core principles of lifestyle medicine. These principles are; an awareness and action around the socioeconomic determinants of health, the use of behaviour change tools in clinical practice and knowledge of the six pillars of lifestyle medicine (mental wellbeing, healthy relationships, physical activity, healthy eating, sleep and avoidance of harmful substances).

The BSLM has bought together a network of thousands of coal-face healthcare practitioners from nurses, health coaches to GPs and consultants to discuss and learn more about the evidence base for this approach in medical practice and the NHS. The BSLM Learning Academy will host courses for busy healthcare practitioners to learn more about these key principles, the practice of lifestyle medicine and how it can contribute to the levelling up that is urgently required in health care.

In the UK, 11.7m people live on a low income, and issues such as poverty, inequality, food insecurity, poor housing and job insecurity all act as barriers to healthy living. The BSLM will be working hard through our conferences, events and courses, to teach clinicians about interventions that have the greatest impact on harder to reach groups and those facing deprivation.

Our members are working on pilots targeting support for these groups and asking people what support they need to live well. However, lifestyle medicine is a clinical tool, not a policy tool; we ask that healthcare leaders and policy makers work just as hard to address the up-stream determinants of health to promote a culture, society and environment that supports our patients to live well.

  • Dr Fallows is a GP in Oxfordshire and and director of the British Society of Lifestyle Medicine’s learning academy

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