Exemplary medical care or Trojan horse? An analysis of the 'lifestyle medicine' movement.

The rise of non-communicable diseases, many of which share common risk factors of smoking, alcohol, poor diet, and physical inactivity, has resulted in calls to develop and expand lifestyle medicine, giving ‘hope to those suffering from chronic illness’ (https://bslm.org.uk/). It has been argued that lifestyle medicine should be recognised as a new medical specialty,1 with primary care leading. There are numerous drivers for lifestyle medicine (Box 1). Our analysis does not aim to argue against the importance of these drivers as many of them are well informed. Instead we seek to balance existing discussions with aspects that, in our opinion, have been less well considered. With this in mind, we focus on the unintended consequences of uncritical endorsement and application of lifestyle medicine including the infiltration of pseudoscience, profiteering, and the potential for widening health inequalities by a continued focus on the ‘individual’. We stress the need for greater attention to public health and community-level interventions and a more critical approach to current practice. | Prevention is better than cure. | || | The patient is an active partner, not a passive recipient. | | Lifestyle medicine treats the root cause (behaviours) of chronic disease, which medicine often overlooks. | | Lifestyle risk factors are the primary cause of non-communicable disease and must therefore be addressed. | | It is better to treat with lifestyle changes than to use potentially unnecessary drugs with the risk of side effects. | | Lifestyle medicine is cost-effective compared with conventional medicine. | | Professional satisfaction is greater, especially compared with usual approaches to chronic disease management (for example, the ‘tick box’ approach of the Quality and Outcomes Framework in England). | | Because of weakening of public health through defunding within local government, individual approaches are necessary. | | Public Health England has been perceived as not being sufficiently independent of government or industry. | Box 1. Key drivers for lifestyle medicine Medical practice guidelines often advise on ‘lifestyle factors’. These are usually in the form of individual behaviours that impact on health, framed as modifiable, often related to smoking, alcohol intake, physical activity, diet, and, to a lesser degree, sleep quality, stress, and social factors. However, translation of guidelines into achievable real-world benefits outside clinical trials is challenging. The British Society of Lifestyle Medicine (BSLM) describes lifestyle medicine as ‘an established approach that focuses on improving the health and wellbeing of individuals and populations … It requires an understanding and acknowledgement of the physical, emotional, environmental and social determinants of disease.’ (https://bslm.org.uk/). Society membership is open to registered health professionals, who can take a diploma, and associate membership is available to others, such as reflexologists, homeopaths, herbalists, and naturopaths. Some have …