Intended for healthcare professionals


Lifestyle medicine: a new medical specialty?

BMJ 2018; 363 doi: (Published 25 October 2018) Cite this as: BMJ 2018;363:k4442

Re: Lifestyle medicine: a new medical specialty?

I am writing as one of the first cohort of physicians to sit the Lifestyle Medicine examination in Edinburgh earlier this year, after years of study and practice of lifestyle medicine principles. In my opinion, although lifestyle and nutrition is listed as the initial step in guideline algorithms, it receives, at best, lip service. I believe that part of the reason for this is that physicians themselves are unaware of the profound benefits that can be achieved with profound lifestyle changes, and that part of this unawareness stems from the guidelines lagging behind the literature.

As an example, most physician colleagues who I communicate with are unaware that research showing the reversal of coronary artery disease has been published in top peer reviewed journals for literally decades. One need only google the names of Dr Esselstyn and Dr Ornish to see that this is so. Yet many busy doctors are not inclined to go to primary literature and are satisfied with reliance on guidelines. This is understandable but unfortunately if we as doctors are not informed, we will not be able to offer our patients real choice as to how to prevent or treat the conditions that cause the most morbidity and mortality.

I believe this is an ethical issue for the profession and especially for creators of guidelines and for educators. We should not be leaving motivated patients at the mercy of the internet which is full of unsubstantiated claims regarding nutrition, and we should not abandon less motivated patients because we do not believe they will make changes. I hope all physicians but first and foremost, GPs, will regard the field of Lifestyle Medicine as a natural extension of the evolution of our advice about smoking. We know that it is bad, and we know we have to tell people, and continue to develop ways to shape the environment to encourage choices which promote human health, and to assist patients to move towards making their own educated healthy choices whether by big steps or small. In addition, since all physicians are also patients, or potential patients, we should examine how we can promote our own health through example and never consider that there is an 'us and them' situation. We are them.

In response to the question of whether the field of Lifestyle Medicine should be separate, or integrated into medicine in general, I would like to bring an analogy to Palliative Medicine, which started out as a separate endeavour but which is widely practised within General Practice and becoming integrated into other specialities. Yet, some situations will always require specialist palliative care expertise, there is no contradiction here.

Competing interests: No competing interests

28 October 2018
Miriam Maisel
Dumfries and Galloway Royal Infirmary, Out of Hours Service