We’re delighted once again to highlight in this issue the importance of lifestyle changes like diet and exercise to prevent cardiovascular diseases and other so-called lifestyle diseases. This was the very purpose why this magazine came to be, hence its name; and it still remains its main mission to instill in its readers, particularly doctors and healthcare professionals, that there can be no pharmacologic or other interventional substitute to a healthy lifestyle.
All treatment guidelines emphasize that the foundation of any chosen treatment strategy is lifestyle intervention. It’s an erroneous mindset to think that drugs are more effective and a physician should not invest too much time in counselling patients about lifestyle changes that he or she needs to implement. Lifestyle intervention is Class 1 Level A evidence in all guidelines, definitely more evidence-based than most Class 1 medicines that we prescribe.
Unfortunately, there are so many barriers to a successful implementation of lifestyle interventions. And we, physicians, have to humble ourselves by accepting that we’re at fault in many instances.
The busier we become, and the more patients that we need to see in our places of practice (clinic or hospital), the more negligent we become on healthy lifestyle counselling. If we have a long queue of patients waiting to see us, chance are, there’s no more time to have the kind of conversation that will motivate the patient to adhere to a healthy lifestyle. Physicians generally go immediately to drug prescription, not minding to check if the patient still smokes, drinks heavily; or if the patient is unable to exercise regularly and manage his or her stress.
Truly unfortunate, because there’s robust evidence showing that addressing effectively modifiable risk factors including unhealthy lifestyle has the potential for preventing 80 percent of cardiovascular diseases and their complications.
Nielsen et al looked into the barriers for maintaining specific lifestylechanges by exploring associations between the perceptions of these barriers by ordinary lay respondents and various sociodemographic and health-related aspects. (BMC Cardiovasc Disord. 2017; 17: 24)
Practically all the respondents stated that they prefer lifestyle changes to taking maintenance drugs, but a big percentage also had at least one perceived barrier why they could not implement the lifestyle change: 45 percent had at least one barrier to maintaining even just 30 minutes of exercise daily, 30 percent could not stick to dietary changes, and 62 percent of smokers had at least one excuse why they could not lick the vice.
What was quite an interesting finding was that social inequality was a strong determinant in the likelihood of the respondents to take appropriate healthy lifestyle preventive measures. Those who belonged to the lower socioeconomic brackets in the study tended to be more negligent of their lifestyle habits—they ate more unhealthy foods, smoked more, and exercised regularly less.
This is ironic because they’re the ones who can’t afford to get sick, and yet, they don’t feel strongly compelled to implement lifestyle measures that can prevent costly and potentially disabling complications. Physicians should have the findings of this study at the back of their minds when they see patients. Hopefully, all physicians realize the vital role they play in motivating their patients to stay healthy and well or have their medical problems maintained in stable condition with healthy lifestyle practices.
One of my favorite healthy lifestyle champions are the couple Jim and Toni Saret. Coaches Jim and Toni have effectively harnessed their high-profile status in inspiring millions of Filipinos to be more physically active, and remain fit and well. Unlike typical gym coaches, they don’t prescribe back-breaking routines, although I’m sure they know all these very well. They’ve designed simple, doable one to four-minute exercises one can do anywhere, anytime. The millions of exercise-adverse Filipinos and hundreds of millions more worldwide can certainly benefit from their real-world fitness approaches. (One Pound Less at a Time, page 10)
We hope the mainstream medical and healthcare organizations also recommending healthy lifestyle interventions are aware that we have an organization specifically focusing on healthy lifestyle, and that is the Asian Institute of Lifestyle Medicine (AILM). This was founded by Dr. Blecenda Varona, who also heads the Healthy Lifestyle workshops being conducted by the FAME Leaders’ Academy. The AILM promotes lifestyle interventions as the primary therapeutic tool in the treatment and management of various diseases. (Nutrition Science and Prescription, page 19; Sleep Health, page 21, and Foundation of Curative and Preventive Medicine, page 16)
The AILM also holds an annual conference and we wish the mainstream medical organizations would recognize it and collaborate with it in its important activities, and in the promotion of Lifestyle Medicine as an important field in Preventive Medicine. (Lifestyle Medicine Education, page 14)
In this issue, we also fondly remember our beloved columnist and chair of the H&L Medical Advisory Board—Dr. Ramon F. Abarquez, Jr. It’s more than a year since his passing, but his presence is still strongly felt in medical gatherings and even in our editorial staff room, as we recall his many teachings and advocacies. (Remembering Dr. Ramon F. Abarquez, Jr., page 23, Tribute to RFA, page 26).
His passion for learning and professional excellence, and his generosity in sharing all that he knew will always be remembered, and many of the trainees and students he has mentored can’t help but ask every time they encounter a problematic case, how would Dr. Abarquez have managed this case if this was his patient?
Cheers! And with the advent of the -ber months, may all of us find the rest of the year ever fulfilling and meaningful. God bless.
RAFAEL R. CASTILLO, MD