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Ode to Lifestyle Medicine and the people and principles that make it so

It occurs to me I have not written as much as I should, and for that I am sorry. Fortunately for me, this is a blog and not a research paper, so I can relax a little in my style and more freely speak my natural tongue at this late hour. My two children are finally asleep and now I sit sipping warm water – continuing my 16 hour daily fast – typing on my f.lux blue light filter screen and monitoring the clock to ensure I get my 20 minutes meditation and 7.4 hours of sleep.

For those who don’t know the ASLM story, let me start there. About 15 years ago, a visionary man wrote the first Lifestyle Medicine textbook in Australia (the second worldwide). Soon after, he founded the Australasian Lifestyle Medicine Association (ALMA), a fully independent not-for-profit organisation, to open the conversation to evidence-based lifestyle interventions for chronic disease, and just as importantly, to the social and environmental drivers of lifestyle-related disease.

Professor Garry Egger AM was joined by other noble minds as he campaigned for timeless common sense; A/Prof John Stevens, Dr Andrew Binns, Dr Caroline West, Tanja McLeish, Dr Joanna McMillan, and the list goes on. In 2015, another great man joined the scene with a vision to reinvigorate the under-resourced ALMA as ASLM; the Australasian Society of Lifestyle Medicine.

Thanks to Stephen Penman, we are now leading a national and international multidisciplinary movement of doctors, allied health, nurses and public health professionals who promote evidence-based lifestyle interventions as the first-line treatment for many chronic diseases.

Lifestyle Medicine is often considered mainly about “diet”. But like so many, I tire of the nutrition wars, becoming often enveloped by ego, agendas and ideology, and all the while being the perfect breeding ground for populist bloggers and media to get more Facebook likes and retweets. Common sense will hopefully prevail and we shall all come back to real food one day.

Instead, we know Lifestyle Medicine is about so much more, and above all, it is about the principles of integrity and humility that must govern it as they have so loyally governed our greatest historical realisations. To examine our own bias as much as we examine others, if not more so. To participate in research and mature dialogue about the evidence as it stands, rather than how we want it to be. To accept we may not know it all, but work to advance scientific progress and innovation in application.

Diet of course matters, but we look to the rapidly growing evidence into sleep, movement, fasting, the strength of connection with others and nature, techniques for smoking cessation and sensible alcohol intake, the use of online and app technology, health coaching and behaviour change techniques, the role of public policy, the agriculture system, the impact of modern marketing, the health of our environments and further, right down to the deepest personal questions; the biological and psychological impacts of meaning and purpose in life.

As for the intricacies of the nutrition wars, I will save that for another night. As for now, I will say within the hubs of passionate lifestyle practitioners there exist certain groups, many sensible and a few zealous. It is so much easier to run from dissonance and remain in our echo chambers, but we must not succumb to the temptation of tribalism nor to the modern weakness of being unable to endure the short term for a greater long term vision. We must see the big picture and play the long game.

Look to any major guideline and there looking back at you, you will see “lifestyle intervention” to be used before and with every other treatment. Lifestyle Medicine is not opposed to medication nor procedure, rather it is simply another option for our patients to prevent and reverse their disease  – and often the option they are most keen to do. How nice it is for me as a GP to suggest a treatment option that people actually want rather than trying to persuade them, and myself, that another medication is the answer to their diabetes or other significantly reversible chronic diseases? Of course, I, like every sensible clinician, celebrate and am deeply grateful for the advances in modern therapeutics, but why not use everything the evidence suggests we should for the betterment of our patients physical, psychological, and social lives?

And why stop with the patient? Lifestyle Medicine is also a social and cultural health movement. To change the system from top down and bottom up; from advocating regenerative agriculture and reconnecting with real food to advancing government policy, from medical school training to the sugar tax, and everything in between. There is a lot of work to be done, especially in addressing health inequities. Fortunately, it is also extremely cost-effective. I will explain all that in another blog soon, but to give you a taste; studies of the Ornish Lifestyle Medicine program to reverse heart disease have shown that it cut overall healthcare costs by 50% in the first year, and these were sustained for at least 3 years.

Whilst we are on the topic of culture, it may be more important for some to make it clear ASLM has no, and never has had, religious or industry influence. Rather, we have always been independent, and are striving to break down the historical occurrences of bias to yield clarity in evidence-based and personalised recommendations. Do we have sponsors for our events? Yes. I think it is a tad naive to think an organisation can host major events without financial support for them, and anyone who has ever run anything knows that partnerships and sponsors are par for the course. However, sponsors have no influence on our education, our actions, or the strategic direction of the Society. They never have and strictly never will.

The Board, unpaid but not unloved, gives uncounted hours to this movement, and I encourage anyone who has read this far to be a part of this too. But how and why?

The “why” is easy – because it matters. This movement matters.

Some will say – “but you are not professing exactly what I want you to”. My response is “join in”. If your reasoning is sound and the evidence is there then you have nothing to fear – so bring your ideas to the table and see if they stand the test of time and peer review. I can say with honesty (another crucial principle), that I do not agree with everything within the international Lifestyle Medicine movement, and that is completely normal in my opinion – I don’t agree with my wife about everything yet we still love each other. Total agreement isn’t necessary for progress, collaboration is necessary for progress. To interact, to learn, to evolve our own understanding, to evolve our own nature (ooh I am getting deep now) and change the movement from within after a period of observation and growth. Dare I say to change ourselves from within (getting really deep now). I encourage anyone to do the same.

As for the “how”; well, 2019 is shaping up for the right time to connect with opportunities that rarely come – to be a part of something great.

We have been blessed this year to receive philanthropic funding (announcement coming soon!), and as a result are commencing a range of new initiatives like creating research projects for lifestyle interventions for specific conditions, for collaborative projects with other professional bodies and colleges, creating student groups for Lifestyle Medicine electives and curricula in university courses, for creating a suite of member resources to help members hit the ground running, Shared Medical Appointment education, health coaching training, utilisation of potential online and app technology, and so much more. And of course, we welcome your ideas.

So that is the story of ASLM so far, but what is the story from here? I encourage you to join this movement, become a member and together we can find out.

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By | 2019-03-06T09:30:34+00:00 February 28th, 2019|1 Comment

About the Author:

Dr Sam Manger
ASLM President Dr Sam Manger, MBBS, BSci, FRACGP, is a GP in South East Queensland with a strong focus on lifestyle medicine and community collaboration. He is a Medical Educator with James Cook University and Generalist Medical Training, and is also completing a Masters in Public Health (MPH). His passion for health and neuroscience has evolved into reflecting on how to change individual and social behaviour to lead to a more healthy, sustainable and ethical culture. He is a founding National Board Director of the Australia wide Transitions Film Festival. The TFF was founded in 2012 and has screened hundreds of positive and solutions focussed films, forums and events around Australia on the transition to a sustainable and ethical culture. He is also a former Committee Member of Doctors for the Environment Australia SA, founder of multiple community organisations, public speaker, permaculture practitioner, and bush survival student.

One Comment

  1. SophJ March 7, 2019 at 1:23 am

    Dr. Manger, I read your well-written article with interest, because I share your ideas, visions and missions in taking lifestyle medicine to the forefront of healthcare. My interest in treating people with behavioural change and coaching them to self manage their health goes back to at least two decades. I have been looking for like-minded professionals in medicine to form a team. Everyone I spoke with agreed with my notion but hardly believed that they would be able to change the system. But I continued to make people aware of the possibility and also started to speak openly at work about the possibility of reversing chronic diseases by adopting a healthy lifestyle. I have given presentations to explain lifestyle is the main reason for obesity and associated chronic diseases and how we can reverse them by adopting healthy lifestyles. I also have started to educate and increase awareness amongst trainees about lifestyle medicine during teaching sessions.

    Everyone agrees with that idea but not many health professionals believe it is possible to change people’s lifestyles. That is because medical training is lacking in certain skills. Doctors are trained to prescribe and not to be role models or to be a coach. Medical education is lacking many other disciplines such as communication skills, counseling and mindfulness etc. I am pleased to say that some universities have recently started to include mindfulness in their curriculum.
    I wish I knew about Professor Garry Egger before. I take my hat off to him, for being a pioneer and being brave to speak his truth 15 years ago when lifestyle medicine would have been laughed at saying it is pseudo-science by many medical professionals. I am so grateful to those who have conducted large randomized controlled trials and other high-quality scientific research to provide evidence for lifestyle medicine.

    I have been trying to take off a research project involving behaviour change to look at chronic disease outcomes for the last few years. In spite of multiple organizational and logistic obstacles and resource constraints, I persisted with it. I would be interested in conducting research in a more supportive environment involving a team of like-minded professionals.

    I have been writing information to the general public in a blog to raise awareness about reversing obesity and chronic diseases by adopting healthy strategies. I speak at small community groups to educate people about the application of mindfulness to adopt healthy behaviours. I also help people with health coaching. I am also studying diploma in counseling to help people with their obstacles to change. I love to get involved in education and health coaching training.

    I am glad you are discouraging tribal approach to lifestyle medicine and encouraging a collaborative approach. I believe we are not an alternative discipline of medicine but another branch of medicine. There is a huge gap exists in the current medical model which is based on medications and surgery. But those alone are not enough to prevent and reverse disease and to improve the quality of life. Lifestyle medicine is required to bridge that big gap.

    Lifestyle medicine interventions are not going to be successful if we are not changing from within. I am sad to say that the current medical model is far from it. Our deepest personal questions that you mentioned can be answered only by developing our deepest qualities. We can help change others by changing ourselves from within.

    I share your thoughts about not having sponsors with influence on our actions and directions. Medical education and research got so much contaminated by the influence of those who had financial interest over bringing the best health intervention into clinical practice. If we were not influenced that way, we will be practicing lifestyle medicine.

    Finally, I thank you and your team for your unpaid efforts and commitments to do the right thing and to drive this noble cause. I have been looking for a team to do the same. You are it. I am in.
    Sophie Jayamaha

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