Are Lifestyle Changes Impossible?

Many years ago, I became exhausted dealing with a friend who ignored my advice on living a healthy lifestyle. His attitude toward exercise was similar to Oscar Wilde’s “I often take exercise. Why only yesterday I had breakfast in bed.” His attitude toward food, especially restaurant food, was that he didn’t care much about quality as long as the portions were huge.

We agreed early on that our friendship would suffer if I were his physician, so I referred him to an excellent internist who was far more patient than I. Now, years later, my friend has diabetes and is on a large daily dose of insulin, his kidneys don’t work too well, and he’s prone to problems with his circulation and cholesterol. He still has a voracious appetite and remains ultra-sedentary.

Also, as you might guess, he spends a lot of time in the waiting rooms of doctor’s offices.

If you know someone like this, or even if you yourself are on the threshold of being a medical regular, just know, right now, that things can change. Chronic medical conditions are preventable and reversible. The wizard behind the curtain is the phrase “lifestyle interventions.”

It’s old stuff
Hippocrates, the father of medicine, expressed lifestyle interventions succinctly: “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.”

Now, almost 2,400 years later, here’s what we know. If you commit to the so-called modifiable risk factors–weight control, not smoking, a healthful diet, and physical activity–you can expect an 81% reduction in what’s called all-cause mortality. Rephrased, this means that if you live a healthy lifestyle, you increase to four out of five your chances of dying at a nice old age, perhaps well into your 90s, free of the chronic illnesses like those besetting my friend.

Think of it! You could avoid, or at least dramatically reduce, your chances of developing heart disease, diabetes, stroke, kidney failure, lung disease, cancer, and congestive heart failure.

David Katz, MD, president of the American College of Lifestyle Medicine, puts it well. “Lifestyle practices have more influence on our medical destinies than anything else in all medicine.” He adds there is no pill, and there never will be any pill, that can reduce our risks for chronic illness the way making healthful lifestyle choices can.

This should be inspirational
But there’s a catch. The major problem is that accomplishing lifestyle change can be challenging. To anyone who’s been overweight for years, you know how hard it is to shed those extra pounds permanently.

New Year’s resolutions to exercise more start each January with gusto and a sweaty t-shirt, but a few weeks later your enthusiasm flags. You’re intent on loading your shopping cart with pastured beef, kale, and quinoa, but one day you’re famished, catch a whiff of a baking cinnamon bun, and before you know it you’ve inhaled two. Even group therapy often fails.

Patients enrolled in cardiac rehab programs or in one of the many weight-loss programs drift back to their old ways months or even weeks after the program ends. The experience of attempting a permanent lifestyle change is, well, humbling.

One question that frequently arises is the doctor’s role in all this. According to surveys of patients, doctors don’t score well on counseling them on lifestyle change. Physicians complain that patients ignore their advice, that they don’t have the time, or that they’re not being paid by insurance companies to give detailed preventive counseling. In fact, some health insurance policies simply won’t cover any obesity treatment, arguing that health insurance companies shouldn’t be required to pay for poor lifestyle choices.

It’s been suggested that other health professionals do the lifestyle counseling, people like physician’s assistants, nurses, nutritionists, or pharmacists. But even with all these, there’s the question of time, knowledge, and money.

So, if lifestyle interventions are extraordinarily hard to accomplish, and the healthcare system says “No time, no money,” let’s review other options.

Money for change
One interesting idea has been to financially reimburse a person for signing onto a healthful change and later accomplishing it. For example, if you’re a smoker and agree to stop, or overweight and join a weight-loss program, expect a check in the mail. Then, as long as you’re smoke-free/losing weight, a check arrives every month, continuing to arrive for a year after you’ve accomplished your goal.

This was actually attempted in the UK, where they paid pregnant women to not smoke during pregnancy and men to lose weight. The results were good. In the US, there’s been bickering over who would cut the check. Insurance companies balked. Congress–well you can imagine Congress. Even patients nixed paying someone else to stop smoking (especially if they were nonsmokers themselves), even if their own personal cost might be a modest $25 annual increase in their health insurance premiums.

Another idea discussed for years is stronger government intervention. Let’s face it, there’s a reason smokers are a rarity these days. It’s not so much because people know smoking is unhealthful, but rather because high taxes made cigarettes breathtakingly expensive, laws restricted where people could smoke, and government hearings that revealed Big Tobacco chicanery brought the industry to its knees from personal injury lawsuits.

We needed the government to step in and take action before tobacco killed us all off.

In one study, the government examined what would occur if a 20% tax were added to all sugary beverages. When the numbers are run, the results are compelling: after ten years, this tax would prevent 95,000 heart attacks, 8,000 strokes, 2,600 premature deaths, save $17 billion in medical costs, and generate $13 billion in annual tax revenue.

However, again in surveys most citizens oppose this, mainly irritated with too much government intrusion. Other models produce equally dramatic results. If the prices of all fast food are increased and those of fruits and veggies are decreased (perhaps by subsidizing them the way junk food ingredients are currently supported by government?), we could expect better weight control and less heart disease and diabetes.

The food industry, like the tobacco industry years earlier and even the auto industry in its opposition to seat belts, argues that this interferes with a person’s right to make a choice. I guess some people drink this sort of KoolAid, too naive or ideological to acknowledge it’s really all about money.

Good government intervention
These days, there’s some positive government intervention you may not even be aware of. All those Divvy bikes and the hundreds of miles of bike lanes are funded through a federal environmental impact grant. Conversely, you can see an interesting failure of government intervention in suburbs where developers never considered that people might want to bike or walk. Not designing decent sidewalks or running/bike paths contributes to the fact that suburbanites weigh an average of six pounds more than city dwellers, according to a 2003 study.

Your health savings account, really useful in these high-deductible days, can be used for nutritional supplements, alternative practitioners, and even your health club membership or personal fitness trainer (you’ll need a letter from me, which I’ll be delighted to write).

If you’re a WholeHealth Chicago patient we can drive you a bit nuts pushing you toward positive lifestyle choices. But as a result of our incessant nagging, we have a scant dozen patients still smoking, we treat a handful of people with diabetes, a few patients with chronic heart disease, and virtually no one with emphysema. At the most, we hospitalize five patients a year. And yes, we’re extremely proud of these stats because we know they reflect an investment on your part in your own health.

Our advanced nurse practitioner, Wendy Ploegstra, left her conventional medicine group to join us so that she could devote herself to the specialty of lifestyle medicine. She is doubly  board-certified both in Family Practice and in Lifestyle Medicine. If you’d like to experience a primary care provider who actually can guide you through the necessary changes for healthy longevity, you’d do well to schedule an appointment with Wendy.

I don’t envy my chronically ill friend or his internist as she helplessly watches him make a slow, steady decline. I left conventional medicine when I recognized that if I didn’t shift my focus toward prevention, my medical career would consist of little more than raising people’s insulin doses and blood pressure meds, adjusting their statins, and ultimately signing their premature death certificates.

We know lifestyle changes are tough, but they’re not impossible. Don’t give up.

Be well,
David Edelberg, MD