Why is lifestyle medicine a medical specialty?
Many people are at risk of developing or already experiencing medical problems that stem from unhealthy behaviors. Behavioral change is then necessary to anticipate these problems, to curb progress, or to (partially) reverse it. However, behavioral change continues to prove extremely difficult. It also appears that a great deal of expertise (and time) is required for such a change process to take place optimally.
The medical problems that arise from unhealthy behaviors fall under the metabolic syndrome. The metabolic syndrome has a range of manifestations (such as obesity, high blood pressure, cholesterol increase, insulin resistance / diabetes, sleep apnea, lung problems, fatigue, pain complaints, inflammation, infections, osteoarthritis / arthritis, depression, dementia, intestinal problems and accelerated aging), which unfortunately often occur simultaneously and reinforce each other.
That is not a coincidence, but precisely because the metabolism is disturbed. Where a cardiologist or pulmonologist or internist is good at treating one of these problems, with a more extensive form of metabolic syndrome it is important to be able to keep an eye on the entire medical picture and therefore have specific knowledge of how this interplay in intertwine and how you can help untangle this tangle for the patient in question.
A combined lifestyle intervention involves a combination of interventions in the bio-psycho-social field. In addition to knowledge about exercise physiology and training programs for people with (morbid) overweight, a great deal of specialist knowledge is needed about proper nutrition. The doctor must also have specific knowledge and skills to guide the patient in these behavioral change processes, but also in reducing medication. In addition, this doctor must be able (and willing) to work interdisciplinary, since these medical problems are often so complex that you cannot solve them on your own.
In the 'case description' box, Jan's situation is described, with extensive chronic complaints such as unfortunately many people have. How does the GP get on with such a patient in a healthcare system in which everyone has less and less time for the patient and seems to increasingly work on an island? Where is medical specialist knowledge available in several medical fields, but also specifically about evidence-based nutritional advice in a world in which everyone seems to have a different opinion about 'good' nutrition?
That is the field of lifestyle medicine, a medical field that requires a completely different kind of knowledge and expertise from highly experienced medical specialists. These are medical specialists such as rehabilitation physicians or internists with additional training in various areas, such as behavioral interventions, evidence-based nutrition, exercise physiology, body composition analysis, training principles and the ability to manage an interdisciplinary bio-psycho-social team.
Such a team does not work in isolation, but must be well embedded in the existing health care system and be able to support and direct integrated care in the field of healthy lifestyle and lifestyle medicine at various levels of complexity.
Jan has long-term treatment-resistant pain in his back with radiation to the right leg. He cannot sleep because of this. As a result, Jan has become increasingly tired and gloomy.
- The GP knows that Jan has morbid obesity, a reduced heart function due to a myocardial infarction in the past, sleep apnea syndrome, diabetes and chronic intestinal complaints.
- The physiotherapist cannot solve it.
- The neurologist diagnosed a mild hernia in the back with degenerative abnormalities.
- The orthopedic surgeon indicates that his right knee is 'worn out', but that Jan is not yet eligible for knee replacement surgery.
- The cardiologist has indicated that there is nothing else to adjust to the heart medication.
- Jan has already visited a dietician 3 times, a short conversation once a month, which was unsuccessful.
- The GP decides to make a referral to the rehabilitation specialist. Then just get moving.
However, the rehabilitation doctor has no knowledge about how he can and may train with the patient in connection with serious obesity. The rehabilitation doctor also knows that 50% of patients with chronic knee or back problems will get rid of their complaints if they could lose 5 kg. In that case, 50% of the patients would be referred to the rehabilitation doctor for nothing.
The rehabilitation doctor 'only' has knowledge of posture and the musculoskeletal system. And if the rehabilitation doctor does want to start training with the patient, the limiting pain soon comes into play. So that training seems possible in advance to a limited extent.
That requires a different answer, an answer from someone with a thorough knowledge of the subject, or medical specialist lifestyle medicine.