what is new in lifestyle medicine? robert kushner, md professor of medicine director, center for...
TRANSCRIPT
What is new in Lifestyle Medicine?
Robert Kushner, MDProfessor of Medicine
Director, Center for Lifestyle Medicine
What is Lifestyle Medicine?
• Lifestyle medicine is a new discipline that has recently emerged as a systemized approach for prevention and management of chronic disease.
• The practice of lifestyle medicine requires skills and competency in addressing multiple health behaviors and improving self-management.
Galter 17
Why Lifestyle Medicine?
• The four main noncommunicable diseases (NCDs) – cardiovascular disease, cancer, chronic lung diseases and diabetes – kill three in five people worldwide, and cause great socioeconomic harm within all countries, particularly developing nations.
• NCDs are caused by a common set of modifiable lifestyle-related risk factors
• Behavioral patterns represent the No.1 factor contributing to premature death, exceeding genetic predisposition, social circumstances, environmental exposure, and access to health-care.
Circ 2011;123:2274-2283
Schroeder SA. NEJM 2007;357:1221
• Self care• Diet and nutrition• Physical activity and
exercise• Substance abuse
(tobacco & alcohol)• Stress and coping• Sleep hygiene
• Body weight control• Spirituality• Socialization• Preventive services• Mind-body techniques• Treatment plan
adherence
Lifestyle Medicine Targets
Percentage of Disability-Adjusted Life-Years (DALYs) related to Leading Risk Factors in US
DALYs are the sum of Life Lost due to Premature Mortality (YLLs) and Years lived with Disabilities (YLDs)
US Burden of Diseases Collaborators. The State of US Health, 1990-2010. JAMA 2013
Skip to main content
Robert Wood Johnson Foundation
Our Approach
The County Health Rankings model of population healthRanking MethodsUsing the Rankings DataMeasuring Progress
Download Rankings Data
Get data for the entire nation or a state
Action Center
Explore guides and tools for improving healthRoadmaps to Health CoachingWhat Works for HealthStoriesProjects ShowcaseNational Partners
RWJF Culture of Health Prize
The RWJF Culture of Health Prize honors and elevates U.S. communities that are making great strides in their journey toward better health.About the Prize2015 & 2016 CompetitionsPast WinnersPrize FAQs
County-by-County Blog
Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.AboutFAQWebinarsTools & Resources
Main menu•Health Rankings•Roadmaps to Health•RWJF Culture of Health Prize•More•
You are hereBack to Tools & ResourcesSearch Resources
County Health Rankings ModelMar 19, 2013Type: Image
2014CHRmodel.jpg
Description
The Rankings are based on a model of population health that emphasizes the many factors that, if improved, can help make communities healthier places to live, learn, work and play. Ready to take action, but not sure what to do next? We offer personalized, free help.CONTACT US
Newsletter SubscriptionSIGN UP
Follow UsSite MapCreditsPrivacy PolicyTerms of Use
Our Approach
The County Health Rankings model of population healthRanking MethodsUsing the Rankings DataMeasuring Progress
Explore the Rankings Data
Download Rankings Data
Get data for the entire nation or a state
Action Center
Explore guides and tools for improving healthRoadmaps to Health CoachingWhat Works for HealthStoriesProjects ShowcaseNational Partners
RWJF Culture of Health Prize
The RWJF Culture of Health Prize honors and elevates U.S. communities that are making great strides in their journey toward better health.About the Prize2015 & 2016 CompetitionsPast WinnersPrize FAQs
County-by-County Blog
Project updates, commentaries, events and news about health across the nation from the County Health Rankings & Roadmaps team.AboutFAQWebinarsTools & Resources
http://www.countyhealthrankings.org/resources/county-health-rankings-model
http://wwwSearchhttp://wwwSearch
How strong is the evidence that lifestyle modification impacts chronic disease?
Mozaffarian, D. et al. Arch Intern Med 2009;169:798-807
Relative risk (RR) of incident diabetes mellitus according to the number of low-risk lifestyle factors among 4883 older
adults from 1989 to 1998
Risk factors assessed: Physical activity Healthy dietary score Never smoking Alcohol use BMI < 25 WC < 88cm F/92cm M
Cardiovascular Health Study*9 of 10 new cases of DM
attributed to these lifestyle factors
Adoption of Healthy Lifestyle Patterns Predict Reduction in Heart Attacks in Women (n= 24,444)
Health Behavior
Healthy Diet
Alcohol intake
Non-smoker
Physically active
Lower Waist-to-hip ratio
% Risk Reduction
√
√
√
√
√
√
√
√
√
√
√
√
√
√
65% 79% 86% 92%
Akesson et al. Arch Intern Med 2007;167:2122
Given the importance of a healthy lifestyle, what % of the population practices healthy behaviors?
A. 45%B. 35%C. 25%D. 15%E. 5%
Adoption of Healthy Lifestyle Patterns Predict Reduction in Heart Attacks in Women (n= 24,444)
Health Behavior
Healthy Diet
Alcohol intake
Non-smoker
Physically active
Lower Waist-to-hip ratio
% Risk Reduction
% of Women
√
√
√
√
√
√
√
√
√
√
√
√
√
√
65% 79% 86% 92%
29% 21% 7% 5%
Akesson et al. Arch Intern Med 2007;167:2122
How Common is Choosing Good Health? (WHS)
Health Habit
Never smoked
Healthy weight (BMI < 22.0)
Alcohol consumption (4 - <10.5 times/wk)
Physical activity (≥4 times/wk)
5th Diet Score Quintile
51.0%
20.8%
20.3%
10.7%
19.7%
Prevalence
Kurth T et al. Arch Intern Med 2006:166;1403-1409
4.7%17 to 20 health index points
How Common is Choosing Good Health? (NHANES)
Health HabitNonsmoking
Non-obese (BMI < 30.0)
Fruit/Veg (≥5 servings/d)
Physical activity (>12 times/mo)
Alcohol (moderate)
73.1%
72.4%
42.0%
52.8%
40.2%
King DE et . Am J Med 2009;122:528-34
8.5%All 5 Healthy Habits
74.0%
64.0%
25.6%
43.3%
51.5%
NHANES III NHANES 2001-2006
15.2%
So what’s the deal? Why are healthy behaviors practiced by a minority of the
American public?1. It is a problem of personal responsibility2. People do not understand the benefits of healthy living3. It’s primarily an access & affordability problem4. It’s a natural consequence of modern changes in Western
society
Health Status is Influenced by Income Level and Race/Ethnicity
Braveman et al. Am J Prev Med 2011;40(SI):S4-S18
FPL=federal poverty level
Access and Affordability
Cardiovascular Health Metrics4 Behaviors + 3 Biometrics
Ideal Cardiovascular Health Metrics
Metric Ideal Health
Current smoking Never or quit > 12 months
BMI < 25 kg/m2
Physical activity ≥150 min/wk moderate or ≥75 min/wk vigorous
Healthy diet score* 4 – 5 components
Total cholesterol <200 mg/dl
Blood pressure <120/<80
Fasting glucose <100 mg/dl
*Ideal diet is defined as meeting ≥4 of 5 dietary recommendations, including (1) fruits and vegetables: ≥4 servings per day; (2) fish: ≥200 g per week; (3) fiber‐to‐carbohydrate ratio: >1 g of fiber per 10 g of carbohydrate; (4) sodium: <1500 mg per day; and (5) sugar‐sweetened foods and beverages: ≤450 kcal per week.
% of Population meeting ‘Ideal’ Cardiovascular Health Metrics
7 6 5 4 3 2 1 00.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
Number of ‘Ideal’ CV MetricsFord ES, et al. Circ 2012;125:987-995
How do we Change America’s Health?Specific examples
Intervention Target
Infrastructure Increase access to places for physical activity (eg., walking trails in parks)
Institutional policy Adding salad bars to schools
Law Ban the use of trans fatty acids in restaurants
Building codes Widening sidewalks
Tax Tobacco excise tax
Zoning regulation Incentives for putting supermarkets in neighborhoods
Healthcare visit Counseling the patient on choosing a healthier diet
Katz MH. JAMA 2009;302:683-685
How well is the medical profession doing?
How often do physicians provide lifestyle counseling?
• Data from 2006-2009 National Ambulatory Medical Care Survey (NAMCS). Office visits included counseling for:
– Nutrition 16.8%– Physical activity 12.3%– Weight reduction 6.3% – Tobacco cessation 3.7%– Stress management 3.0%
Nerurkar A et al. Arch Intern Med 2013;173(1):76-77
Hypertension
Type 2 diabetes
Dyslipidemia
Risk factors Heart disease
Treat the diseases Manage heart disease
Spending Time on Prevention:The Power of a Healthy Lifestyle
Treat the cause
Unhealthy lifestyle
How do I become Healthier?
• Choose one lifestyle habit to focus on• Be practical and reasonable in what you are
trying to change• Get social support (don’t need to keep it a
secret)• Set a goal and monitor it
Comparison of Consumption to Recommendations
* Solid fats and added sugars
HealthBenefit
Intensity
All Physical Activity Counts
Self Monitoring
Weight (obesity)
Blood Pressure (hypertension)
Blood Sugar (diabetes)
30
Internet & Smart Phone programs
32
Tracking Physical Activity
JawBone AccelerometerNike FUEL
Fitbug FitbitBodyMedia
Take Away Themes
• Healthy lifestyle patterns (diet, exercise, body weight, no smoking, moderate alcohol) are enormously important in preventing the occurrence of chronic disease
• However, healthy lifestyle patterns are practiced by a minority of the population
• Improvement in America’s health will need involvement of multiple stakeholders (professional, government, industry)
• Good health begins with yourself!