Benefits of lifestyle changes in managing chronic diseases

A survey reported widely in the Kenyan media last week on attitudes of Kenyan doctors towards patients with lifestyle diseases confirmed something I have suspected for long: Health workers are quick to prescribe medications without offering advice on lifestyle changes such as diet, exercise, stopping smoking, reducing their weight or moderating their consumption of alcohol.

Unless we act, the prevalence of type 2 diabetes and the devastating effects associated with the condition – heart disease, stroke, blindness, kidney disease and amputation – will continue to rise. However, if one wants to make a significant impact on mortality arising from these diseases, one must also target preventive measures like cigarette smoking, weight reduction, physical activity, diet and high blood lipids. Simple control of blood sugar levels or high blood pressure using drugs is not enough.

AFFECT HEALTH

There is evidence that what we eat and how much we exercise and sleep affect our health. Patients have a right to hear this from their doctors.

A March 2017 study published in JAMA indicated that nearly half of all cardiometabolic deaths (deaths from heart disease, stroke, and type 2 diabetes) in the US alone were associated with suboptimal intake of vegetables, fruits, nuts, seeds and omega-3 fatty acids.

It is often said that if all you have is a hammer, every problem looks like a nail. Just to be fair, traditionally, doctors have been trained to focus more on diagnosing and treating diseases. Matters relating to nutrition are often left to dieticians and nutritionists. In such a scenario, it is hard to see risk factors of the disease as the problem. The reality is that lifestyle factors like diet play a significant role in health and disease. Again, patients need to hear this from their doctors first hand to see it as important. But, you ask, what can policy-makers and educationists do about it?

EDUCATION LACKING

Worldwide, adequate nutrition education is lacking at medical schools. For example, a 2015 study published in Journal of Biomedical Education on the state of nutrition in US medical schools revealed that over 71 per cent did not meet the recommended goal of providing at least 25 hours of nutrition education to medical students. The same study showed that 14 per cent of the doctors surveyed felt uncomfortable counselling patients about nutrition.

Again, most nutritional studies linking what we eat with diseases are based primarily on epidemiological studies that often do not prove a causal link. It is common to find one study promoting consumption of certain foods this week and another disputing the previous recommendations. Conflicting information makes it difficult even for the best trained doctor to distinguish the wheat from the chaff when counselling patients on diet.

One challenge is that sometimes what we eat is dictated by a person’s religious and cultural beliefs or economic status. Another problem is that a lot of information found on the Internet about nutrition can be misleading and sometimes patients come to the clinic with unrealistic expectations. To lower patients’ expectations, I always refer them to tools like the Weight Loss Predictor, which predicts the expected weight loss based on how much one reduces their food intake by. 

TOO RESTRICTIVE

In order to lose weight and keep off conditions such as diabetes, hypertension and heart diseases, patients often go for diets that are either too restrictive and unbalanced or those that cause rapid weight loss, which leads to weight regain after some time.  There are health benefits associated with weight loss, and at the time of diagnosis, everyone with type 2 diabetes should be told this.

There is a graph that I like to share with patients on health benefits of weight loss. It shows that weight loss of between five and 10 per cent improves diabetes control, reduces the need for diabetes medications and improves associated symptoms of urinary stress incontinence and joint pain. Above 10 per cent weight loss, there is chance to reverse type 2 diabetes and the need for medications altogether. There is ample evidence on benefits of lifestyle changes in managing chronic diseases and, again, patients have a right to hear from the doctor that a holistic approach works.

Subiri Obwogo is a medical doctor and public health practitioner.

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