April 30, 2025

Episode 5: Does spending the right amount of time on lifestyle advice make clinicians more contented?

1 hour 16 minutes

THE CASE

Nurse J and advanced nurse practitioner and Dr A are taking a short coffee break and discussing the management of lifestyle issues in their mixed practice. Many of their patients are living in poverty, with a lot of patients having Long Term Conditions. They feel under pressure from health service management to push lifestyle advice on patients and tell them to stop smoking, eat more healthily, take regular exercise and cut down on alcohol. They both feel they have enough to do in their consultations without all this to do as well. Furthermore, many patients get irritated and complain about being “nagged” to change their habits when they have come to the doctor to talk about the problems they see as most important. “Why is EVERYTHING always blamed on me being overweight?” complains one patient, attending in her third pregnancy, I had two lovely normal babies before!”

Show Notes

Lifestyle medicine: a cultural shift in medicine that can drive integration of care

British Society of Lifestyle Medicine

BSLM Lifestyle Screening Tool questionnaire

GP EVIDENCE

Primary Care Validation of a Single-Question Alcohol Screening Test

The key trials using a lifestyle medicine approach

Lean, Michael EJ et al.Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial, The Lancet, Volume 391, Issue 10120, 541 – 551

Ornish D et al, Can Lifestyle Changes reverse coronary Heart disease? The Lifestyle Heart Trial, Lancet 1990;336:129-133

Frattaroli, Joanne, et al. “Clinical events in prostate cancer lifestyle trial: results from two years of follow-up.” Urology 72.6 (2008): 1319-1323.

Ornish, Dean, et al. “Effects of intensive lifestyle changes on the progression of mild cognitive impairment or early dementia due to Alzheimer’s disease: a randomized, controlled clinical trial.” Alzheimer’s Research & Therapy 16.1 (2024): 122.

Sindi, Shireen, et al. “Baseline telomere length and effects of a multidomain lifestyle intervention on cognition: the FINGER randomized controlled trial.” Journal of Alzheimer’s Disease 59.4 (2017): 1459-1470.

Wong, Vincent Wing-Hei, et al. “Lifestyle medicine for depression: a meta-analysis of randomized controlled trials.” Journal of affective disorders 284 (2021): 203-216.

Headley, Samuel A., et al. “A personalized multi-component lifestyle intervention program leads to improved quality of life in persons with chronic kidney disease.” medRxiv (2019): 19007989.

Castro, Carolina B., et al. “Multi-domain interventions for dementia prevention–a systematic review.” The Journal of nutrition, health and aging 27.12 (2023): 1271-1280.

Lehtisalo, Jenni, et al. “Effect of a multi-domain lifestyle intervention on cardiovascular risk in older people: the FINGER trial.” European Heart Journal 43.21 (2022): 2054-2061.

Strandberg, T. E., et al. “Health-related quality of life in a multidomain intervention trial to prevent cognitive decline (FINGER).” European Geriatric Medicine 8.2 (2017): 164-167.

Neirich L, et al, Physical activity and Mediterranean diet as potential modulators of osteoprotegerin and soluble RANKL in gBRCA1/2 mutation carriers: results of the lifestyle intervention pilot study LIBRE-1. Breast Cancer Res Treat. 2021 Dec;190(3):463-475.

Food approaches to T2D remission

Great quick summary on the concept of LM for remissionType 2 diabetes: treating not managing – The Lancet Diabetes & Endocrinology

Useful summary by PCDS ABCD-and-PCDS-final-statement-3March2019.pdf

Lean, Michael EJ et al.Primary care-led weight management for remission of type 2 diabetes (DiRECT): an open-label, cluster-randomised trial

Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data

Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes

Cost and Health Care Utilization Implications of Bariatric Surgery Versus Intensive Lifestyle and Medical Intervention for Type 2 Diabetes

Lifestyle medicine for type 2 diabetes: practice-based evidence for long-term efficacy of a multicomponent lifestyle intervention (Reverse Diabetes2 Now)

Diets for weight management in adults with type 2 diabetes: an umbrella review of published meta-analyses and systematic review of trials of diets for diabetes remission

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By James McCormack

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