Evolving medical care

Kathy KL Tsim 詹觀蘭

HK Pract 2025;47:1-2

As we enter spring with its new beginnings and transformation, we can sit back and reflect on the time that had passed. We reflect on the dark period of COVID-19 pandemic with its associated quarantine and isolation measures and ponder on the lessons learned. The measures that were implemented were for our good but it also had a significant impact on inperson social interactions leading to the reliance on virtual platforms for meetings, play and even daily conversations. This technological boom has helped us maintain contact through our darkest hour.

We have each adapted to this change in our social interactions from face to face to virtual. Some better than others. Some have found the lack of or reduce social interaction has brought anxiety and worries. The sense of social isolation was great not only for the elderly but also for the younger generations, even some educated university students.¹ It seemed that the change to virtual means of social interaction were not sufficient to foster social cohesion to the level that was found prior to the COVID physical interactions.

Social connectivity is arguably one of the vital elements for maintaining good health.² Social isolation has been associated with an increased risk of developing dementia. Poor social relationships have also been associated with an increased risk of coronary heart disease and stroke. Inflammatory biomarkers and impaired immune function factors associated with adverse health outcomes and mortality have been noted to be associated with poor quality or low quantity of social ties.³

This importance of fostering a healthy social connectiveness is one of the core pillars of the practice of Lifestyle medicine. Medicine as practiced nowadays has evolved through the human illness history. From the 19^th century where the cause of mortality was dominated by acute infective diseases to the 21^st century by the insidious killers, the chronic diseases and cancers. We now are in an era where we have come to understand that unhealthy behaviours are linked to human morbidity and mortality. This paradigm shift is towards the concept of healthy lifestyle habits which could actually prevent the onset of human diseases. The emphasis now is shifted to a need to deal with the root causes of chronic diseases and cancers.

The determinants of human health can be divided into 5 groups:

1. genetics
2. behaviour
3. environmental and physical influences
4. medical care
5. social factors

By dealing with these determinants we can hopefully prevent human illnesses. Modern medical practices can be briefly summarised as below:

Conventional medicine, which incorporates the elements of lifestyle medicine but relies preferentially on pharmacotherapy, technology, and surgery to treat patients. The emphasis is on treatment over prevention, and individuals over population health.

Preventive medicine, which uses both elements of lifestyle and conventional medicine for the treatment of individual patients. Its primary focus is on prevention and health promotion. Preventive medicine is also the only discipline with a major emphasis on population health.

Integrative medicine, which consists of both the elements of lifestyle and conventional medicine integrating evidence-based complementary therapies, such as acupuncture, yoga, massage, and chiropractic to optimise patient treatment. There exists the element of prevention, but the primary focus is on individual patient healing.

Functional medicine, which also incorporates both elements of lifestyle and conventional medicine. Here the focus is on biochemical imbalance identification via blood, stool, and skin testing. Once these are identified the imbalances will be corrected by targeted supplements. The discipline is primarily devoted to treatment rather than prevention, and to individual patient care rather than population health.

Lifestyle medicine, is evidence-based healthcare emphasising disease prevention over curative medicine. The American college of lifestyle medicine (ACLM: founded in 2004) defines lifestyle medicine (LM) as “a medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions including, but not limited to, cardiovascular diseases, type 2 diabetes, and obesity. Lifestyle medicine certified clinicians are trained to apply evidence-based, whole-person, prescriptive lifestyle change to treat and, when used intensively, to reverse such conditions.” Its focus is on evidence-based lifestyle applications for the prevention, management, and reversal of chronic diseases.⁴

It is one of the fastest growing medical specialties not only in America but internationally. Both physicians and allied health care providers can be certified in lifestyle medicine via the American Board of Lifestyle Medicine (ABLM). Accreditation is also obtainable via certification through the international board of LM which have been setup in various countries throughout the world.

Since 2015 the Lifestyle Medicine Global Alliance (LMGA) has been established via an initiative by the ACLM. It represents the convergence of national Lifestyle Medicine professional associations from around the world, with members from Europe, Oceania and closer to home: Korea, Malaysia, Thailand and Philippines to name but a few. Despite the COVID pandemic, China hosted its first on-line China Lifestyle Medicine Alliance (CLMA) conference in May 2021.⁵ Lifestyle medicine courses are also available in Hong Kong e.g. the Chinese university’s Chanwuyi Lifestyle Medicine Programme.

Central to the creation and maintenance of health, LM’s main focus lies in its 6 pillars and by applying these to effectively prevent illness.⁴ The 6 pillars of LM are:

1. whole-food, plant-predominant eating pattern,
2. physical activity,
3. restorative sleep,
4. stress management,
5. avoidance of risky substances,
6. positive social connections

Lifestyle medicine emphasises patient empowerment for their health. Patients create healthy lifestyle behaviours to prevent or reverse health issues. To quote: “the principles of LM can positively impact not only the years of life but life in the years”. In a world that is ever changing, with new technologies and artificial intelligence, we ask what is next for the practicing physician? LM seems to bring us back to the care of the person as a whole. Let us aim not to deal with the disease but the person within.

References

1. Barankevich R, Loebach J. Self-Care and Mental Health Among College Students During the COVID-19 Pandemic: Social and Physical Environment Features of Interactions Which Impact Meaningfulness and Mitigate Loneliness. Front Psychol. 2022 Jun 16; 13:879408. doi: 10.3389/fpsyg.2022.879408. PMID: 35783724; PMCID: PMC9244538.)
2. National Academies of Sciences, Engineering, and Medicine, Division of Behavioral and Social Sciences and Education, Health and Medicine Division, Board on Behavioral, Cognitive, and Sensory Sciences, Board on Health Sciences Policy, Committee on the Health and Medical Dimensions of Social Isolation and Loneliness in Older Adults. Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. National Academies Press (February 27, 2020)
3. Kiecolt-Glaser JK, McGuire L, Robles TF, et al. Emotions, morbidity, and mortality: new perspectives from psychoneuroimmunology. Annu Rev Psychol. 2002; 53:83-107. doi: 10.1146/annurev.psych.53.100901.135217. PMID: 11752480.
4. D. Lippman, M. Stump, E. Veazey, et al. Foundations of lifestyle medicine and its evolution. Mayo Clin Proc Innov Qual Outcomes, 8 (1) (2024), pp. 97-111,10.1016/j.mayocpiqo.2023.11.004
5. Lifestyle Medicine Global alliance: https://lifestylemedicineglobal.org/about/accessed 7^th February 2025.