Andrew Binns

Health and the Environment: Clinical Implications for Lifestyle Medicine

Abstract The term “Lifestyle Medicine” implies individual responsibility for chronic disease causality. However, this can inadvertently deflect criticism from systemic causes, such as exist in various environments, and result in “victim blaming,” making resolution even more difficult. Environmental “anthropogens” driving behaviors thus need to be understood and managed, where possible. Both micro- and macroenvironments can be broken down into four main types (physical, economic, sociocultural, and political), some of which have implications for clinical practice.The term “Lifestyle Medicine” implies individual responsibility for chronic disease causality. However, this can inadvertently deflect criticism from systemic causes, such as exist in various environments, and result in “victim blaming,” making resolution even more difficult. Environmental “anthropogens” driving behaviors thus need to be understood and managed, where possible. Both micro- and macroenvironments can be broken down into four main types (physical, economic, sociocultural, and political), some of which have implications for clinical practice.

Overweight and Obesity: The Epidemic’s Underbelly

Obesity is now in pandemic proportions. This accompanies, and is associated with, rises in related chronic diseases. Whether obesity is a direct causal factor for such disease, however, is not clear, thus justifying a lifestyle medicine approach to the problem. Hence, whilst a linear approach to energy balance may still be useful for individual management, a systems approach using a modified understanding of energy dynamics and including the range of determinants from proximal to distal would seem to be necessary for effectively managing the epidemic as a whole.Abstract Obesity is now in pandemic proportions. This accompanies, and is associated with, rises in related chronic diseases. Whether obesity is a direct causal factor for such disease, however, is not clear, thus justifying a lifestyle medicine approach to the problem. Hence, whilst a linear approach to energy balance may still be useful for individual management, a systems approach using a modified understanding of energy dynamics and including the range of determinants from proximal to distal would seem to be necessary for effectively managing the epidemic as a whole.

Introduction to the Role of Lifestyle Factors in Medicine

Lifestyle medicine (LM) is a relatively new adjunct to conventional medicine, focused on the increasing proportion of lifestyle and environmentally related chronic diseases associated with modern economic development. As such, it brings added skills and a “systems theory” approach to clinical practice, with an emphasis on patient involvement and behavior change to facilitate better long-term self-management of modern chronic diseases and conditions.

Chapter 15 – Depression

Depression, at some level, is prevalent in up to one in five people in advanced countries and is increasing worldwide. At the severe end of the scale, referral for psychiatric and biological treatment is necessary. However, in many cases the progression to a biological state can be prevented by managing early symptoms, which should be a common process of Lifestyle Medicine.

Relationships, Social Inequity, and Distal Factors in Lifestyle Medicine: Tackling the Big Determinants

Abstract While not immediately relevant to the clinician, the quality of social relationships and relative income inequalities within a society are clear determinants of chronic disease outcomes. Mediating factors appear to be lifestyle behaviors like smoking, drinking, inadequate nutrition, inactivity, stress, depression, etc., considered throughout this book. Without awareness of these more distal drivers and involvement of the broader health system, lifestyle medicine will not fulfill its potential to mitigate chronic disease.

Medicines: The Good, The Not So Good, and The Sometimes Overused

Abstract While medications are absolutely vital in most fields of medicine, these are often counterproductive or contraindicated in managing lifestyle and behaviorally induced problems. Significant side effects from medications in general are weight gain, sexual inadequacy, nausea, and fatigue, all of which can have consequences for correct resolution of a problem. Alternatives should be sought where available and/or preventive approaches are more actively considered. Deprescription is a modern lifestyle modification approach to polydrug use in certain individuals.

Meaninglessness, Alienation, and Loss of Culture/Identity (MAL) as Determinants of Chronic Disease

Abstract Psychological influences on health (with the exception of stress, which is often a mediating factor anyway) are often overlooked in any etiological analysis of chronic disease. Recently, influences such as lack of Meaning (or purpose) in life, Alienation (particularly due to adverse childhood experiences) and/or Loss of culture or identity are being seen for their true influences on adult health. Management of these problems is difficult, but needs to be addressed in any comprehensive Lifestyle Medicine intervention.

Dealing With Worry and Anxiety

Abstract Anxiety is an adaptive phenomenon, which has evolutionary value in appropriate amounts, but health implications in the extreme. Just about everyone has to deal with mild levels of anxiety and worry from time to time but this chapter focuses on overwhelming and distressing anxiety that interferes with quality of life. Causes, physiological responses, and clinical treatment options are discussed.