Should Doctors Prescribe Lifestyle Changes?

Alice peers at the doctor, wondering what he is going to say. Yes, she’s overweight. No, she doesn’t exercise enough. True, her diet is less than exemplary. “But that’s my choice,” Alice thinks, even as she winces when the doctor tells her she has hypertension and that her diabetes has worsened. “Don’t you say it,” Alice thinks. Then she sighs in relief. The doctor hands her a prescription for an antihypertensive medication and a renewal of her diabetes pills. The elephant in the room stays silent.

There is something very wrong with this picture, although the scenario is all-too-common. Alice clearly could benefit from more exercise and a healthier diet, yet the doctor never broaches the subject of lifestyle changes. Instead, he writes a prescription for more drugs.

For years, doctors have been nervous about recommending lifestyle changes to their patients because they feared they would be seen as judgmental, discriminatory, or infringing on the right to personal choice.

Yet don’t patients have the right to refuse to fill their medication prescriptions just as much as they have the right to ignore lifestyle recommendations?

Prescribing lifestyle changes is pure common sense. We are replete with research showing that increasing physical activity and eating healthfully can prevent, ameliorate, and even reverse many diseases. And positive lifestyle changes not only affect our physical well-being; they improve our emotional well-being too.

Luckily, the medical community is starting to show a bit more boldness with their patients. Here are three examples:

• Dr. Edward M. Phillips directs the Institute of Lifestyle Medicine in Brighton, Massachusetts, which he co-founded along with the Spaulding Rehabilitation Hospital Network and Harvard Medical School. Somewhat of a pioneer in the field of lifestyle medicine, his institute focuses on education, research, and advocacy that move the primary care field toward integrating lifestyle medicine into daily practice.
• Dr. John Principe, who was inspired by Dr. Phillips, started WellBeingMD Ltd. in Palos Heights, Illinois with the goal of helping patients take charge of their own health. The office offers two “Roadmaps to Wellness.” The first centers on nutrition (including healthy cooking), physical activity and stress reduction. The second focuses on “functional fitness” – the ability to carry out daily physical tasks – and strategies for maintaining a healthy lifestyle.
• Dr. Michael Joyner, a professor of anesthesiology at the Mayo Clinic, recently wrote a commentary published in the Journal of Physiology. He strongly recommended that doctors prescribe physical activity for sedentary patients. But they shouldn’t stop at writing “Exercise!” on a prescription pad. In order for patients to follow through, they need detailed plans that include trainers in a welcoming environment and possibly cognitive-behavioral therapy to help patients adhere to the program.

This is encouraging to see doctors taking steps to make lifestyle medicine a natural part of primary care. I would love to see lifestyle changes more widely integrated into mental health treatment plans as well.

What are your thoughts? Do you agree that doctors should prescribe lifestyle changes, or is this something that should stay private and unaddressed? Post a comment here, especially if you have personal experience with this (as a doctor or a patient).