Lifestyle Medicine focuses on applying behavioral and environmental principles to managing lifestyle-related health problems. Chronic diseases now account for 75% of healthcare costs in the US, many of which are strongly associated with diet and physical inactivity. While genetics play a role, the rise of these "lifestyle diseases" correlates with changes in American diets and exercise patterns over recent decades. Prospective randomized studies demonstrate that organized lifestyle interventions can significantly reduce disease incidence and healthcare costs compared to prescription medications. Lifestyle Medicine aims to educate and empower individuals to make personal choices that can transform health outcomes on both individual and societal levels.

1. Lifestyle Medicine
The power
of
personal choices!
Stephan Esser USPTA, MD
Institute of Lifestyle Medicine
2011

4. Goals
• Define Lifestyle Medicine
• Explore the growth of “lifestyle diseases” in
America today
• Evaluate the potential of LM interventions
• Review some ‘Opport-unacles’
• What can we do!

5. What is going on
How we got here
What WE can do about it

6. Fun!

8. 56 y/o male Joe
High Blood Pressure
Obese
High
High Blood Cholestero
Sugars l
Depression Arthritis of
Fatigue the knees

9. “A global response to a
global problem: the epidemic
of overnutrition.” WHO
It is estimated that by 2020 2/3 rds of the global burden
of disease will be attributable to chronic non-
communicable diseases, most of them strongly
associated with diet. The nutrition transition towards
refined foods, foods of animal origin, and increased
fats plays a major role in the current global
epidemics of obesity, diabetes and cardiovascular
diseases, among other non-communicable conditions.
Sedentary lifestyles and the use of tobacco are also significant
risk factors. …….. A concerted multi-sectoral approach,
involving the use of policy, education and trade mechanisms,
is necessary to address these matters.

10. Lifestyle Medicine
Finger s, Feet , For ks:
– the application of environmental, behavioral,
medical and motivational principles to the
management of lifestyle-related health problems
The M er Lever s of
ast
in a clinical setting.
– Modalities:
•
•
Dest iny!
Diet
Exercise
• Sleep
• Emotional Poise
• Reduced toxic exposures

11. Characteristics
• Preventive/ Proactive
• Associative model of care
• Empowering/Optimistic
• Wholistic

12. “It is time we descended from Olympus
and began to address the people….
to educate them about the realities of health and
disease, to teach them what they can do to help
themselves and what we cannot do. They must be
taught about the marvelous capabilities and
the serious limitations of medicine.”
Moser, R.H
“Knowledge is not Enough.” NEJM 1977

13. Classic Medical
Model
Surgery
Pharmaceuticals

14. Enlightened
Medical Model
Surgery
Pharmaceuticals
Botanicals
Physical Modalities
Mind-Body Interventions

15. Ideal
Medical Model
Surgery
Pharmaceuticals
Botanicals
Physical Modalities
Lifestyle Interventions

16. The function of protecting and developing
health must rank even above that of restoring
it when it is impaired.
-Hippocrates-

17. US Healthcare Today!

19. Mortality Statistics

20. Leading Causes of Death in US

21. Top Ten Causes of Death for Men in the United States

22. Actual Causes of Death in US

23. 2 of 3

24. Associated Pathology
• CVD: • Obtstetrics:
– Hypertension – Gestational DM
– Congestive Heart Failure – Macrosomia
– PVD – Inc. C Section rate
– Impotence – Inc. Perinatal Morbidity
DIABETES
– Inc. Pre/Eclampsia
– Claudication
• Cancer:
• Endocrine: – Prostate
– Diabetes – Colon
– PCOS – Breast
Metabolic Syndrome
– Hypothyroidism
– Infertility
– Endometrial
– Renal Cell
– Gallbladder
• Orthopedics: – Esophageal Adeno.
– Osteoarthritis
• Other:
– AVN • Hyperuricemia, Pancreatitis,
• Hepatic: Gallstones, Sleep Apnea, Alzheimer’s,
– #1 cause of liver dz in US Dyslipidemia, Metabolic Syndrome

25. Overweight ↑ risk of DM2 by 3 fold
Obesity ↑ risk by 9 fold

29. Total Healthcare Spending
• $2 TRILLION in 2005, or $6,700 per person
• >16.2% of the gross domestic product (GDP)
• Projected to exceed $4 TRILLION by 2015

31. Financial Expenditures
• Chronic Dz ≈ 75% of health care costs
– Acc. to Dept of HHS:
• CVD and CVA $351.8 billion (2003)
• Cancer $171.6 billion (2002)
• Diabetes $132 billion (2002)
• Obesity $117 billion (2000)
• Arthritis $82 billion (1995)
• Smoking DMC $75 billion
LP $80 billion
• Physical Inactivity $76 billion (2000)
• Poor Nutrition DMC $33 billion
LP $9 billion

32. Metabolic Costs
• $4 of every $10 spent on prescription drugs
is spent to tx symptoms of
Metabolic Syndrome
– ↑ Cholesterol/LDL
– ↑ BP
– ↑ Blood Sugar

33. Waist Circumference > 40” M > 35” W
> 25%
of Americans
Triglycerides > 150 HDL < 40 M or < 50 W
BP ≥ 130/85 Fasting Glucose of ≥ 100

34. Obesity
Waist Circumference > 40” M > 35” W
Triglycerides >Dyslipidemia < 40 M or < 50 W
150 HDL
HTN/CVD
BP ≥ 130/85 Fasting Glucose of ≥ 100
Diabetes

35. We spend more
yet
we are one of the
sickest
most obese
societies on Earth!

36. How did this happen?

42. Genetic Shift
or
Lifestyle
Choices?

43. They did not display their parent’s susceptibility to cancer and diabetes….
……..the effects of the agouti gene had been virtually erased.

44. Pima Indians

46. ↑39%
Av. of 52 tsp added sugar/person/day in 2000

47. •IOM:
(UL) for salt is 5.8 g/day
> 95 percent US Males 31 - 50
> 75 percent of US females 31- 50
regularly in excess of the UL.

48. ↑66%

49. ↑57 lb/capita

50. ↑400%

51. Michelangelo’s David:
12 month 20 city tour of the US

52. What about Exercise?

54. US Gov. Reccomendations
150 minutes per wk
30 minutes/day
+
2-3 days/Strength Tr.
4-5 days a week

56. CDC Exercise Stats
• > 60% of adults are not regularly active
• 25% are not active at all
• 50% of all youth ages 12-21 are not vigorously
active on a regular basis
• By age 75 1:3 men and 1:2 women engage in NO
physical exercise

57. • Physical inactivity is more common in:
Women > Men
African American > Whites
Hispanic > Whites
Older > Younger
Less affluent > More Affluent

58. Exercise
• Reduces risk of
– Heart Disease ≈ 40%
– Obesity: ≈ 30-100%
– Stroke ≈ 50%
– Type 2 Diabetes ≈ 50%
– Hypertension ≈ 50%
– Disability delayed ≈15 years
– Colon Cancer ≈ 25-40%
– Breast Cancer ≈ 20%-44%
– Osteoporosis ≈ 20+%

59. Perspective
• We eat more
– Sugar, Salt, Meat, Dairy, Fat
– 1970-2000:
• ↑ 24.5 % C/day ≈
530K/day
• We get less then ideal
– Exercise

60. We
have a problem
of
epidemic
proportions!

62. What can we do?

63. What if
We ate
less fat, salt and sugar
and
more fruits, vegetables and grains
&
increased our exercise habits????

64. Some Say…..
– If 10% of adults began a regular walking program,
$5.6 billion in heart disease costs could be saved.
– If Americans↓ Na intake by 2300mg/day = 3-6 mm Hg ↓
in SBP
• 11 % ↓ strokes
• 7 % ↓ coronary events
• 5 % ↓ total mortality

65. What’s the evidence?

66. Common Misconceptions
1.
#
There is no
evidence that a healthy lifestyle decreases
M&M or
extends a healthy lifespan.

69. 12 year Cohort Study
1507 men 832 Women
Ages 70-90 years
50% ↓ in all-cause
Outcomes: 10 yr all cause mortality
4 Factors: Med. diet, Moderate EtOH, physical exercise
and non-smoking were ass. w ↓ in ACM
and cause specific
mortality

70. “Not only do persons with better health habits
survive longer, but in such persons, disability is
postponed and compressed into fewer years
at the end of life.”
Vita, AJ et al. NEJM 1998; 338:1035-1041

72. Retrospective Cohort Study
Outcomes: Incidence of CVD events
379,0003 Diabetics to 9 Million non-DM2
Diabetics four times more likely to have CVD
“Diabetes confers an
equivalent risk to
ageing 15 years!”

73. Misconception 2 #
There are no good
prospective, randomized trials
to prove that
Organized Lifestyle Interventions
are effective.

74. Finnish Diabetes Prevention Trial
Total 522: 172M 350W
Av. age 55
Risk of
Av. BMI 31
Randomized to standard of care or
individualized lifestyle counseling
Diabetes ↓ 58 %
Av. f/u 3.2 yrs
(P<0.001)
“The reduction in the incidence of diabetes was
directly associated with changesN in lifestyle”
Engl J Med 2001;344:1343-50

75. Misconception 3 #
Prescription Medications
are
more
effective.

76. Multi-Center Randomized Controlled Trial
n=3234 non-diabetics w/ ↑plasma glucose
3 Arms: placebo, Metformin (850BID), Lifestyle
Intervention
Lifestyle =7% weight loss/ healthy diet/150min wk exercise
Av. f/u = 2.8yrs
↓ 58%
Diabetes Incidence ↓’d by 31% in Metformin
and by 58% in Lifestyle Intervention
NEJM:2002

78. Misconception 4 #
The benefits of lifestyle interventions
don’t last.

80. Misconception 5 #
Lifestyle Interventions
are
too expensive.

81. “Compared with the placebo intervention,
the cost per QALY was approximately
$1100 for the lifestyle intervention and
$31300 for the metformin intervention.
From a societal perspective, the
interventions cost approximately 8800
dollars and 29,900 dollars per QALY,
respectively. From both perspectives,
the lifestyle intervention dominated
the metformin intervention.”2005
intervention

82. “After controlling for differences in
sociodemographics, smoking and comorbidity,
individuals with cardiometabolic risk factor
clusters missed 179% more work days and
spent 147% more days in bed (in addition to
lost work days) than those without. Lost work
days and bed days resulted in $17.3 billion
annually in lost productivity.”

83. Economic Woes

84. Perspectives
• There is significant evidence that:
– Lifestyle dramatically impacts M&M
– Organized Lifestyle Interventions are:
• Effective
• Cost Efficient
• Feasible
• Sustainable

85. Lifestyle Medicine Programs

86. Duke Rice Diet Program

87. 0.5-3lbs/day

89. ½ lb/day

95. Perspective
• Lifestyle-Associated Diseases are the leading
expenditure and cause of mortality in the
western world
• Personal choices can alter this trajectory
• We can transform lives

96. Challenges Ahead

97. Challenge 1#
Lifestyle Medicine is not paid for
by many insurance companies.

98. Challenge 2
#
Lifestyle Medicine is not a
respected field of medical
research or practice.

99. Challenge 3
#
In clinical training today,
students receive insufficient
education on lifestyle medicine.

100. Challenge 4
#
The individual
adds an extra variable to
medical care in LM…
……each of us has to perform the
treatment.

101. Challenge 5#
You have to walk the talk.
An advocate for a healthy diet and
exercise must do both.

102. “A global response to a
global problem: the epidemic
of overnutrition.” WHO
It is estimated that by 2020 2/3 rds of the global burden of
disease will be attributable to chronic noncommunicable
……if…….Lifestyle is the
diseases, most of them strongly associated with diet.
Problem
The nutrition transition towards refined foods, foods of
animal origin, and increased fats plays a major role in the
current global epidemics of obesity, diabetes and
cardiovascular diseases, among other noncommunicable
We Have the Answer
conditions. Sedentary lifestyles and the use of
What is risk factors. …….. A concerted
tobacco are also significant
the answer……..?
multi-sectoral approach, involving the use of policy, education
and trade mechanisms, is necessary to address these matters.

103. What can we do?

104. Foremost
• Lead by example
• Identify personal lifestyle goals
• Optimize our own health
• Encourage family and friends to do likewise

105. Then
• Seek to educate and empower
• Through transmission of knowledge and
motivation
• Get involved in your circle of influence

106. Finally
• Advance health on the national and global
level through political action
• Get involved

107. Conclusion
• America is facing an epidemic of disease
fostered by lifestyle choices
• Lifestyle interventions are the answer
• Plant Based Nutrition is central

108. Together we can make a difference

109. Thank