Lifestyle medicine in general practice

The management of long-term conditions is the cornerstone of GP work; the upstream determinants of these conditions include less modifiable risk factors that can be addressed through policy and public health but also more modifiable risk factors that can be addressed by supported lifestyle changes. Such support has been demonstrated to not just prevent, but both treat and for some, potentially reverse the underlying disease process such as leading to disease remission – this is particularly evidenced in metabolic diseases such as Type 2 diabetes, metabolic liver disease, obesity and hypertension. 

GPs are ideally placed as expert generalists, to deliver lifestyle medicine and most GPs have provided this type of care long before the formalisation of this discipline. GPs and their teams have a wider exposure to the entire population than any other health professional – regularly seeing those in need of support to make lifestyle changes – and are viewed by the public as a trusted source of information in this regard. Whilst delivering support for lifestyle change is core work for GPs, GPs with an extended role in lifestyle medicine (GPwERLMs) can bring specialist knowledge and skills along with leadership to deliver Lifestyle Medicine across primary care teams where the consultation agenda can often be crowded by medication-based targets or simplistic lifestyle advice rather than behaviour change support. Research, particularly in the field of nutrition and sleep, is now fast moving and the GPwERLM can proficiently cascade this up-dated knowledge amongst their team. 

Lifestyle medicine is a globally recognised medical discipline with a strong evidence base and widespread practice. The British Society of Lifestyle Medicine (BSLM) is the largest UK medical charity promoting education and awareness of this. The BSLM defines Lifestyle Medicine as:

“Evidence-based, clinical care that supports behaviour change through person-centred techniques to address the 6 pillars of Lifestyle Medicine: (a) healthy eating, (b) mental wellbeing, (c) healthy relationships, (d) physical activity, (e) minimising harmful substances and (f) restorative sleep.” 

Lifestyle medicine describes the work that clinicians from all backgrounds can do to support their patients with lifestyle changes. Lifestyle medicine requires strong policy and public health action to address the commercial, social, economic and environmental determinants of health such that people are more easily able to live healthy lives.  

A GPwERLM should have additional knowledge and skills in the three core principles of lifestyle medicine:

1. An understanding of the socioeconomic determinants of health and health inequity.
2. Training to use behaviour change tools and techniques such as health coaching, motivational interviewing, brief interventions, signposting, goal setting, the use of group consultations and supported person-centred care including shared decision-making. The RCGP acknowledges the view of some of its members that the evidence base for group consultation models is still in development.
3. An understanding of how to assess and support improvements in the six pillars of lifestyle medicine:
   1. adoption of a nutrient-dense whole food plant predominant diet
   2. incorporating exercise and movement
   3. restorative sleep
   4. avoiding substance abuse
   5. meditation and stress management
   6. healthy social relationships