insights

Embracing change can be challenging. Anyone who has tried to alter their diet, break a bad habit, or add more exercise to their day can attest to this. Yet for many patients with chronic illness, lifestyle modifications are an important element on the path to wellness that may have huge impacts on clinical outcomes. Some estimates suggest that up to 40% of patients do not adhere adequately to clinician instructions, with the rate rising to 70% or more when significant lifestyle modification or complex behavior changes are recommended.¹ How can clinicians help their patients fully embrace lifestyle change?

A 2020 prospective cohort study suggests that adherence to a healthy lifestyle at mid-life is associated with a longer life expectancy free of major chronic diseases like cancer, diabetes, and cardiovascular diseases.² The life expectancy free of diabetes, cardiovascular diseases, and cancer at age 50 was 23.7 years (95% confidence interval 22.6 to 24.7) for women who adopted no low risk lifestyle factors, in contrast to 34.4 years (33.1 to 35.5) for women who adopted four or five low risk factors. At age 50, the life expectancy free of any of these chronic diseases was 23.5 (22.3 to 24.7) years among men who adopted no low risk lifestyle factors and 31.1 (29.5 to 32.5) years in men who adopted four or five low risk lifestyle factors.² The low risk lifestyle factors included: never smoking, body mass index 18.5-24.9, moderate to vigorous physical activity (≥30 minutes/day), moderate alcohol intake (women: 5-15 g/day; men 5-30 g/day), and a higher diet quality score (upper 40%).

Establishing and maintaining a strong, empathic relationship with the patient may be the most crucial factor for his or her success in the long-term with lifestyle changes such as weight loss, tobacco cessation, and increased activity level.^3,4 Some questions clinicians may want to consider prior to developing a plan for lifestyle change include:

• Is your patient ready to consider this change?
• What might your patient need to give up in order to embrace change?
• What barriers might your patient face that might discourage lifestyle change?
• How has your patient successfully changed behavior in the past?¹

A health provider can play a critical role in this process by increasing patient awareness through a collaborative approach to sharing information, education, and personal feedback. The functional medicine model was developed, in part, to do just this. Functional medicine is grounded in a strong patient/provider relationship. Specific tools—like the IFM Timeline and Matrix—help the practitioner understand the course of the patient’s life as seen through the lens of health and disease. Often, disease occurs when fundamental lifestyle factors like diet, movement, rest, and/or sleep are lacking or imbalanced in an individual’s life.

However, patients with chronic conditions may already be overwhelmed by burdensome illnesses and treatments and have a difficult time incorporating behavioral modifications into their daily routine. Lifestyle goals and targets can be tailored to patients’ preferences and progress while building confidence in small steps.⁵ More often than not, behavioral change occurs gradually over time. Patients who are mindful of their decision-making when it comes to lifestyle change, and who are more conscious of the benefits of changing an unhealthy behavior, may find it easier to adhere to clinician-prescribed behavior modification.¹ IFM offers a range of tools—like the IFM Food Plan and Elimination Diet—to guide the practitioner in designing a personalized treatment plan that helps the patient achieve an optimal outcome.

Integrating the simple strategies of modifiable lifestyle factors and monitoring progress in a healthcare plan may improve patient responsibility and increase overall health and well-being. In the following video, attendees of IFM’s foundational course, Applying Functional Medicine in Clinical Practice (AFMCP), explain how the conference provides the basis for understanding patient motivation:

AFMCP is a different kind of medical conference, where practitioners learn proven techniques for helping patients follow treatment plans. Using case-based, interactive presentations, expert educators engage attendees in real-world situations and demonstrate proper use of a suite of clinical tools that help improve patient outcomes. For more information about AFMCP and other research on the importance of lifestyle change, please visit the following pages:

Lifestyle Interventions for Patients With Metabolic Syndrome

The Right Food Plan for Cardiometabolic Patients

Reducing Chronic Disease Risk at Menopause Using Nutrition

References

1. Stonerock GL, Blumenthal JA. Role of counseling to promote adherence in healthy lifestyle medicine: strategies to improve exercise adherence and enhance physical activity. Prog Cardiovasc Dis. 2017;59(5):455-462. doi:1016/j.pcad.2016.09.003
2. Li Y, Schoufour J, Wang DD, et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ. 2020;368:l6669. doi:1136/bmj.l6669
3. Brandt CJ, Søgaard GI, Clemensen J, Søndergaard J, Nielsen JB. Determinants of successful eHealth coaching for consumer lifestyle changes: qualitative interview study among health care professionals. J Med Internet Res. 2018;20(7):e237. doi:2196/jmir.9791
4. Brandt CJ, Clemensen J, Nielsen JB, Søndergaard J. Drivers for successful long-term lifestyle change, the role of e-health: a qualitative interview study. BMJ Open. 2018;8(3):e017466. doi:1136/bmjopen-2017-017466
5. Koenigsberg MR, Corliss J. Diabetes self-management: facilitating lifestyle change. Am Fam Physician. 2017;96(6):362-370.