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 and may even alter 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?

In a JAMA case discussion, Thomas Bodenheimer, MD, explained that the more actively the patient is involved in their healthcare plan, the higher the level of adherence and the greater the chance that the patient engages in healthy diet and exercise behaviors.² Recent studies suggest that 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.⁵ Lifestyle goals and targets can be tailored to patients’ preferences and progress while building confidence in small steps.⁶ 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.

A study of overweight, insulin-resistant individuals found that while weight loss and cardiovascular risk factors improved during a four-month intervention, more frequent monitoring for an indefinite period of time was necessary for nearly two-thirds of patients to maintain their lifestyle changes long-term.⁷ 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. Bodenheimer T. A 63-year-old man with multiple cardiovascular risk factors and poor adherence to treatment plans. JAMA. 2007;298(17):2048-2055. doi:1001/jama.298.16.jrr70000
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. Bodde AE, Shippee ND, May CR, et al. Examining health promotion interventions for patients with chronic conditions using a novel patient-centered complexity model: protocol for a systematic review and meta-analysis. Syst Rev. 2013;2:29. doi:1186/2046-4053-2-29
6. Koenigsberg MR, Corliss J. Diabetes self-management: facilitating lifestyle change. Am Fam Physician. 2017;96(6):362-370.
7. Dale KS, Mann JI, McAuley KA, Williams SM, Farmer VL. Sustainability of lifestyle changes following an intensive lifestyle intervention in insulin resistant adults: follow-up at 2-years. Asia Pac J Clin Nutr. 2009;18(1):114-120.