Lifestyle Medicine - A Doctor's Journey

According to the British Society of Lifestyle Medicine, Lifestyle Medicine is "evidence-based, clinical care that supports behaviour change through person-centred techniques to improve mental wellbeing, social connection, healthy eating, physical activity, sleep and minimisation of harmful substances and behaviours".

The American College of Lifestyle Medicine defines it as "the use of a whole food, plant-predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease".

These definitions all centre around the premise of addressing root causes of disease with lifestyle interventions.

Growing up, I was exposed to the devastating effects of war and conflict in Iran up until the age of 5. My family then moved to the UK, and I remember my parents often used traditional herbal and nutritional approaches to treat minor ailments at home. From these early years, I developed a sense of the power of adverse childhood experiences, environment, and lifestyle on health.

Later, during medical school in 2001, I had the opportunity to spend time in placement at Wellbeing Television, a health-focused channel owned by Boots. This was my first professional taste of lifestyle medicine.

Two years later, as a junior doctor, I observed patients being treated with antibiotics who subsequently developed C. difficile diarrhoea. This was a crucial turning point. I started to ponder the role of the microbiome, probiotics, and overall lifestyle in disease prevention and management.

In pursuit of these thoughts, I moved to Cyprus and began working at an integrative medicine clinic. It was a unique experience to combine conventional and complementary medicine. I spent time learning from experts all over Europe and discovered two key insights:

1. Of all the modalities, the most effective and evidenced based were changes in lifestyle factors.
2. Lifestyle medicine could be used for both prevention and treatment.

However, I noticed that many patients, including myself, struggled to make sustainable lifestyle changes. It was apparent that we needed to address the environmental determinants of lifestyle behaviours.

Armed with this knowledge, I decided to further my education and pursue a Masters and then a doctorate at Harvard, researching healthy homes and cities. It became strikingly evident how profoundly our health-related behaviours intertwine with our built environment - our personal dwellings and the cities we inhabit.

Our homes, typically seen as personal havens, can substantially mould our health and overall wellbeing. Factors such as space for physical activity, exposure to natural light, air quality, noise levels, and even the configuration of our kitchens, play pivotal roles in influencing our lifestyle choices. For instance, a well-furnished kitchen could inspire homemade meals, thereby promoting healthier dietary habits. Likewise, a dedicated workspace can enhance mental wellbeing by establishing distinct boundaries between our professional and domestic lives.

Cities, conversely, impact our health behaviours on a more extensive scale. The art of urban planning and design is pivotal in fostering or impeding physical activity. Thoughtfully designed metropolises that prioritize walkability, embed green spaces, and ensure the accessibility of healthy food options encourage healthier lifestyles among their inhabitants. On the other hand, cities afflicted with pollution, poor public transport, and restricted access to fresh produce can exacerbate health concerns and deter a health-conscious lifestyle.

In essence, our homes and cities can serve as vehicles for promoting health-related behaviours, steering our choices, routines, and ultimately, our health outcomes. Gaining insight into the effects of our built environment becomes a crucial element of lifestyle medicine and a central point for our discussions around patient engagement and behavioural change.

As healthcare practitioners, our role extends to offering insight into the health impacts of different design choices, ensuring that the built environment supports the healthy lifestyle modifications we are encouraging our patients to adopt. By opening a dialogue with architects and urban designers, we can enlighten the design process from a health perspective, contributing towards the creation of healthier built environments.

After my doctorate, I then joined the US Centers for Disease Control and Prevention (CDC), serving as an Epidemic Intelligence Service officer (a.k.a, Disease Detective). Meanwhile, Lifestyle Medicine was gaining recognition in the US. To bring this knowledge to the UK and Europe, I collaborated with leaders in the field and we published a paper on Lifestyle Medicine.

If you'd like to read more about this, I highly recommend Undo It! by Dean Ornish, the Lifestyle Medicine textbook by Garry Egger, and my conversation with David Katz, who created the True Health Initiative.

When I was a public health registrar in the UK, I spent time with a new drop-in health promotion clinic for staff, patients, and visitors, based at Oxford University Hospitals. We directed people towards free resources and services across Oxfordshire.

However, in 2015, life came full circle when my son was born prematurely. The event, coupled with my doctoral research into the role of early life exposures, sparked a realisation: we often attempt to intervene and help patients when they have developed risk factors or disease in adult life. Yet the risk factors may have started early in life, or even in previous generations, when we consider genetic and epigenetic risk factors.

Sadly, my father developed terminal mesothelioma as a result of asbestos exposure decades ago, reinforcing the crucial role of environment in our health.

Relocating to Cyprus served a dual purpose: it allowed me to be near my parents at this difficult time, while providing the chance to teach at a local medical school. It marked a pivotal juncture in my career, exposing me to the fields of artificial intelligence, blockchain technology, digital health, innovation, and entrepreneurship.

It quickly dawned upon me the enormous potential these technologies presented for Lifestyle Medicine. Harnessing the power to gather and dissect large datasets unveiled an unparalleled understanding of individual and population health trends. Simultaneously, blockchain technology offered a secure and efficient system for medical record-keeping, facilitating the coordination of patient care.

I recognised that digital health tools could revolutionise interactions between doctors and patients, streamline diagnostic processes, and most importantly, empower patients to play an instrumental role in their healthcare journey - a fundamental aspect of Lifestyle Medicine.

Embracing innovation and entrepreneurship can tear down walls, paving the way for ground-breaking possibilities in practicing Lifestyle Medicine. By innovating state-of-the-art technologies, we can create tools that enable individuals to take ownership of their health, track their progress, and make informed decisions about their lifestyle habits.

For example, wearables can keep track of physical activities, sleep patterns, and vital signs, providing valuable data that can guide users in adjusting their behaviour. Entrepreneurs, in contrast, have the means to make healthy choices more attainable and attractive. They can launch ventures that offer nutritious meals, conduct online fitness classes, or establish platforms for mental health support. By creating services and products that endorse a healthier lifestyle, entrepreneurs are contributing to a cultural shift where health-conscious choices become the standard, not the exception.

Take a look at Big Health, co-founded by an old school friend, Peter Hames, and Colin Espie.

Moreover, the convergence of digital health and artificial intelligence holds the potential to revolutionize healthcare delivery. AI-powered systems can process vast quantities of health data to predict health risks and suggest preventive measures, aligning perfectly with the principles of Lifestyle Medicine that prioritize prevention over treatment.

After my father passed away, we decided to return to the UK, where I served as a Consultant Epidemiologist and Public Health Physician. The year 2020 arrived with an unforeseen menace—the COVID-19 pandemic—that would turn lives upside down globally. For me, this was the final straw that broke the camel's back, following a series of personal challenges that had been piling up. I found myself in the throes of burnout.

It was a pivotal moment that underscored the importance of self-care, resilience, and the need to prioritise mental health alongside physical health. This experience only reinforced my belief in the principles of Lifestyle Medicine and the necessity to proactively manage stress and adopt a balanced lifestyle to maintain holistic wellbeing.

The pandemic highlighted the interplay of communicable and non-communicable diseases and the role of inequalities. Looking to the future, we are tasked with a greater emphasis on mental health, climate change, planetary health, and their interplay with lifestyle.

We're one insight away...

Love,

Behrooz

PS/ A Happy Life: Have We Got It All Wrong About Work, Health, & Love?

DISCLAIMER: The content is provided for information and education only and is not intended as a substitute for medical, psychological, financial, legal, tax or other professional advice. The content is not necessarily representative of any organisations or institutions affiliated with Dr Behrooz Behbod. The views or opinions expressed by guests are not necessarily shared or endorsed by Dr Behrooz