Lifestyle Medicine: Targeting the Cause, Not the Number

A new focus in the age of chronic disease

According to the World Health Organization (WHO), noncommunicable diseases account for 75% of non-pandemic deaths; in 2021 the number of deaths from these diseases was 43 million. The picture is similar in Türkiye: in the Turkish Statistical Institute (TurkStat) 2024 data, 36% of deaths came from circulatory system diseases and 16% from tumors. The presentation treats this picture as the reason medicine’s focus is shifting toward chronic disease.

The main idea is this: behavior and environment lie at the root of most chronic diseases. About 70% of modern health problems are estimated to have lifestyle roots. Correcting cholesterol or blood sugar with medication may extend life, but it does not resolve the behavioral cause that started the disease. Addressing the cause means changing behavior.

A definition in one sentence, and a short history

Lifestyle medicine is a relatively new branch of medicine. The definition adopted in the presentation (Sagner and colleagues, 2014) is this: an evidence-based practice that helps individuals and communities make comprehensive lifestyle changes. Its aim is to prevent, treat and reverse the progression of chronic diseases by addressing the underlying cause. In a single sentence: treating the cause of chronic disease through evidence-based behavior change.

The history of the term is also short. Epidemiologist Ernst Wynder used it around 1988 in the context of smoking and lung cancer risk. In 1999 James Rippe published the first book with this name. In 2010 a national consensus panel published a definition and 15 core competencies; in 2017 the American Board of Lifestyle Medicine (ABLM) held its first certification exam. Definitions differ, but the common ground is the same: evidence-based, non-drug and aimed at the cause.

Six pillars

Today the American College of Lifestyle Medicine (ACLM) describes six core components: whole-food, plant-predominant eating; physical activity; restorative sleep; stress management; avoidance of risky substance use; and positive social connections. According to the presentation, putting these components into practice helps both prevent and treat chronic diseases.

Other frameworks existed in the past. NEWSTART, from around 1982, listed items such as nutrition, exercise, water, sunlight, air and rest. What they share is putting a person’s daily habits at the center of care. Sagner’s definition also adds social support and environmental exposures to the scope. In 2017 the ABLM emphasized nutrition, movement, resilience (emotional health), connectedness (social) and sleep.

Within medicine, alongside medication

Practitioners regard lifestyle medicine as part of conventional (allopathic) medicine; it is neither complementary nor alternative medicine. Alternative medicine means methods used in place of conventional treatment, and according to the presentation most of them have weak scientific foundations. Lifestyle medicine aims to stay within methods that have evidence, so its range of methods is narrower.

Its scope covers three levels: primary prevention (preventing diabetes in prediabetes through lifestyle, illustrated with the 58% figure from the Diabetes Prevention Program (DPP) study), secondary prevention (early detection with measures such as waist circumference, blood pressure and HbA1c) and tertiary prevention (cardiac rehabilitation, remission of type 2 diabetes in some cases). Regression of fibrosis (scarring) in fatty liver disease is also cited as an example in some cases. Even so, lifestyle change does not replace medication or procedures but is added to them; treatment decisions are made together with a physician.

The physician as coach, the environment as partner

In the traditional model the physician is the authority, gives instructions and expects adherence. In lifestyle medicine the physician is a coach and educator who hands control to the patient. Still, the physician does not simply say “set your own goal”: emergencies call for direct instructions, in chronic disease the patient manages the process, and the physician states plainly what is right. Even adherence to blood pressure medication is about 50% after 1 year; lifestyle change faces a similar adherence problem.

That is why advice turns from general remarks into a prescription with a schedule and a goal, supported by a team. Because culture and environment can encourage unhealthy behavior, responsibility does not rest on the individual alone. Structural solutions such as bike lanes and green spaces aim to make the healthy choice the easy choice.

The team may include a physician, dietitian, psychologist, health coach, exercise physiologist and nurse; according to the presentation, in the most effective model, a well-equipped general practitioner or primary care physician coordinates it. In Türkiye, family health centers and Healthy Life Centers offer an existing infrastructure for this model.