Patient Info on Polypharmacy Should Emphasize Lifestyle Behavior
Beth Frates, MD, FACLM, DipABLM
President, American College of Lifestyle Medicine
The Patient Page for “Polypharmacy and Deprescribing” published recently in the Journal of the American Medical Association (JAMA) brought much-needed attention to a critical issue. Patients have a right to know that taking too many pharmaceuticals may cause adverse health effects and that there are processes to safely and effectively “deprescribe” unnecessary or harmful medications. However, I would contend that, while the potential of lifestyle behavior change to address health conditions was mentioned, it deserved greater emphasis.
There is a substantial body of evidence supporting lifestyle medicine to treat and, when used intensively, reverse common chronic conditions such as cardiovascular disease and type 2 diabetes. Management of these conditions and associated chronic diseases through medications alone is a considerable driver of our overreliance on pharmaceuticals, as well as our unsustainable healthcare costs. Unknown to many patients is that an evidence-based lifestyle medicine approach is the first treatment plan recommended in the majority of chronic disease care guidelines.
How many patients know, for example, that is possible to achieve remission for type 2 diabetes through diet alone, as a 2022 expert consensus statement concluded? That is an empowering message for individuals who otherwise feel destined to a lifetime of taking ever-increasing amounts of medications and shouldering the associated costs. To help guide clinical decision making on when and how to describe medications following successful lifestyle medicine interventions for type 2 diabetes, the American College of Lifestyle Medicine (ACLM) recently produced the first published examples of deprescribing protocols.
The field of lifestyle medicine is growing. Since lifestyle medicine certification began in 2017, almost 2,500 U.S. physicians and 1,000 other health professionals have earned certification. Almost 100 health systems have joined ACLM’s Health Systems Council, a collaborative group supporting the implementation of lifestyle medicine into some of the country’s largest and most innovative health organizations.
New York City expanded lifestyle medicine services to six public health care sites, the most comprehensive expansion of lifestyle medicine programming in the country.
Lifestyle medicine professionals don’t eschew medications; their approach is whenever possible to first treat the root cause of many chronic diseases–by addressing nutrition, physical activity, sleep, stress, social connection, and substance use–with the clinical goal of health restoration rather than disease management. We should empower patients and clinicians with the knowledge that lifestyle behavior change is a viable and optimal solution to reduce polypharmacy and its many ails, both for the patient and our health care system.