Lifestyle medicine potential for reversing a world of chronic disease epidemics: from cell to community.

The leading causes of mortality worldwide are chronic non-communicable diseases (NCDs); cardiovascular disease (17 million), followed by cancer (7.6 million), respiratory disease (4.2 million) and diabetes (1.3 million) (1). The newly published Global Burden of Disease Study (2010) has systematically highlighted the epidemiological shift in morbidity and mortality resulting from infectious diseases and malnutrition, to NCDs (2). While we have gained approximately 10 years of life expectancy since 1970, we are spending more years living with injury and illness (2). Representing 63% of all deaths, most that die from NCDs are in the prime of their productive years (3). There is now overwhelming evidence that lifestyle factors such as poor dietary patterns, physical inactivity, tobacco use, excessive alcohol consumption and psychosocial factors, e.g. chronic stress and lack of social support and community, are key proximal factors in the pathogenesis and incidence of NCDs (4). Lifestyle factors may also be more distal stressors, including economic, political or a high density population (5). We define lifestyle-related diseases (LRDs) as diseases where the pathophysiology is significantly influenced by lifestyle factors and where a change in these aetiological factors can significantly improve prevention and treatment of the disease. The world’s population has more and more adopted an ‘unnatural’ environment to which it has not had a chance to adapt physiologically. This leads to numerous biological dysfunctions, probably stemming from a form of low-grade systemic inflammation, which underlies most chronic diseases and risk factors such as hyperlipidaemia and hypertension. The first sign of such an unadapted lifestyle accumulating allostatic load is often increased body weight through a hypercaloric diet and inadequate physical activity (6). It is imperative that we finally and systematically address the underlying causes of LRDs rather than superficially treating symptoms. Today, one in two Americans and Europeans is either overweight or obese (7). Average body mass indices have on average risen by as much as 2–2.5 kg/m per decade and is now 30 kg/m or higher in some countries (8). As humans, we are designed to move, yet we have never been more sedentary. Physical activity has decreased drastically over the past cetury, because of economic growth, digitalisation and urbanisation. Over 70% of people in much of the modern industrialised world are not achieving adequate levels of healthpromoting physical activity (7). The impact of poor lifestyle is not limited to physical diseases but also increases the risk for mental disorders such as depression and anxiety, which is increasing worldwide (9). The economic burden of poor lifestyle choices is no longer sustainable and is impossible to ignore. LRDs have been established as a clear threat not only to human health but also to development and economic growth (2). Paradoxically, however, it is the The leading causes of mortality and healthcare costs worldwide are chronic diseases, resulting from lifestyle and environmental factors. The economic burden of poor lifestyle choices is no longer sustainable and impossible to ignore. Most chronic diseases are preventable. To treat the causes of these diseases and to be successful in prevention, a strong focus must be placed on lifestyle medicine aspects. Lifestyle Medicine encompasses research, prevention, diagnosis and treatment of dysfunctions caused by a non-physiological lifestyle (lifestyle-related diseases, LRDs) and morbidogenic environments conducive to promoting such lifestyles. The ultimate goal and primary focus of Lifestyle Medicine is to promote healthier lives through salutary environments and healthier lifestyle choices. Treatment of LRDs includes nutritional, exercise, psychological, social, economic and environmental interventions. To successfully do this requires education, training and communication about Lifestyle Medicine at the professional and general public level, while avoiding the trap of ‘victim blaming’ of individuals whose lifestyles are influenced by circumstances beyond their control. Lifestylerelated Diseases are now the leading cause of death on the planet and modern medicine needs to address the underlying causes with a new medical speciality, lifestyle medicne