“You need to lose weight.” Doctors say that to patients every day. What they don’t do is tell patients how to do it. That’s because most doctors don’t know what to tell patients – our expertise in nutrition is severely limited. Our knowledge of exercise science is basically non-existent. Many of my physician colleague bemoan that patients don’t make healthy lifestyle choices, so they don’t “waste” time on it and just prescribe drugs. The problem with this reasoning is that it exists within a self-fulfilling prophecy—doctors provide little guidance on healthy diet and exercises, and then they complain that patients aren’t losing weight and getting healthier!
Lifestyle Changes May Be Better Than Rx Drugs
Let me be clear about this point — There’s a wealth of data that shows when specific healthy lifestyle interventions are performed correctly – with actionable recommendations – the effect can be just as good if not better than some prescription drugs. Take diabetes as an example. The Diabetes Prevention Program (DPP) evaluated how intensive lifestyle changes might compare to medication in preventing the progression of prediabetes to diabetes. With more than 25 research sites around the country and thousands of participants, this study serves as a landmark trial should change how we think about lifestyle intervention!
Here’s what they did: They split participants into three groups – one received the drug metformin, one received no specific intervention, and the third receives intensive lifestyle coaching that consisted of a low-calorie, low-fat diet and at least 150 minutes per week of moderate intensity exercise. Participants received specific advice on what and how to eat, as well as what types of exercises to do.
The goal was to lose 7% of their baseline body weight. For most people, that was 15-20 lbs. Guess who got the most benefit? The lifestyle group did the best of all three groups—it even out-performed the one group that received medication. As for the belief that older folks won’t make changes (“can’t teach an old dog new tricks”), lifestyle changes for people over 60 years of age resulted in 71% reduction in diabetes risk! This wasn’t a one-time benefit where participants gained weight when the program was finished. Even after 10 years, the risk reduction was 34%.
If you combine social support with lifestyle changes, the results can be even more impressive! A recent study teaching lifestyle changes in a group support setting included patient-centered counseling techniques, motivation to change, social support and assistance with goal setting, action planning and self-monitoring. Again, the goal was 7% weight loss, 150 minutes per week of moderate-intensity exercise including 2-3 sessions of muscle strengthening, as well as a program for healthy-eating. All of this was not done in a vacuum – There were 12 hours of educational group sessions. The majority of participants were followed by 2 years. No medications were prescribed.
Again, impressive results in reversing high blood sugars! In fact, there was a 40-47% reduction in the risk of developing type 2 diabetes in those who participated in the study.
Lifestyle changes work! Of course, they have to be done properly. We often like to quip “medications only work in people who take them” – well, lifestyle changes need to be prescriptive with specific advice and results measured consistently over time if you’re going to recommend them. I find the biggest problem is that physicians don’t encourage patients in a meaningful way to eat healthy, be more active, and focus on quality sleep. They don’t talk to patients about the benefits, so patients often don’t make a real effort.
Physicians Have Their Limits – Look at Varied Coaching Options
The argument from physicians will be “ I don’t have time” or “I don’t get paid to give that type of advice.” That should not be a sufficient reason to not provide proven therapeutic interventions. Yes, we must be practical – most physicians are not equipped right now to do this.
The remedy? We use consultants all the time as part of our medical training, and now we need to start consulting for help with strategies to address lifestyle. Let’s partner with nutritionists and personal trainers to advise patients with specific information on how to eat healthy, as well as give detailed advice about different exercises. We need to use digital tools that provide real-time feedback to help patients make healthy choices. These include apps that can analyze food quality through pictures, continuous glucose monitors to assess blood sugar, as well as devices that tell you whether you are burning fat or carbs in the morning, at bedtime, and before exercise. And we need insurance coverage to ensure everyone can benefit from it.
Lifestyle changes work! Sure, there’s still a role for medications for many people – but let’s not jump to them all the time.
[Editor’s Note: Dr. John Whyte is author of the bestselling health guide: “Take Control of Your Diabetes Risk.” From his newest work, you can learn more about ways to reduce your diabetes risk and change your mindset from “I hope I don’t get diabetes to I can prevent diabetes.“]
Perreault L, Kahn SE, Christoph CA, Knowler WC, Hamman RF; Diabetes Prevention Program Research Group. Regression from pre-diabetes to normal glucose regulation in the diabetes prevention program. Diabetes Care. 2009 Sep;32(9):1583-8. doi: 10.2337/dc09-0523. Epub 2009 Jul 8. PMID: 19587364; PMCID: PMC2732165.
Sampson M, Clark A, Bachmann M, et al. Lifestyle Intervention With or Without Lay Volunteers to Prevent Type 2 Diabetes in People With Impaired Fasting Glucose and/or Nondiabetic Hyperglycemia: A Randomized Clinical Trial. JAMA Intern Med. 2021;181(2):168–178. doi:10.1001/jamainternmed.2020.5938