A magic pill or personalised lifestyle medicine?

As compared to the 1980s, the average life expectancy has increased today by an average 6 years. This seems to be good news. However, if you zoom in on the underlying numbers, you discover that those ‘extra’ years are not lived in good health.

In the present decade, chronic diseases emerge before we are in our mid-forties. This is 15 to 20 years longer of chronic disease than it was in the 1980's, with an increasing disparity between people with a low versus those with a higher socioeconomic position.

The increasing burden of chronic diseases

The world is being confronted with chronic diseases such as obesity, type 2 diabetes and cardiovascular diseases, as well as with dementia, different types of cancer and autoimmune diseases. For all of these, lifestyle is often a major driver.

Lifestyle in this case does not only entail diet, smoking, alcohol and physical activity, but also less obvious factors such as stress, loneliness and a 24/7 society with increasing numbers of nightshift workers and people with disrupted sleeping patterns. The common denominator in these chronic diseases: dysmetabolism, a chronic disturbance of homeostatic metabolic regulation.

Our longer life expectancy, in combination with growing numbers of people with a chronic lifestyle-related disease is causing an increase in the number of people who need health care.

Based on current models, it is estimated that in 2060, one out of three people in our society would need to work in health care to deal with the overabundance of patients. If we don’t change anything, we will be confronted with a tsunami of patients to our care system, which will be unaffordable.

Hope on the horizon

The news isn’t all bad, however. In fact, there’s reason for hope. For a long time, it was believed that type 2 diabetes is a progressive disease that could not be halted, let alone cured.

However, recent research showed that lifestyle change – especially in the earlier phases of the disease – can help about 40% of type 2 diabetes patients achieve remission, with glucose metabolism fully under control without anti-diabetic medication. Long-term follow-up of people who achieved diabetes remission showed a lower rate of chronic kidney disease as well as cardiovascular disease and events, illustrating that underlying progress towards complications and comorbidities can (partly) be halted.

This is in contrast to anti-diabetic medication, which can successfully get blood glucose under control, but does not halt disease progression unless there is also healthier lifestyle behaviour. So, the ‘magic pill’ for these diseases isn’t a pill at all, but a change in lifestyle habits. If this is possible for type 2 diabetes, why not for the other chronic, lifestyle-related diseases mentioned earlier?

The change is personal

Obviously, implementing lifestyle as medicine at a large scale involves some hurdles. To overcome them, we will require innovation, creativity and ecosystem-thinking, combined with biomedical and digital technology and novel solutions from agri- and food. Moreover, new governmental policies should support such changes in order to sustain them.

One of the biggest challenges is the achievement of a long-term lifestyle behaviour change in people with a chronic disease. Here, personalisation comes into play. Ideally, biological cause as well as socioeconomic and cultural background, personality, preferences and goals should be considered in the treatment. In type 2 diabetes, for example, it is known that different subtypes of the disease exist with a different biological cause, etiology and complications, requiring a tailored treatment strategy.

Furthermore, it is pivotal to make the invisible visible, especially to show the impact of the lifestyle treatment and a person’s behaviour on the biological cause of the disease. In particular, continuous monitoring coupled with just-in-time adaptive interventions have shown to be very powerful in lifestyle behaviour change and in stimulating people to regain to healthy habits in case of a relapse. Blended solutions, in which digital health innovations are combined with face-to-face contact from healthcare professionals, lifestyle coaches, peers, peer coaches or buddies showed to be scalable and cost-effective for lifestyle medicine.

The ‘magic pill’ for chronic, lifestyle-related diseases is personalised lifestyle medicine. For this, we need all of you! To achieve a healthy society in which we live long and in good health, we need to collaborate and combine forces to create fun, tasty, convenient and easy-to- adopt agri and food and high-tech solutions. If we work together, a very large market will welcome us and more importantly we can help to reduce the chronic disease burden and to maintain a high quality health care system.

Source: TKS